Live birth rates with a freeze-only strategy versus fresh embryo transfer in subjects with elevated progesterone levels during IVF: secondary analysis of a randomized clinical trial

DOI https://doi.org/10.1016/j.rbmo.2018.12.012

Live birth rates with a freeze-only strategy versus fresh embryo transfer in subjects with elevated progesterone levels during IVF: secondary analysis of a randomized clinical trial

LN Vuong^1,2, TD Pham², VQ Dang², TM Ho², VNA Ho², RJ Norman³, BW Mol^3,4

1. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi
Minh City, Ho Chi Minh City, Vietnam (lanvuong@ump.edu.vn)

2. IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam (toan.pd@myduchospital.vn)

3. Fertility SA, Level 9 431 King William Street, Adelaide, South Australia, Australia.

4. Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia.

Abstract

Research question

What are the roles of serum progesterone and endometrial thickness as biomarkers in the decision between a freeze-only and fresh embryo transfer in vitro fertilization (IVF) for women without polycystic ovary syndrome (PCOS)?

Design

This was a secondary analysis of a randomized controlled trial including 782 couples who were followed up until the end of the first completed cycle. Couples scheduled for their first or second IVF cycle with a follicle-stimulating hormone/gonadotropin-releasing hormone antagonist protocol) were randomized to a freeze-only (n=391) or fresh embryo transfer (n=391) strategy. The endpoint for this analysis was live birth rate (LBR) after the first embryo transfer.

Results

There was no significant difference in LBR after the first cycle between a freeze-only and fresh transfer strategy. When serum progesterone levels at trigger were in the third quartile (Q3, 1.14–1.53 ng/mL), LBR was significantly higher in the freeze-only versus fresh transfer group; when serum progesterone was ≥1.14 ng/mL, LBR was significantly better in the freeze-only group (37.4% vs 23.8% in the fresh transfer group; p=0.004). Live birth rates in the freeze-only and fresh embryo transfer groups were similar across all quartiles of endometrial thickness, although a small advantage for freeze-only in women with a very thin endometrium could not be excluded.

Conclusions

Serum progesterone level on the day of trigger may have potential as a biomarker on which to base a prospective decision about whether to use a freeze-only or fresh embryo transfer strategy in women undergoing IVF.

KEYWORDS:

in-vitro fertilization, freeze-only protocol, embryo transfer, progesterone, endometrial thickness, biomarkers, randomized clinical trial

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