Daimin Wei1,2, Yunhai Yu3, Mei Sun1,2, Yuhua Shi1,2, Yun Sun4, Xiaohui Deng5, Jing Li1,2, Ze Wang1,2, Shigang Zhao1,2, Heping Zhang6, Richard S Legro7, Zi-Jiang Chen1,2. 1. Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 2. Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, and National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China. 3. Department of Obstetrics and Gynecology, the Second Hospital of Shandong University, Jinan, China. 4. Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai, China. 5. Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China. 6. Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut. 7. Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania.
Abstract
Context:Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective: To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s): This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results: Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions: Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.
RCT Entities:
Context: Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective: To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s): This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results: Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOSwomen with peak estradiol level >3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with <16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions: Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.
Authors: Jeffery S Babischkin; Graham W Aberdeen; Jonathan R Lindner; Thomas W Bonagura; Gerald J Pepe; Eugene D Albrecht Journal: Endocrinology Date: 2019-06-01 Impact factor: 4.736
Authors: Graham W Aberdeen; Jeffery S Babischkin; Jonathan R Lindner; Gerald J Pepe; Eugene D Albrecht Journal: Endocrinology Date: 2022-04-01 Impact factor: 4.736
Authors: Ye Pan; Bo Li; Ze Wang; Ying Wang; Xiaoshu Gong; Wenqing Zhou; Yuhua Shi Journal: Front Endocrinol (Lausanne) Date: 2020-09-30 Impact factor: 5.555