Revisiting the management of recurrent implantation failure through freeze-all policy

A freeze-all policy may improve clinical pregnancy, implantation, and ongoing pregnancy rates in cases with recurrent implantation failure.

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Volume 108, Issue 1, Pages 72–77

Authors:

Yasmin Magdi, M.Sc., Ahmed El-Damen, M.Sc., Ahmed Mohamed Fathi, M.Sc., Ahmed Mostafa Abdelaziz, M.D., Mohamed Abd-Elfatah Youssef, M.D., Ph.D., Ahmed Abd-Elmaged Abd-Allah, M.D., Mona Ahmed Elawady, M.D., Mohamed Ahmed Ibrahim, M.D., Yehia Edris, M.D.

Abstract:

Objective

To determine whether a freeze-all policy for in vitro human blastocysts improves the ongoing pregnancy rate in patients with recurrent implantation failure (RIF).

Design

Prospective cohort study.

Setting

Single private center.

Patient(s)

A total of 171 women with RIF divided into two groups: freeze-all policy group (n = 81) and fresh embryo transfer (ET) group (n = 90).

Intervention(s)

Freeze-all policy.

Main Outcome Measure(s)

Ongoing pregnancy rate.

Result(s)

The clinical pregnancy rate (52% vs. 28%; odds ratio [OR] 1.86; 95% confidence interval [CI], 1.29–2.68) and ongoing pregnancy rate (44% vs. 20%; OR 2.2; 95% CI, 1.04–3.45) were statistically significantly higher in the freeze-all group than the fresh ET group, respectively. The implantation rate was also statistically significant (freeze-all group 44.2% vs. fresh ET group 15.8%; OR 2.80; 95% CI, 2.00–3.92).

Conclusion(s)

The freeze-all policy statistically significantly improved the ongoing pregnancy and implantation rates. Thus, a freeze-all policy is likely to be the new key to helping open the black box of RIF. These findings also are useful for further investigating the adverse effect of controlled ovarian stimulation on in vitro fertilization outcomes.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

3 Comments

Go to the profile of Ben Willem J. Mol
Ben Willem J. Mol over 1 year ago

Dear editor, dear authors,


With interest I read the article of Magdi et al. This study is labelled as a prospective cohort study in the abstract and in the full text. "This prospective cohort study was conducted at a specialized fertility and gynecology center from April 2014 to October 2016. "

In the text the authors write "A total of 171 women with RIF were randomly assigned on the day of oocyte retrieval by use of a computer-based Microsoft Excel spreadsheet into two groups: ...."

Could the authors explain what has happened here. 

Was this an RCT or not?

Sincerely

Professor Ben Mol 


FRANZCOG PhD


 


Professor of Obstetrics and Gynaecology


NHMRC Practitioner fellow


Email ben.mol@monash.edu 


www.studies-obsgyn.nl| www.globalobstetricsnetwork.org


 


 


Department of Obstetrics and Gynaecology
Monash University
Monash Medical Centre


246 Clayton Road


Clayton
Victoria 3168


Australia


 






Go to the profile of Yasmin Magdi
Yasmin Magdi 10 months ago

Thanks Prof. Ben for your comment

It is not RCT.

Go to the profile of Yasmin Magdi
Yasmin Magdi 10 months ago

In View of some questions about our study, we performed a re-analysis. Although the main final outcome data turned out to be robust, there was a discrepancy in the baseline data on female age and BMI in the published article and the original dataset re-analyzed by Madelon van Wely & Rik van Eekelen.

 

PAPER

DATA

 

Topic

Fresh n=90

Frozen n=81

Fresh n=90

Frozen n=81

 

 

 

 

 

 

 

Female age

31.18 (SD 3.41)

31.47 (SD 2.55)

30.18 (SD 3.41)

31.47 (SD 2.55)

p for difference: 0.005

BMI

26.72 (SD 2.19)

27.11 (SD 2.26)

26.02 (SD 2.19)

27.11 (SD 2.26)

p for difference: 0.002

Also, there exists a difference in the number of multiple pregnancies between the paper and the data as follow:


Multiples (Sac variable?)

8

19

8

23 (including a quadruplet...)