Freeze all policy: fresh vs frozen thawed embryo transfer

Even in patients that undergo fresh embryo transfer without progesterone elevation, endometrial receptivity may be impaired by controlled ovarian stimulation, and outcomes may be improved by using the freeze-all policy.


Matheus Roque, M.D., Marcello Valle, M.D., Fernando Guimarães, B.S., Marcos Sampaio, M.D., Ph.D., Selmo Geber, M.D., Ph.D.

Volume 103, Issue 5, Pages 1190-1193



To compare in vitro fertilization (IVF) outcomes between fresh embryo transfer (ET) and frozen-thawed ET (the “freeze-all” policy), with fresh ET performed only in cases without progesterone (P) elevation.


Prospective, observational, cohort study.


Private IVF center.


A total of 530 patients submitted to controlled ovarian stimulation (COS) with a gonadotropin-releasing hormone–antagonist protocol, and cleavage-stage, day-3 ET.



Main Outcome Measure(s):

Ongoing pregnancy rates.


A total of 530 cycles were included in the analysis: 351 in the fresh ET group (when P levels were ≤1.5 ng/mL on the trigger day); and 179 cycles in the freeze-all group (ET performed after endometrial priming with estradiol valerate, at 6 mg/d, taken orally). For the fresh ET group vs. the freeze-all group, respectively, the implantation rate was 19.9% and 26.5%; clinical pregnancy rate was 35.9% and 46.4%; and ongoing pregnancy rate was 31.1% and 39.7%.


The IVF outcomes were significantly better in the group using the freeze-all policy, compared with the group using fresh ET. These results suggest that even in a select group of patients that underwent fresh ET (P levels ≤1.5 ng/mL), endometrial receptivity may have been impaired by COS, and outcomes may be improved by using the freeze-all policy.

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