The likelihood of a healthy live birth after frozen embryo transfer with endometrium prepared by natural ovulation regimen vs programmed regimen: a propensity-score matching study

Ze Wang; Yingxin Zhang; Xue Shang; Ruolan Miao; Mengfei Yin; Huiming Yang; Yunhai Yu; Daimin Wei

doi:10.1016/j.xagr.2023.100210

The likelihood of a healthy live birth after frozen embryo transfer with endometrium prepared by natural ovulation regimen vs programmed regimen: a propensity-score matching study

AJOG Glob Rep. 2023 Apr 26;3(2):100210. doi: 10.1016/j.xagr.2023.100210. eCollection 2023 May.

Authors

Ze Wang¹, Yingxin Zhang², Xue Shang¹, Ruolan Miao¹, Mengfei Yin¹, Huiming Yang¹, Yunhai Yu³, Daimin Wei¹

Affiliations

¹ Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei).
² Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China (Dr Zhang).
³ Department of Obstetrics and Gynecology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (Dr Yu).

Abstract

Background: The number of frozen embryo transfer cycles is increasing, but the optimal method of endometrial preparation for frozen embryo transfer remains controversial. Few studies have investigated the healthy live birth outcome after the natural ovulation regimen vs the programmed regimen.

Objective: This study aimed to explore whether the likelihood of a healthy live birth after frozen embryo transfer differs between the natural ovulation regimen and the programmed regimen.

Study design: We conducted a retrospective cohort study including 7824 ovulatory women who underwent the first frozen embryo transfer cycle of single-blastocyst transfer with endometrial preparation by natural ovulation regimen vs programmed regimen, between June 2017 and June 2021. Propensity score matching was used to control for confounding variables in a 1:1 ratio. The primary outcome was healthy live birth, defined as birth of a live, singleton infant born at term, with an appropriate birthweight for gestational age.

Results: The natural ovulation regimen resulted in a higher probability of achieving healthy live birth compared with the programmed regimen (35.8% vs 30.6%; P<.0001). In addition, a higher rate of singleton live birth was observed after the natural ovulation regimen relative to the programmed regimen (49.6% vs 45.7%; P=.003). Women with the natural ovulation regimen were also less likely to experience clinical pregnancy loss (16.0% vs 19.7%; P=.005) and hypertensive disorders of pregnancy (3.9% vs 6.0%; P=.004) compared with women with the programmed regimen. Singletons born after the programmed regimen had greater mean birthweight (3441.50±539.97 vs 3394.96±503.87; P=.020) and higher risk of being large for gestational age (23.3% vs 18.7%; P=.003) than those conceived after the natural ovulation regimen.

Conclusion: The natural ovulation regimen may be superior to the programmed regimen with regard to higher likelihood of healthy live birth and lower risk of pregnancy loss and maternal hypertensive disorders of pregnancy.

Keywords: corpus luteum; frozen embryo transfer; healthy live birth; programmed regimen; propensity score.