Abstract
Author(s): Batool Abdulwahid Hashim Alkhalidi
Background: Owing to the worldwide rising interests in embryo freezing and the adoption of thawed Frozen Embryos Transfer (TFET) in preference to Fresh Cycles Embryo Transfer (FET) by Assisted Reproduction (ART) practitioners in a step that thought to bypass the unwanted effects of exaggerated rise in estradiol level of fresh cycles on endometrium, developing embryos, and placentas, and as preventive measure to Ovarian Hyperstimulation Syndrome (OHSS) consequences especially in polycystic ovary syndrome patients, This study was conducted in fertility centre to retrospectively analyze embryos vitrification technology in our province regarding factors affecting the outcome of FTET. Aim: To study factors affecting outcomes of frozen thawed embryos transfer cycles in it is recent introduction in our center. Design: Retrospective study of all thawed frozen embryos transfer cycles done in our center since the technology was first introduced there. Setting: Kufa University, medical college -affiliated fertility center. Population of patients: all patients treated by thawed frozen embryos transfer cycles Outcomes measured: Biochemical pregnancy rate. Patients and method: A retrospective observational study was conducted in the Fertility Centre in Al sadder medical city in Najaf province in Iraq, a cohort of 47 FTET cycles were collected during the period from April 2014 to June 2016 patients were included having their records reviewed retrospectively, the following demographic criteria were collected; age, Body Mass Index (BMI), cause, type and duration of infertility, antecedent cycle criteria for each patient which include Cycle Day 2 (CD2) hormonal assay, infertility, antecedent cycle criteria for each patient which include Cycle Day 2 (CD2) hormonal assay, type of protocol for Controlled Ovarian Hyperstimulation( COH), number of retrieved oocytes, maturity, and quality of oocytes, fertilization rate, in transfer cycles of FTE embryo numbers, stage after thawing and clinical pregnancy rate. All patient seen at cycle day 2 or 3 transvaginal confirmed down regulated ovarian endometrial cycles, endometrial builtup with oral estradiol, when desired thickness achieved, progesterone added for a period that match day of embryos age. The patients were tested using serum B-Human Chorionic Gonadotrophin (B-HCG) assay 14 days after embryo transfer, and if the pregnancy test was positive, prescription of estradiol valerate (6mg per day) and progesterone in form of vaginal suppositories (800mcg per day) was continued until 11 weeks of gestation. When the embryo transfer catheter returned back to the embryologist after the procedure, it is carefully checked under the microscope to confirm catheter clearance off. Embryo at vetrification. Embryo transfer is usually done in our center without anesthesia, guided by transabdominal sonography with partially filled urinary bladder, When the embryo transfer catheter returned back to the embryologist after the procedure, it is carefully checked under the microscope to confirm catheter clearance, serum pregnancy test routinely done 2 weeks following FTET, if test positive for pregnancy luteal phase support would continue throughout 1st trimester. Results: A total of 47 women who underwent embryo cryopreservation were all involved. Their biochemical pregnancy rate was 35% calculated for 40 patients who reached embryo transfer (in 4 patients no valid embryo to transfer after thawing, and in 3 patients no information was obtained about pregnancy result). Demographic information (patients age, BMI, type of infertility, duration of infertility) and frozen thawed embryo transfer cycle criteria (endometrial thickness, number of transferred embryos, stage of transferred embryos) of all of them were studied and interpreted. Significant differences were found for body mass index (P value 0.002) and endometrial thickness (P value 0.004 ) in predicting pregnancy positivity. Lower body mass index and thicker endometrium were noted in positive pregnancy group. Moreover, there is a significant difference in number of expanded blastocyst stage between the two groups with 78.6% of them found to have a positive pregnancy test (P <0.001).