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Frozen Embryo Transfer (FET) is a safe and controlled procedure for infertility treatment. It is performed with hormonal support cycles or during natural ovulation cycles. High success rates and outcomes achieved using previously frozen embryos are as good or even better as compared to fresh embryos.
In the last few years, new techniques for freezing egg and storing embryos have provided advancement in infertility treatments, closely matching the success of fresh IVF cycles. It has given infertile couples a chance to deal with their infertility. Frozen Embryo Transfer (FET) procedure has also increased chances of successful pregnancy which means patients have the same chances of success in second embryo transfer, without going through the complicated steps and expenses of a new IVF cycle. (1) (2)
In this article, we will look at:
- What is the procedure of frozen embryo transfer?
- What are the protocols of frozen embryo transfer?
- What are the advantages of frozen embryo transfer?
- What is the success rate of frozen embryo transfer?
Frozen embryo transfer is a comparatively easy and simple process. Using an ultrasound, the doctor uses a fine catheter to move the embryos through the vagina and cervix into the uterus. Once the transfer has occurred, the doctor may advise you to rest on your back for 30 minutes to one hour in the recovery room, before being released. Unlike the egg retrieval process, FET does not require any anesthetic or sedation, and you can expect to be discharged within 2 to 4 hours. FET is a very safe and controlled procedure; although you may experience some mild cramping, severe side effects are very rare. Some patients may be given supplemental progesterone to support the possible early pregnancy. (3)
Hormone Preparation for FET: There are two basic kinds of FET-IVF cycles: hormonal support cycles and “natural” cycles. The most common way in which a frozen embryo transfer is performed is by using hormones to prepare the uterus. The pituitary gland is suppressed to reduce the chances of unexpected ovulation. Generally, two weeks of daily GnRH agonist Lupron injections are given to women for pituitary suppression. During this two week wait, you may experience symptoms that feel as if you are about to start your period such as slight bloating, fatigue, mood swings, sore breasts and light spotting. The next step in a frozen embryo transfer cycle is to use hormones to simulate the changes that normally occur in the uterus during a regular menstrual cycle. Estrogen and progesterone are two hormone medications used during frozen embryo transfer. (4)
Estrogen Preparation for FET: During a normal menstrual cycle, estrogen is produced while the follicle is developing. This estrogen stimulates the uterus by thickening and maturing the uterine lining. (5) Estrogen drugs are given in FET cycle for the same reason. (5) There are various different ways that estrogen can be taken during a frozen embryo transfer cycle:
- Estrogen pills – Estrace, Premarin
- Estrogen patches – Estraderm, Climera
- Estrogen injections – Delestrogen, Depogen
- Vaginal estrogen – Vagifem, Femring
During the time when estrogen is given, the woman visits the doctor periodically to be monitored. A transvaginal ultrasound is performed to determine the thickness of the uterine lining and a blood test to look at the level of estrogen in the blood. If the lining is not thickening as it should, the dose or type of estrogen is increased. The duration of estrogen may be extended to delay the day of embryo transfer to accommodate the patient’s schedule. Unlike a fresh IVF cycle during which the growth of embryos is synchronized with the growth of the follicles in the ovary, in an FET cycle, the days can be adjusted at any time. Therefore, a frozen embryo transfer cycle is much less stressful on the patient.
Progesterone in an FET cycle: Once the uterine lining becomes thick as expected, progesterone is given to the patient and dosage of Lupron is stopped. Progesterone is approximately given after two weeks of estrogen support. Progesterone helps to mature the uterine lining and makes it suitable for an embryo implant. Once the use progesterone begins, there is a certain window of implantation during which the embryo is transferred. The stage of the embryo must match the state of development of the uterus. If the embryo transfer is not performed on the predicted day, the cycle must be canceled and a new preparation with hormones must be started after allowing a period to occur. (6)
Natural FET Cycle: With a FET natural cycle, medications aren’t used to suppress or control ovulation. Instead, the embryo transfer is planned based on when ovulation naturally occurs. In Natural Cycle FET, the timing of the embryo transfer is crucial. It must be performed a particular number of days after ovulation. The exact day will also depend on the number of days the embryos are left to grow. As timing is essential, the cycle is closely monitored either at home with ovulation predictor tests or at the fertility clinic with ultrasound and blood work. When ovulation is detected, progesterone supplementation is started, and the embryo transfer date is scheduled. (7)
FET is normally used in later transfers when there are extra embryos remaining from an earlier cycle, but sometimes it can be a preferred option during the first IVF cycle. Here are some of the benefits of frozen embryo transfer (FET) (8):
Preventing late-onset Ovarian Hyperstimulation Syndrome (OHSS): In some cases, women have an elevated risk of developing OHSS after egg retrieval and transfer. After stimulation of the ovaries, the addition of human chorionic gonadotropin (HCG) from the pregnancy can trigger OHSS. Though it is usually not severe, OHSS causes cysts and the release of large amounts of hormones, including estrogens, progesterone, and local cytokines. Swelling and discomfort are typical in mild cases, while rare severe cases can be dangerous for the mother and also the baby. FET allows delaying the transfer from the stress of ovarian stimulation, reducing or even eliminating the chance of OHSS. (9)
Uterine lining may be more receptive to embryo implantation: Giving your body time to recover from the IVF stimulation cycle and the egg retrieval process could mean that the endometrial lining in your womb can get the time to create an ideal environment for implantation to occur.
Allowing time for sophisticated genetic test results: If you would like to perform Preimplantation Genetic Diagnosis (PGD) or screening (PGS) tests to help ensure that the healthiest embryo is selected for transfer, FET gives the lab time to process, examine each embryo before transfer.
Babies born from frozen embryos are of healthy weight: Studies have shown that FET babies are less likely to be linked to low birth weight and may have a lower chance of being small for their gestational age.
Today, frozen embryo transfers have a 15 percent higher pregnancy rate due to the huge improvements in freezing and storage techniques. The success rates of fresh IVF cycles are comparable to FET cycles. In some cases, FET can result in a higher success rate because of the opportunity to optimize the lining of the uterus before implantation. Studies suggest that success rates and outcomes using previously frozen embryos are at least as good or better compared to fresh embryos. Women younger than 35 years have over a 60 percent chance of pregnancy per transfer. This rate declines as the maternal age at the time of the freeze increases. In 2006, researchers compared the pregnancy rates obtained when embryos were frozen for different lengths of time. The data showed no difference in the chance for pregnancy even when embryos were frozen for more than ten years. Studies have also been performed in women who had a very vigorous stimulation of their ovaries and were considered to be at high risk for ovarian hyperstimulation syndrome (OHSS). In spontaneous FET cycles, the proportion of cycles in which luteal phase progesterone had been administered was similar between the groups with and without miscarriage. In hormonally substituted FET, the proportion of cycles with GnRHa did not differ between women with and without miscarriage. When all treatment types were analyzed together, hormonally substituted FET was associated with an increased miscarriage rate. (10)
Understanding the advantages of both fresh and FET transfers should help you feel more prepared when you sit down to discuss your options with your fertility specialist. Whether you and your doctor choose to do a fresh embryo transfer or FET, it is an important milestone in your fertility journey.
Improve Chances of Implantation
After FET procedure, you should make sure that you are eating a healthy diet, like you were already pregnant, with plenty of protein, fiber, and vegetables. Avoid unsafe foods such as soft cheese and seafood high in mercury. Above all, make sure that you have a source of emotional support during this stressful time. Whether you turn to your partner, family, friend, a therapist or even an online community, irrespective of that, having someone to talk to helps relieve stress and anxiety. You can also contact OVO Fertility to get a second opinion. We also guide you throughout your fertility journey and put all our efforts to help you achieve the gift of parenthood. You can contact us at +918268260808 to get a free appointment with one of our reliable infertility specialists.
SOURCES AND REFERENCES:
- ^ Frozen Embryo Transfer (FET) Procedure | Verywell Family Verywellfamily.com, 17 September 2019
- ^ Embryo transfers: What you need to know | Medical News Today Verywellfamily.com, 17 September 2019
- ^ Frozen Embryo Transfer Process | Beverly Hills Reproductive.org, 17 September 2019
- ^ Impact of Endometrial Preparation Protocols for Frozen Embryo Transfer on Live Birth Rates Rmmj.org.il, 17 September 2019
- ^ Endometrial Preparation for FET Fertstert.org, 17 September 2019
- ^ Progesterone Support After Frozen Embryo Transfer Fertstert.org, 17 September 2019
- ^ Modified Natural Cycle Frozen-Thawed Embryo Transfer Ncbi.nlm.nih.gov, 17 September 2019
- ^ An Obstetrical Perspective: The Benefits of a Frozen Embryo Fertstert.org, 17 September 2019
- ^ Ovarian Hyperstimulation Syndrome Mayoclinic.org, 17 September 2019
- ^ Embryo Freezing: What Is the Process and Who Benefits? Medicalnewstoday.com, 17 September 2019
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