The future of frozen-thawed embryo transfer in hormone replacement therapy cycles.

Kristine Løssl, Anne Lærke Spangmose, Louise Laub Asserhøj, Tine Vrist Dam, Anja Pinborg

Current opinion in obstetrics & gynecology 2023 Jun 01

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This review focuses on the efficacy of letrozole stimulated frozen-thawed embryo transfer (FET) compared to hormone replacement therapy (HRT) FET in women with polycystic ovarian syndrome (PCOS) and/or oligo-anovulation. Further, obstetric and perinatal risks in HRT FET are summarized. The presence of a corpus luteum seems to reduce the risk of pregnancy-related hypertension and preeclampsia after FET. As a natural cycle (NC) FET is not an option for women with oligo-/amenorrhea these women may benefit from FET with mild stimulation compared to HRT FET. The intention of mild stimulation in anovulatory women is to induce (mono) ovulation to mimic the endocrine profiles of the natural cycle and the early pregnancy after natural conception. Mild stimulation by letrozole is patient friendly and cheap compared to gonadotropin stimulated FET and has been increasingly used in recent years. Although the quality of evidence is low, the pregnancy outcomes after letrozole FET seems similar or even better compared to HRT FET in women with PCOS and/or oligo-anovulation. Natural and modified NC FET should be used whenever possible to mitigate adverse obstetric and perinatal outcomes after HRT FET. For anovulatory women, whenever ovulation can be induced, we advocate the use of mild stimulation FET to create a corpus luteum awaiting results from RCTs limited to oligo-anovulatory women. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Citation

Kristine Løssl, Anne Lærke Spangmose, Louise Laub Asserhøj, Tine Vrist Dam, Anja Pinborg. The future of frozen-thawed embryo transfer in hormone replacement therapy cycles. Current opinion in obstetrics & gynecology. 2023 Jun 01;35(3):200-209