Fresh versus frozen embryos for infertility in the polycystic ovary syndrome

Z. J. Chen, Y. Shi, Y. Sun, B. Zhang, X. Liang, Y. Cao, J. Yang, J. Liu, D. Wei, N. Weng, L. Tian, C. Hao, D. Yang, F. Zhou, J. Shi, Y. Xu, J. Li, J. Yan, Y. Qin, H. ZhaoH. Zhang, R. S. Legro

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223 Scopus citations

Abstract

BACKGROUND: The transfer of fresh embryos is generally preferred over the transfer of frozen embryos for in vitro fertilization (IVF), but some evidence suggests that frozen-embryo transfer may improve the live-birth rate and lower the rates of the ovarian hyperstimulation syndrome and pregnancy complications in women with the polycystic ovary syndrome. METHODS: In this multicenter trial, we randomly assigned 1508 infertile women with the polycystic ovary syndrome who were undergoing their first IVF cycle to undergo either fresh-embryo transfer or embryo cryopreservation followed by frozen-embryo transfer. After 3 days of embryo development, women underwent the transfer of up to two fresh or frozen embryos. The primary outcome was a live birth after the first embryo transfer. RESULTS: Frozen-embryo transfer resulted in a higher frequency of live birth after the first transfer than did fresh-embryo transfer (49.3% vs. 42.0%), for a rate ratio of 1.17 (95% confidence interval [CI], 1.05 to 1.31; P = 0.004). Women who underwent frozen-embryo transfer also had a lower frequency of pregnancy loss (22.0% vs. 32.7%), for a rate ratio of 0.67 (95% CI, 0.54 to 0.83; P<0.001), and of the ovarian hyperstimulation syndrome (1.3% vs. 7.1%), for a rate ratio of 0.19 (95% CI, 0.10 to 0.37; P<0.001), but a higher frequency of preeclampsia (4.4% vs. 1.4%), for a rate ratio of 3.12 (95% CI, 1.26 to 7.73; P = 0.009). There were no significant between-group differences in rates of other pregnancy and neonatal complications. There were five neonatal deaths in the frozen-embryo group and none in the fresh-embryo group (P = 0.06). CONCLUSIONS: Among infertile women with the polycystic ovary syndrome, frozen-embryo transfer was associated with a higher rate of live birth, a lower risk of the ovarian hyperstimulation syndrome, and a higher risk of preeclampsia after the first transfer than was fresh-embryo transfer.

Original languageEnglish (US)
Pages (from-to)523-533
Number of pages11
JournalNew England Journal of Medicine
Volume375
Issue number6
DOIs
StatePublished - Aug 11 2016

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Chen, Z. J., Shi, Y., Sun, Y., Zhang, B., Liang, X., Cao, Y., Yang, J., Liu, J., Wei, D., Weng, N., Tian, L., Hao, C., Yang, D., Zhou, F., Shi, J., Xu, Y., Li, J., Yan, J., Qin, Y., ... Legro, R. S. (2016). Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 375(6), 523-533. https://doi.org/10.1056/NEJMoa1513873