Natural cycle frozen embryo transfer: a survey of current assisted reproductive technology practices in the U.S

Purpose Emerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.). Methods In this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers' perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses. Result(s) The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1-2 physicians in their practice. Common reasons for not offering NC-FET included lack of timing predictability for transfer (81%) and increased burden on staff/laboratory personnel on holidays and weekends (54%). Of clinics offering NC-FET, 76% reported < 25% of cycles used the NC for endometrial preparation. Over half (52%) of clinics that offered NC-FET reported having eligibility restrictions for NC-FET. Reported benefits of NC-FET were patient satisfaction (18%), decreased cost of medications (18%), and avoidance of intramuscular progesterone (17%). The attitude towards NC-FET in their clinics was reported as positive by 65% of respondents. Conclusion NC-FETs are offered by most U.S. ART clinics but are used only in the minority of FET cycles for endometrial preparation, and use is often restricted.

Automated summary

Most U.S. ART clinics offer NC-FET, but it is not frequently used for endometrial preparation in FET cycles, and there are often restrictions on its use.