Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 103, Issue 7, Pages 2735-2742Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2018-00613
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Funding
- Major Program of National Natural Science Foundation of China [8149073]
- State Key Program of National Natural Science Foundation of China [81430029]
- National Natural Science Foundation of China [81701515, 31601199]
- Natural Science Foundation of Shandong [ZR2017BH011]
- Thousand Talents Program
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Context: Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not. Objective: To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number). Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s): This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth. Results: Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level. 3000pg/mL but not in those with estradiol level <= 3000 pg/mL. In women with PCOS who have >= 16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with,16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups. Conclusions: Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.
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