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2022 18 February

Frozen embryo transfer in natural cycle vs hormone replacement therapy cycle

Gryshchenko Clinic-IVF is a modern medical center where you can get a full range of services for infertility treatment.

One of the most demanded services at our clinic is IVF. When patients find out that it is necessary for them to have IVF, they may hear from their fertility specialist such a notion as IVF frozen embryo transfer. What does it mean, what is necessary for it and is it worth using such a method of treatment? Let’s consider all these questions!

What is cryopreservation and how is it connected with IVF?

The classic version of the IVF procedure includes stimulation of follicle growth, puncture, oocyte retrieval, artificial fertilization, embryo cultivation and the so-called fresh embryo transfer (without vitrification). But sometimes during the stimulation hormones can increase to a very high level and this can lead to ovarian hyperstimulation syndrome (OHSS). Nevertheless medicine is constantly developing, that’s why nowadays there are different ways to conduct IVF safely and effectively. One of the successful technologies is cryopreservation (vitrification).

Vitrification is a method of ultrafast freezing, which is the most effective and advanced method in modern medicine. This method of cryopreservation is based on the use of cryoprotectants of high concentration and an instant temperature drop to -196 degrees. The advantage of this method is the possibility of long-term storage of eggs, sperm and embryos without losing their ability for fertilization.

IVF frozen embryo transfer is an IVF procedure with the use of cryopreserved embryos. This type of treatment allows to conduct an additional study – preimplantation genetic testing (PGT) in order to test the embryos for abnormal chromosomes before they are transferred to the uterus.

There are two main options for the IVF frozen embryo transfer procedure.

The first one is called frozen embryo transfer in a natural cycle. The main point of such a protocol is that ovulation must be clearly tracked (we diagnose it with the help of ultrasound, and we also control an increase in the level of progesterone in the blood), and then the embryo transfer must be performed after 5 days. Thus, the stage of endometrial development and the stage of the embryo are synchronized (vitrification is usually carried out on the 5th day of embryo development). When pregnancy occurs, the body perceives it as natural, so the development of pregnancy will be as physiological as possible. Also, the advantage of this scheme is the minimum hormonal support and a high chance of success of the frozen embryo transfer (the effectiveness reaches 70-80%).

But it is worth noting that the frozen embryo transfer in the natural cycle can only be planned if the woman has a regular period and full ovulation. In addition, the woman will need daily meetings with a doctor and hormonal monitoring. It happens that the cycle is not ovulatory, and therefore it is necessary to wait for the next one. A doctor needs to choose ideal conditions before making transfers.

The second IVF option to get a winning IVF frozen embryo transfer is a frozen embryo transfer on hormone replacement therapy (HRT). Now we’ll find out what it means and what indications should be for it.
It is used in frozen embryo transfers when a woman does not have her own ovulation or has hormonal disorders. She requires artificial growth of the endometrium and maintenance of pregnancy.

Frozen embryo transfers on HRT are divided into 2 types: without pituitary blockade and with pituitary blockade. Medicines that stop the release of own hormones and in this way stabilize the hormonal background are used for the blockade. This allows to fully control the cycle and prevent various unexpected situations, such as the growth of own follicle, and, as a result, hormonal failure. The doctor`s task is to repeat the natural cycle with the help of medicines and create favorable conditions for the implantation of the embryo.

In order to understand better – hormones in the natural cycle work like this. The follicle grows, estradiol is released – it increases the thickness of the endometrium. When the follicle is mature, LH (luteinizing hormone) is produced, this hormone causes ovulation and activates endometrial receptors.

Then the main hormone of pregnancy – progesterone – begins to act. When ovulation has passed, progesterone is produced, thereby relaxing the uterus and causing secretory transformation of the endometrium. When an embryo reaches the uterine cavity, it interacts with endometrial receptors and implantation occurs.

Therefore, in the course of recreating the same process, respectively, the scheme of the program of the frozen embryo transfer on HRT by day repeats the order of hormone release of the natural cycle and looks like this.

From day 3-5 of the cycle, estradiol medications are prescribed and the endometrium is increased to the thickness of 8-10 mm, this usually occurs on day 10-14 of the cycle. The fertility specialists check the hormonal background – estradiol and progesterone. After that, a trigger that activates endometrial receptors is prescribed. Two days later, progesterone medications are prescribed.

Embryo transfer occurs 5 days after the prescription of progesterone. After the onset of pregnancy, it is very important to ensure sexual abstinence and physical rest, as well as adjust the medications to maintain pregnancy, since the body is not used to it yet and there are more threats of miscarriage.

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If you have questions about the information in this article, you can ask the doctor. Appointment registration:
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The secret of the success of frozen embryo transfer at Gryshchenko Clinic-IVF

The success of any protocol at Gryshchenko Clinic-IVF depends on several factors: the quality of the material, the doctor, the equipment, and the most important factor is the patients’ faith in the best result.
Proper organization and the best equipment of the embryological laboratory of GC-IVF allow us to ensure the comfort and safety of embryos, which means the achievement of good results. The laboratory premises are designed based on the experience of well-known European experts, and with the use of non-toxic materials. The laboratory is equipped with a specialized multi-level medical gas supply system, an uninterrupted power supply system, monitoring and warning systems.

In 2019 Gryshchenko Clinic-IVF was awarded an exclusive prize and an international certificate from REPROLIFE ‘100 SURVIVAL CLUB’. The award of such a high level is given to clinics of reproductive medicine if during the thawing procedure all 100 blastocysts out of 100 vitrified blastocysts survive.

Within the framework of the program, GC-IVF embryological laboratory team confirmed the high efficiency of the Cryotec Method and the good quality of the vitrification processes, ensuring 100% continuous survivability of the embryos after they were thawed. The staff of Gryshchenko Clinic-IVF managed to cope with this task successfully.

Therefore, a successful frozen embryo transfer with the blockade or another type of treatment, which begins with a detailed consultation and ends with the birth of a child and the happiness of parenthood, will be carried out thanks to the well-coordinated work of patients, doctors and embryologists.

Preparation for the frozen embryo transfer

To start any IVF procedure, in particular frozen embryo transfer, you need some preparation for it. After consulting with a doctor and determining further actions, the couple undergoes a set of examinations. In the presence of any disorders, the doctor prescribes treatment. The doctor also recommends eliminating contact with chemicals, varnishes, paints, eating healthy food, sleeping well, not overloading the body and eliminating bad habits. The next step is the choice of a protocol, medications and dosage. A woman will also need to have tests before the frozen embryo transfer.

Before such a procedure, a complete list of mandatory tests is carried out, like in IVF. Also, if necessary, the doctor may prescribe additional examinations.
The standard list of tests includes:
• Syphilis (RW or ELISA);
• HIV AIDS;
• Hepatitis B, HBsAg;
• Hepatitis C;
• Fluorography/X-ray examination of the lungs;
• Karyotype test;
• Blood type + Rh factor;
• Homocysteine;
• Anticardiolipin Antibodies Test (ACA);
• MTHFR (methylenetetrahydrofolate reductase);
• Lupus anticoagulant;
• Therapist’s conclusion about the state of health and the possibility of carrying a pregnancy;
• PCR – Chlamydia, Gonococci, Trichomonas;
• Femoflor-16 (real-time PCR);
• PCR – Herpes, Cytomegalovirus;
• Blood test (IgM, IgG with avidity) for toxoplasmosis, rubella;
• AMH (anti-Mullerian hormone), Prolactin, FSH, LH, TSH, Progesterone, Estradiol;
• Colposcopy + cytological examination;
• Ultrasound of the mammary glands;
• Ultrasound of the thyroid gland;
• Clinical blood test;
• Blood sugar test;
• Total protein; bilirubin: total, free, bound;
• Coagulogram;
• Bacterioscopic analysis of discharge from three sources (vagina, urethra and cervical canal).

Pregnancy after frozen embryo transfer

Right after the embryo transfer, a woman can continue a normal life, however, during the first three days (including the day of the transfer), it is advisable to limit activity. 3 days after the embryo transfer, it is possible to travel for long distances, in particular by train or car.
It is also recommended to:
• walk in the fresh air, sleep about 8 hours a day (in any comfortable position);
• have a balanced diet, including high-fiber foods, sufficient fluid intake;
• control stool and urination;
• comply with all medical recommendations of a fertility specialist;
• avoid staying in crowded places, especially during epidemics;
• exclude heavy physical exertion;
• exclude baths and saunas;
• exclude alcohol and smoking;
• exclude X-ray studies and fluorography.

In HRT cycles, the ovaries do not release their own hormones to maintain pregnancy, so progesterone supplementation is continued up to 12 weeks.

In the second trimester, the placenta is fully formed, which provides the necessary level of its own hormones, so HRT is gradually canceled.

During pregnancy, it is also important to control the coagulogram, if necessary, medications for blood thinning can be prescribed.

If the schemes are correctly selected in the frozen embryo transfer on HRT, then everything goes well and the pregnancy is carried well. Childbirth can be natural, and breastfeeding proceeds normally.

In the second and third trimesters, pregnancy management after IVF is no different from natural pregnancy.

No matter how difficult your path to parenthood may be, the specialists of GC-IVF will help you overcome all obstacles. In our clinic you can also get such services as surgical gynecology, reproductive andrology, various types of tests, prenatal care, etc.

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