08 Nov To freeze or not to freeze?
To freeze or not to freeze?
No we have not woken up today in a Saxperian poetic mood. Don’ t take us wrong. We love Shaekspear. But this has to do with reproductive medicine. Answer to the above question, for each cycle, can really affect the chances of success.
Initially let us inform you, that since the vitrification freezing method, has come up in our lives, the freeze all technique is gradually heading towards becoming the normal everyday practice.
All Units should have a zero tolerance towards hyperstimulation.
Indeed, freezing with vitrification, that does not affect the quality of the embryos grossly, together with the introduction of antagonists and agonists triggers in our practice, have turned hyperstimulation, that was common in the past into sth that nowadays happens rarely and actually, should not happen at all.
When you know that freezing will not cause any issues to the embryo, why to risk?
Also there is plenty of data, that confirms that when the total amount of eggs collected is increased, then the cumulative chances of success of an IVF cycle are also increased.
Vitrification has brought a revolution into our practice.
We can now target towards getting as many eggs as we can, from one ovarian stimulation, without really worry about things like: increase in oestrogens and progesterone, implantation window being affected by the hormones, thickness of it and hyperstimulation.
We can just freeze the embryos and expect that, to have a very minor, non significant impact on the quality of it. But is it always the case ?
The answer is that in majority of the cases, in labs that have proper and advance vitrification facilities, yes. Freeze all technique has significant advantages. Especially in women with PCOs should be obligatory. Same in patients with endometriosis, especially severe one, that is also associated with poor
ovarian reserve. Endometriosis is always better to be suppressed before the embryo transfer. Usually though, that also means suppression of the ovaries. If that happens before the egg collection, usually is connected with reduced amount of eggs. So the best would be to freeze the embryos and go ahead suppressing the ovaries , before the frozen embryo transfer. Same when PGT- A is decided. We cannot have NGS results on the same day. So in cases like that freezing is necessary
What about straight forward cases?
We have noticed that the freeze all technique has started becoming epidemic. On many cases is used, unreasonably, even in cases that a fresh embryo transfer would be possible. Don ‘ t forget. Vitrification affects the embryo in a very minimum degree, but does affect. A fresh transfer is always a fresh transfer.
So: In cases that the endometrium thickness is ok, the oestradiol levels on trigger day are normal and the progesterone levels on the same day are less than 1 ng/ ml, DO go ahead with fresh transfer without hesitation. Benefits outweight the risks.