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Are We Closer to “Freeze-All” for ART?

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Emerging Topics in Reproduction

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Abstract

Embryo cryopreservation is critical to the success of any in vitro fertilization (IVF) program. With a conventional approach to IVF, the top-quality embryo(s) is transferred in a fresh cycle, and the remaining supernumerary embryos are cryopreserved. A freeze-all is performed only in cases of preimplantation genetic testing (PGT) for single-gene conditions or aneuploidy screening, fertility preservation, or concern for ovarian hyperstimulation syndrome (OHSS). Over the last 10 years, though, a different strategy has emerged, in which the IVF cycle is intentionally segmented into two phases: (1) controlled ovarian stimulation (COS) with planned cryopreservation of all suitable embryos and (2) frozen embryo transfer (FET) after at least one intervening menses. With increasingly compelling data, it has become apparent that not only are implantation rates higher with a planned freeze-all strategy, but also pregnancy and neonatal outcomes may likewise be improved. Indeed, the incidence of adverse events such as OHSS, miscarriage, ectopic pregnancy, and low birth weight may all be reduced following FET (Acharya et al. Fertil Steril 104 (4):873–878, 2015; Chen et al. N Engl J Med 375(6):523–533; Kalra et al. Obstet Gynecol 118(4):863–871). This chapter reviews the effect of COS on endometrial development, indications for, and evidence supporting a planned freeze-all strategy including premature progesterone elevation (PPE) and delayed embryo development, the optimal developmental stage and method for cryopreservation, and programmatic changes to consider when transitioning to a freeze-all program.

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Abbreviations

COS:

Controlled ovarian stimulation

FET:

Frozen embryo transfer

PPE:

Premature progesterone elevation

WOR:

Window of receptivity

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Author information

Authors and Affiliations

  1. IVI-RMA New Jersey, Basking Ridge, NJ, USA

    Daniel J. Kaser MD

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Jason Franasiak MD, HCLD/ALD

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  1. Daniel J. Kaser MD
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Editors and Affiliations

  1. Division of Andrology, University of Utah School of Medicine, Salt Lake City, Utah, USA

    Douglas T. Carrell

  2. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Catherine Racowsky

  3. Department of Urology, Weill Cornell Medical College, New York, New York, USA

    Peter N. Schlegel

  4. NICHD, National Institutes of Health, Bethesda, Maryland, USA

    Alan H. DeCherney

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Kaser, D.J., Franasiak, J. (2018). Are We Closer to “Freeze-All” for ART?. In: Carrell, D., Racowsky, C., Schlegel, P., DeCherney, A. (eds) Emerging Topics in Reproduction. Springer, Cham. https://doi.org/10.1007/978-3-319-90823-6_12

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