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The impact of timing modified natural cycle frozen embryo transfer based on spontaneous luteinizing hormone surge

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

To evaluate whether adjusting timing of modified natural cycle frozen embryo transfer (mNC-FET) 1 day earlier in the setting of a spontaneous LH surge has an impact on pregnancy outcomes.

Methods

This retrospective cohort study evaluated all mNC-FET with euploid blastocysts from May 1, 2016 to March 30, 2019, at a single academic institution. Standard protocol for mNC-FET included ultrasound monitoring and hCG trigger when the dominant follicle and endometrial lining were appropriately developed. Patients had serum LH, estradiol, and progesterone checked on day of trigger. If LH was ≥ 20 mIU/mL, trigger was given that day and FET was performed 6 days after surge (LH/HCG+6), with the intent of transferring 5 days after ovulation. If LH was < 20 mIU/mL, FET was performed 7 days after trigger (hCG+7). Primary outcomes included clinical pregnancy and live birth rates. To account for correlation between cycles, a generalized estimating equation (GEE) method for multivariable logistic regression was used.

Results

Four hundred fifty-three mNC-FET cycles met inclusion criteria, of which 205 were in the LH/HCG+6 group and 248 were in the HCG+7 group. The overall clinical pregnancy rate was 64% and clinical miscarriage rate was 4.8%, with similar rates between the two groups. The overall live birth rate was 60.9% (61.0% in LH/HCG+6 group and 60.9% in HCG+7 group). After implementing GEE, the odds of CP (aOR 0.97, 95% CI [0.65–1.45], p = 0.88) and LB (aOR 0.98, 95% CI [0.67–1.45], p = 0.93) were similar in both groups.

Conclusions

In our study cohort, mNC-FET based on LH/HCG+6 versus HCG+7 had similar pregnancy outcomes.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA

    J. K. Johal

  2. Division of Reproductive Endocrinology & Infertility Department of Obstetrics & Gynecology, Stanford University, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA

    B. Bavan, R. B. Lathi & A. A. Milki

  3. Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA

    W. Zhang

  4. Quantitative Sciences Unit, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA

    R. M. Gardner

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  1. J. K. Johal
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  2. B. Bavan
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  3. W. Zhang
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  4. R. M. Gardner
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  5. R. B. Lathi
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Correspondence to J. K. Johal.

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J. K. Johal and B. Bavan are co first authors.

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Johal, J.K., Bavan, B., Zhang, W. et al. The impact of timing modified natural cycle frozen embryo transfer based on spontaneous luteinizing hormone surge. J Assist Reprod Genet 38, 219–225 (2021). https://doi.org/10.1007/s10815-020-01994-1

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  • DOI: https://doi.org/10.1007/s10815-020-01994-1

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