Should I Freeze My Embryos Before Transfer?
by Dr. Paul R. Gindoff, MD · · Updated
From Dr. Paul Gindoff of Chelsea Fertility NYC:
There are certainly a number of useful techniques to help embryos implant. For example, transfer on day 5-6 blastocyst transfer or transfer on day 2-3 cellular embryo transfer. Both are time-tested successful applications. Additionally, thawing a frozen embryo is yet another way to successfully transfer embryos.
Recent innovation suggests that implantation may improve when the uterine lining is bolstered by supplemental estrogen and progesterone - the so-called hormone replaced embryo transfer cycle. This can only be efficiently done on a non-stimulated cycle, i.e. when a patient does not take fertility drugs.
This technique is perfect for donor-recipient synchronized cycles or standard frozen-thaw embryo transfer cycles (FET). So, if it can benefit many, what is all the fuss about? Can this be done for patients having routine IVF cycles where after egg retrieval normally one expects to have an embryo transfer in the same cycle?
Yes, but the logistics and mechanics of the IVF cycle would need to be adjusted. In order to “freeze-all” as it is known and then transfer, fertility specialists have to batch up several rounds of embryos from at least one or more egg retrievals, which means potentially one or more cycles of treatment with fertility drugs before the real attempt begins to try to get pregnant (the embryo transfer cycle). There is a delay of 1-2 months minimum and added cost for the extra steps in this process - the cryopreservation as well as the thaw cycle.
Thus, the real question is: Is it worth it? Is it cost effective or is the pregnancy rate so much higher than not doing a freeze-all scenario?
Unfortunately, the jury is still out on this. No one has studied this head to head, but in our experience at Chelsea Fertility and from several clinical studies it is clear that compared to failed attempts in patients with borderline lining this maneuver has finally led to implantation and pregnancy. So yes, there is a niche for this technique of “freeze-all”.
This niche includes: patients with known poor lining, failed implantation or miscarriages on prior IVF, and the large group of patients with PCOS (polycystic ovarian syndrome). PCOS patients have lower implantation rates due to poor egg quality and embryo quality, as well as uterine lining challenges due to baseline elevated estrogen levels and hyperstimulation from the egg retrieval cycle. Culturing out embryos first and then freezing them for a subsequent thaw to an endometrial lining optimized by supplemental estrogen and progesterone is a plan that addresses these pitfalls.