REVIEW  HOT TOPICS IN FEMALE INFERTILITY 

Panminerva Medica 2019 March;61(1):52-7

DOI: 10.23736/S0031-0808.18.03492-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Freeze-all strategy in IVF/ICSI cycles: an update on clinical utility

Matheus ROQUE ^{1, 2} ✉, Beatrice NUTO NÓBREGA ¹, Marcello VALLE ¹, Marcos SAMPAIO ³, Selmo GEBER ^{2, 3}, Thor HAAHR ^{4, 5}, Peter HUMAIDAN ^{4, 5}, Sandro C. ESTEVES ⁶

¹ Center for Reproductive Medicine ORIGEN, Rio de Janeiro, Brazil; ² Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; ³ Center for Reproductive Medicine ORIGEN, Belo Horizonte, Brazil; ⁴ Faculty of Health, Aarhus University, Denmark; ⁵ The Fertility Clinic, Skive Regional Hospital, Skive, Denmark; ⁶ Andrology and Human Reproduction Clinic ANDROFERT, University of Campinas (UNICAMP), Campinas, Brazil

Over the years concerns have arisen about possible adverse effects associated with controlled ovarian stimulation (COS) as regards not only the endometrium, but also on obstetrical and perinatal outcomes in pregnancies after fresh embryo transfer (ET) during in-vitro fertilization (IVF) treatment. The improvements in cryopreservation techniques associated with the possible impairment in endometrial receptivity due to the supra-physiologic hormonal levels observed during conventional COS have increased the implementation of the so-called “freeze-all” policy. With this strategy, the entire cohort of embryos is cryopreserved to be transferred to the uterus in subsequent cycles in a more physiological environment, avoiding the supra-physiologic hormonal levels observed during COS. The initial studies showed that this strategy could be beneficial for subgroups of patients, however, the freeze-all policy is being more and more frequently used for all patient categories. Unfortunately, currently, no clinical data support this widespread use of the freeze-all strategy. Based on available trials, it seems justified to implement the strategy in patients with risk of ovarian hyperstimulation syndrome, hyper-responders and when performing preimplantation genetic testing for aneuploidy in blastocyst stage. Therefore, all the other indications, such as implantation failure, high progesterone levels on the trigger day, advanced maternal age, and endometriosis, still lack the evidence to support routine use of the freeze-all policy.

KEY WORDS: Freezing - Embryo transfer - Cryopreservation - Fertilization in vitro - Intracytoplasmic sperm injections - Endometrium