Comparison of Pregnancy Rates in Fresh Embryo Transfer vs. Frozen Embryo Transfer in Women with Polycystic Ovary Syndrome, Undergoing in Vitro Fertilization in Jalandhar, Punjab

Abstract

Anovulation being the major cause of subfertility, among the Indian women, PCOS accounts for almost, 80% of them. Such women seek advice for irregular periods & almost 25% of them seek medical advice for infertility due to anovulation. Sedentary lifestyle of adolescents & adults, ingestion of food with transfat, obesity, lack of exercise etc., aggravate these problems further. Clomiphene Citrate is the first line treatment of PCOS. But in women receiving clomiphene citrate, though 60-70% show ovulation, only 25-30% of them conceive. In case of unsuccessful CC treatment, gonadotrophin treatment is started, but it comes with the high risk of hyper stimulation (10-12%). OHSS is a medical emergency with fluid shift into the third space, due to increased capillary permeability. It is one of the most common & serious complication in an IVF clinic, ranging from 1-8%, with hospitalization rate of 0.7% usually, it is expected to occur in a fresh cycle. There is some data to suggest that Embryo Freezing (Cryopreservation) in a fresh cycle, followed by Frozen-Thawed-Embryo Transfer in a natural cycle in which the endometrium is primed, could result in a higher clinical pregnancy rate. Also the problems of superovulation leading to poor implantation could be avoided.
Methodology: This study was conducted at Babies World IVF centre, Chhabra hospital & Maternity Home, Jalandhar, Punjab. This study was conducted from 1st January 2017 to 31st January 2020. Study Design: It was a longitudinal observational study. Purposive sampling was adopted.
Sample Size: 100 cases.
Main Outcome Measures: Clinical pregnancy rate was the primary outcome. Secondary outcome was any adverse event like miscarriage & ectopic pregnancy.
Results: The occurrence of pregnancy either biochemical or clinical 46% v/s 42% & adverse event/miscarriage (39.1% v/s 14.3%) in fresh v/s frozen was not significantly associated with type of Embryo Transfer (P>0.05). However, higher proportions i.e. 30.4% had more than one foetuses among fresh embryo group compared to frozen embryo group (4.8%) (P<0.05); implicating lesser ovarian hyperstimulation among the frozen group.