Frozen versus fresh embryo transfer in women with low prognosis for in vitro fertilisation treatment: pragmatic, multicentre, randomised controlled trial.
Summary
In a pragmatic multicenter RCT of 838 low-prognosis IVF patients, fresh embryo transfer achieved higher live birth rates than a freeze-all strategy. Findings challenge routine freeze-all policies in poor responders and support fresh transfer unless specific indications for freezing exist.
Key Findings
- Pragmatic multicenter RCT (n=838) in low-prognosis IVF showed lower live birth with freeze-all versus fresh embryo transfer.
- Secondary outcomes included cumulative live birth within 1 year and obstetric/neonatal outcomes; the primary superiority of fresh transfer held in ITT analysis.
- Findings challenge routine use of freeze-all in poor responders absent specific indications.
Clinical Implications
For women with low prognosis, prioritize fresh embryo transfer over a freeze-all approach unless there are clear medical indications (e.g., OHSS risk, PGT-A strategy). Counsel patients about potentially higher live birth with fresh transfer.
Why It Matters
High-quality RCT addressing a widespread clinical decision with immediate practice implications in reproductive endocrinology. Results may reduce unnecessary freeze-all strategies in poor responders.
Limitations
- Conducted in China across academic centers; generalizability to other settings and protocols may vary.
- Open-label by nature; embryo quality assessment and lab variation could influence outcomes.
Future Directions
Head-to-head trials stratified by ovarian response and adjunctive strategies (e.g., PGT-A) to refine transfer policy; cost-effectiveness and patient-centered outcomes (time to pregnancy) analyses.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Pragmatic multicenter randomized controlled trial assessing live birth.
- Study Design
- OTHER