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IVF With Frozen Embryos Isn't Best For Everyone

All frozen IVF, or IVF performed with frozen embryos, is quickly becoming one of the most popular procedures advertised by other fertility centers. Listen to Dr. Gleicher explain why embryo freezing isn't necessary, or even recommended, for everyone.

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Hello! Once again, I want to talk to you today about a somewhat controversial issue. This is one of those, what we here at CHR have come to call, "fashions of the moment," which unfortunately, on a pretty regular basis affect our specialty. A few years ago, some investigators in Las Vegas started promoting the concept of avoiding fresh embryo transfers in IVF cycles. In current-- still standard-- IVF practice, we (for over almost 40 years) have always preferred fresh embryo transfers over frozen embryo transfers. And the reason was that uniformly fresh embryos performed better than frozen embryos. In the early days of IVF there where maybe technical reasons (at least partially) behind those results because our abilities to freeze embryos were not as good as they are today. And so over time, as our abilities to freeze embryos greatly improved, and that has really (especially in the last decade) found increasing application in in IVF, we have gotten so much better with embryo freezing that some people started to consider the option of transferring only frozen embryos. And their motivation was the hypothesis (and it is important for you to understand that this is purely a hypothesis), their hypothesis was that in a fresh cycle (in a stimulated cycle), hormone levels are so high (they are so called supra physiological), that they negatively affect the endometrium and therefore reduce chances of embryos to implant. Theoretically again, one of those wonderful concepts that sounds very, very good, may have some logic behind it, but before it is translated and the clinical practice obviously should be very, very carefully investigated because the downside of being wrong is that instead of improving IVF outcomes, you start really negatively affecting IVF outcomes. And we have seen that happening in our field over the last decade, unfortunately ,on quite a number of occasions with other so-called, "fashions of the moment," whether that is now preimplantation genetic testing for aneuploidy (now called PGTA, in the past called pre-implantation genetic screening or PGS) or other rather short-lived interventions into routine IVF practice that have been promoted here and there. So, unfortunately, this concept of, "all-freeze and then transfer," quickly gained popularity based on studies (that is again so often the case) were not properly conducted and, more importantly, were not properly analyzed. One of the big problems that we face in IVF practice is that when studies are performed, they are performed in highly selected patient populations, but the results that are obtained in those studies are then announced as applicable to everybody. This is happening all the time and this also happened in this instance. There are obviously patients who may benefit from all-freeze cycles. I mean the most obvious ones are patients who do not have adequate thickness of their endometrium at time of a fresh transfer. Or they may be patients who are hyper-stimulated and you don't want to endanger them by getting pregnant while being already hard to stimulate it because pregnancy would make things even worse. Nobody argues that embryos should be frozen in all of those cycles, but to make it a routine procedure on everybody including older patients who may just have one or two embryos is simply silly. And therefore, this video is meant to tell you to be very careful when somebody's trying to tell you that you should automatically have all of your embryos frozen and then transferred at a later time. And, besides that point, it's also more expensive. Thanks for listening.

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