Elective freeze-all of embryos: a strategy of safety, flexibility and effectiveness

Dr N Christoforidis at the15th Congress of the Hellenic Society of Obstetrics and Gynaecology: 4 September 2021, Athens, Greece.

Over the last few years we have seen a significant increase in the number of elective frozen embryo transfer cycles (eFET), following the widespread use of the strategy of elective freeze of all embryos (EFA). The latter has proven not only a safe route to almost eliminate the risk of ovarian hyperstimulation syndrome (OHSS), it has also been associated with a significant increase in the chance of clinical pregnancy in high responders and women diagnosed with PCOS.

However, despite the initial premise, it has not been proven useful as a strategy in other groups, such as the normal responders, or the poor responders. In addition, evidence accumulates regarding a small increase in pregnancy related complications, namely, hypertensive disorders of pregnancy, as well as fetal complications, in particular, fetal macrosomia and large birth weight, with associated increased perinatal morbidity.

The question remains as to the cost effectiveness of the strategy of elective freeze-all of embryos. Although previous studies have suggested that such an approach can be cost effective in the setting of hyper responders, more data are needed, as the widespread use of such an approach worldwide necessitates careful evaluation of the extra time required to complete treatment, cost of additional visits and cryopreservation, not to mention the increased stress experienced by many women that go through such an approach.

©2021, Nicholas Christoforidis, Fertility Matters
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