Frozen Thawed Embryo Transfer versus Fresh Embryo Transfer in Cases with Repeated Unexplained ICSI Failure

 
Background: A variety of maternal, genetic, and environmental factors can lead to unsuccessful embryo implantation, which necessitates synchronization between the blastocyst and endometrium. Couples who experience recurrent implantation failure (RIF) may benefit from treatments such as blastocyst transfer, endometrial receptivity, and enhanced embryo quality. In contrast to fresh embryo transfer (ET) following ICSI, recent research indicates that a freeze-all policy might increase implantation success.
Objectives: To determine whether a freeze-all policy for in vitro human blastocysts and subsequent frozen thawed embryo transfer (FET) can improve the ongoing pregnancy rate in patients with recurrent implantation failure instead of fresh embryo transfer.
Patients and Methods: This prospective cohort study at El-Basma Infertility Center in Egypt involved 150 women with infertility who underwent ICSI after ovarian stimulation. The participants were randomly divided into two groups: Group 1 (75 women) followed a freeze-all protocol with a FET after ICSI, while Group II (75 women) underwent conventional ICSI followed by a fresh day-5 embryo transfer.
Results: There was no significant difference between the frozen and fresh embryo transfers in terms of ovarian responses, demographics, or infertility profile variances. On the other hand, the frozen group’s chemical pregnancy rate was significantly higher (53.3% vs 33.3%) and their clinical pregnancy rate (CPR) was also higher (49.3% vs 28%), indicating better implantation conditions. despite similar embryo quality and multiple pregnancy rates. Early pregnancy loss was lower in the frozen group, indicating better implantation conditions.
Conclusion: FET significantly improves chemical and CPRs in cases of repeated unexplained implantation failure, with higher ongoing pregnancy rates and lower early pregnancy loss, suggesting improved implantation and pregnancy maintenance.