Department of Obstetrics and Gynaecology, Fertility Clinic Section 455, Hvidovre University Hospital, Hvidovre, Copenhagen, Denmark.
Department of Public Health, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen K, Denmark.
Hum Reprod. 2019 Apr 1;34(4):679-688. doi: 10.1093/humrep/dez006.
What are the attitudes towards different aspects of a freeze-all strategy and elective frozen embryo transfer (eFET) in comparison with fresh embryo transfer in assisted reproductive technology treatment among female and male patients before and after their first ART treatment cycle in a public health care setting?
Despite concerns about the delay in embryo transfer associated with eFET, nearly 60% of the participants were in favor of eFET compared with fresh embryo transfer assuming that the clinical pregnancy rate was equivalent.
Vitrification and blastocyst transfer have considerably improved success rates after FET with ongoing pregnancy rates in frozen cycles approaching those seen in fresh treatment cycles. Furthermore, the risk of ovarian hyperstimulation syndrome (OHSS) is essentially eliminated in FET cycles, and FET may be beneficial to the endometrial and fetal development because a hormonal environment mirroring the natural cycle is enabled. However, the freeze-all strategy is not yet implemented as standard care. One reason is the presumption of negative patient attitudes towards a freeze-all embryo strategy. So far, no data regarding patients' attitudes on a freeze-all strategy have been published.
STUDY DESIGN, SIZE, DURATION: This study was designed as a descriptive cross-sectional study including 165 fertility patients referred for their first ART treatment from December 2014 to June 2016.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All newly referred patients participating in a mandatory meeting before initiating ART treatment at the Fertility Clinic, Hvidovre Hospital, Copenhagen, Denmark were requested to fill in an online web-based questionnaire separately for men and women covering attitudes towards a freeze-all strategy, socio-demographic data and reproductive history. The patients were informed about both conventional fresh embryo transfer strategy and the freeze-all strategy prior to answering the questionnaire.
The total response rate was 77.1% (n = 165), and for women and men respectively 85.8 versus 66.0%. The female respondents were significantly more likely to consider the postponement of embryo transfer difficult compared to the male population (78.6 versus 35.5%; P < 0.001) and they were significantly more willing to accept a risk in treatment on own health to achieve a pregnancy than were the male respondents on their partners health (82.5 versus 96.8%; P = 0.025). However, 59.2% of the women and 59.7% of the men agreed that they would choose eFET over fresh embryo transfer if the chance of pregnancy were the same. Most of the patients furthermore agreed that the health of the mother and their baby was of highest importance. In the adjusted analyses we found no significant predictive factors for preferences towards a freeze-all strategy apart from a negative attitude towards delay of transfer in case of previous unsuccessful ART attempts.
LIMITATIONS, REASONS FOR CAUTION: Selection bias cannot be excluded, as the total response rate was 77.1%. The hypothetical nature of the items may furthermore limit the validity of the results. In addition, the participants were from a single Fertility Clinic in the Capital Region of Denmark and may therefore not be representative for all fertility patients.
In a clinical setting with similar pregnancy rates for eFET and fresh embryo transfer, these results indicate that patients, when given access to information on advantages and disadvantages of both fresh embryo transfer and eFET, are less prone to opt for fresh embryo transfer. This may be ground breaking for a patient-centered paradigm shift in routine ART treatment with a wider implementation of a freeze-all and eFET-strategy eliminating the risk of OHSS.
STUDY FUNDING/COMPETING INTEREST(S): The Danish Council for Independent Research and Merck Serono supported the study. The study is part of the Reprounion Collaborative study, co-financed by the European Union, Interreg V ÖKS. No competing interests exist.
在公共医疗保健环境中，比较辅助生殖技术（ART）治疗中首次 ART 治疗周期前后的女性和男性患者对冷冻全部策略和选择性冷冻胚胎移植（eFET）的不同方面的态度，以及与新鲜胚胎移植相比的态度。
尽管对 eFET 相关的胚胎移植延迟存在担忧，但近 60%的参与者赞成 eFET，而不是新鲜胚胎移植，假设临床妊娠率相当。
玻璃化和囊胚移植极大地提高了 FET 的成功率，使持续妊娠率接近新鲜治疗周期的水平。此外，FET 可以避免卵巢过度刺激综合征（OHSS）的风险，并且 FET 可能对子宫内膜和胎儿发育有益，因为可以实现类似于自然周期的激素环境。然而，冷冻全部策略尚未作为标准护理实施。一个原因是假定患者对冷冻全部胚胎策略持负面态度。迄今为止，尚无关于患者对冷冻全部策略的态度的数据。
研究设计、规模、持续时间：本研究设计为描述性横断面研究，包括 2014 年 12 月至 2016 年 6 月期间在丹麦哥本哈根 Hvidovre 医院生育诊所首次接受 ART 治疗的 165 名生育患者。
参与者/材料、设置、方法：所有新转诊的患者在丹麦哥本哈根 Hvidovre 医院生育诊所接受 ART 治疗前，均被要求单独填写一份在线网络问卷，涵盖对冷冻全部策略的态度、社会人口统计学数据和生殖史。在回答问卷之前，患者会被告知传统的新鲜胚胎移植策略和冷冻全部策略。
总回复率为 77.1%（n=165），女性和男性分别为 85.8%和 66.0%。与男性人群相比，女性受访者明显更难以接受胚胎移植的延迟（78.6%比 35.5%；P<0.001），并且她们明显更愿意接受治疗对自身健康的风险，以实现怀孕，而不是男性受访者对伴侣健康的风险（82.5%比 96.8%；P=0.025）。然而，59.2%的女性和 59.7%的男性同意，如果怀孕的机会相同，他们会选择 eFET 而不是新鲜胚胎移植。大多数患者还认为母亲和婴儿的健康是最重要的。在调整分析中，除了对以前不成功的 ART 尝试的转移延迟持负面态度外，我们没有发现对冷冻全部策略偏好的显著预测因素。
局限性、谨慎的原因：选择偏差不可避免，因为总回复率为 77.1%。项目的假设性质可能会进一步限制结果的有效性。此外，参与者来自丹麦首都地区的一家生育诊所，因此可能无法代表所有生育患者。
在具有相似 eFET 和新鲜胚胎移植妊娠率的临床环境中，这些结果表明，当患者获得有关新鲜胚胎移植和 eFET 的优缺点的信息时，他们不太倾向于选择新鲜胚胎移植。这可能会打破常规 ART 治疗的以患者为中心的范式转变，更广泛地实施冷冻全部和 eFET 策略，消除 OHSS 的风险。
研究资金/利益冲突：丹麦独立研究委员会和默克雪兰诺支持这项研究。该研究是 Reprounion 合作研究的一部分，由欧盟、Interreg V ÖKS 共同资助。不存在竞争利益。
