title: The endometrial preparation for frozen-thawed euploid blastocyst transfer: a prospective randomized trial comparing clinical results from natural modified cycle and exogenous hormone stimulation with GnRH agonist.
abstract: OBJECTIVE
  The aim of the study was to evaluate two methods of endometrial preparation for frozen-thawed single euploid blastocyst transfer: modified natural and artificial cycle with GnRH-agonist pituitary suppression.
  
  
  METHODS
  In this prospective, controlled randomized trial, a total of 236 patients undergoing infertility treatment were randomized in 1:1 ratio; 118 received a frozen-thawed single euploid blastocyst transfer in a modified natural cycle and 118 in an artificial cycle with GnRH-agonist pituitary suppression. In the artificial protocol, GnRH-agonist combined with estradiol valerate was administered. In the natural protocol, only final oocyte maturation was induced using human chorionic gonadotropin administration. The primary end-points were the clinical pregnancy and implantation rates; the secondary end-points were the cost-benefit in terms of drug cost and the number of visits and the woman psychological distress caused by the treatment.
  
  
  RESULTS
  No significant differences were found in clinical pregnancy, implantation, and miscarriage rates between protocols. The number of clinical and ultrasound controls and the number of laboratory dosages and venous samplings were similar in both study groups. No significant differences were found between the groups in the anxiety and depression values before the start of treatment, on the days of progesterone administration, the blastocyst transfer, and pregnancy test.
  
  
  CONCLUSIONS
  The findings of this study evidence that in case of frozen-thawed single euploid blastocyst transfer, both protocols are equally effective in terms of clinical outcomes, cost-benefit, and patient compliance. The choice of endometrial preparation protocol should be based on women menstrual and ovulatory characteristics or otherwise on patient need for cycle planning.
  
  
  BACKGROUND
  www.clinicaltrials.gov with number NCT02378584.
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy. ergreco1@virgilio.it.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Greco
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Litwicka
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Arrivi
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Varricchio
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Alina
authors.initials: A
authors.lastname: Caragia
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Greco
authors.affiliation: Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149, Rome, Italy.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Minasi
authors.affiliation: GENOMA-Molecular Genetics Laboratory, Via Castel Giubileo, 11, 00138, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiorentino
mesh_terms: D000022:Abortion, Spontaneous; D000328:Adult; D001007:Anxiety / Q000523:psychology; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D015925:Cryopreservation / Q000379:methods*; D003863:Depression / Q000523:psychology; D010064:Embryo Implantation / Q000502:physiology; D004624:Embryo Transfer / Q000379:methods*; D004717:Endometrium / Q000502:physiology; D004958:Estradiol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D010062:Ovulation Induction / Q000379:methods; D010902:Pituitary Gland / Q000187:drug effects; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D004967:Estrogens; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol
keywords: Blastocyst transfer; Endometrial preparation; Euploid embryos; Vitrification