PRogrammed Versus Modified Natural Cycle After Euploid Failed Embryo Transfer

Other criteria

• Major Inclusion Criteria: The following are major inclusion criteria:
• Patients planning to undergo frozen embryo transfer cycle with a single euploid blastocyst
• Patients who have previously undergone their first unsuccessful frozen embryo transfer cycle, defined as either failure of implantation with negative pregnancy test or biochemical pregnancy, using a programmed cycle protocol
• Preimplantation genetic testing for aneuploidy (PGT-A) of the embryo used in failed programmed embryo transfer cycle must have occurred after January 1, 2017
• Patients ages 18 to 53 years old as per practice guidelines
• Patients with BMI between 16-45 kg/m2
• Patients with at least one embryo remaining in storage, from either the same or a separate cohort
• Patients with proven ovulatory function, as defined by the presence of regular menstrual cycles or detection of luteinizing hormone surge on serum or urinary test kits
• Patients with ≥ 7 mm endometrial thickness prior to progesterone start in prior transfer cycle
• Normal uterine cavity as evidenced by recent (within 1 year) saline sonogram or hysteroscopy; Major Exclusion Criteria: The following are exclusion criteria:
• More than 1 prior unsuccessful frozen embryo transfer cycle
• The prior FET failure having had resulted in a clinical loss or ectopic pregnancy
• Previously cancelled frozen embryo transfer cycle for inadequate endometrial response
• Patients who required a different route of estrogen administration in the prior programmed cycle (vaginal, transdermal, intramuscular)
• PGT-A analysis of the available embryo for transfer performed prior to January 1, 2017
• Anovulatory or oligo-ovulatory patients unable to undergo modified natural endometrial preparation
• Patients with an endometrial thickness < 7 mm prior to progesterone start in prior cycle
• History of hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia
• Mullerian anomalies, excluding arcuate uterus and repaired septum
• No euploid embryos available for transfer
• Concurrent submucosal fibroids, unrepaired uterine defects or present indication for uterine surgery
• Communicating hydrosalpinx without plans for surgical correction prior to study enrollment
• Failure of patient to agree to enrollment in study with written consent
• Concurrent pregnancy
• Concomitant use of adjunctive therapies for endometrial proliferation or receptivity, including anticoagulation and antihistamines. These must be discontinued upon enrollment
• Embryo planned to be used for transfer generated from surgically obtained sperm
• Recurrent/persistent endometrial fluid in prior cycles visualized on the majority of transvaginal ultrasound monitoring
• Third party reproduction patients (donor sperm sources can be included)