Comparing the incidence of pre-eclampsia following freeze-all versus conventional in-vitro fertilization: a systematic review and meta-analysis of randomized controlled trials

Ibrahim G. A. Badawi; Afnan S. H. Mgbel; Hussain S. S. Alqahtani; Atheer N. Alhrany; Aisha Z. Alabdali; Somaya M. I. Saabi; Riyadh A. M. Almastur

doi:10.18203/2394-6040.ijcmph20242570

Authors

Ibrahim G. A. Badawi Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia
Afnan S. H. Mgbel Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia
Hussain S. S. Alqahtani Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia
Atheer N. Alhrany Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia
Aisha Z. Alabdali Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia
Somaya M. I. Saabi Department of Obstetrics and Gynecology Abha Maternity and Children's Hospital Asir Province, Saudi Arabia.
Riyadh A. M. Almastur Department of Obstetrics and Gynecology, Abha General Maternity and Children Hospital, Asir Province, Saudi Arabia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20242570

Keywords:

In-vitro fertilization, Pre-eclampsia, Freeze-all strategy, Conventional embryo transfer, Randomized controlled trials, Meta-analysis

Abstract

In vitro fertilization (IVF) is commonly used to treat infertility, but its association with pre-eclampsia is well-documented. The freeze-all strategy in IVF has gained popularity, but its impact on the incidence of pre-eclampsia compared to conventional fresh embryo transfer remains uncertain. This systematic review and meta-analysis aimed to compare the incidence of pre-eclampsia in pregnancies following freeze-all versus conventional fresh embryo transfers in randomized controlled trials (RCTs). A comprehensive search was conducted across PubMed, Web of Science, Scopus, Medline, the Cochrane Library, and Google Scholar databases. A total of 611 records were identified and screened for suitability for inclusion in the quantitative synthesis. Data extraction and quality assessment were performed, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using fixed-effects models. Heterogeneity was assessed using Chi² and I² statistics. The meta-analysis included data from 7 RCTs, involving a total of 4,749 participants (2,434 in the freeze-all group and 2,315 in the conventional group). The pooled analysis revealed a significantly higher risk of pre-eclampsia in the freeze-all group, with an OR of 2.14 (95% CI 1.47, 3.11; p<0.0001). The heterogeneity among the studies was low (Chi square=5.88, df=6, p=0.44; I²=0%). This meta-analysis indicates that the freeze-all strategy in IVF is associated with a significantly higher risk of pre-eclampsia compared to conventional fresh embryo transfer. Clinicians should consider this increased risk when planning IVF treatments and counsel patients accordingly.

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References

Shamsi U, Saleem S, Nishter N. Epidemiology and risk factors of preeclampsia; an overview of observational studies. Al Ameen J Med Sci. 2013;6(4):292-300.

Roberts JM. Preeclampsia epidemiology(ies) and pathophysiology(ies). Best Pract Res Clin Obstet Gynaecol. 2024;94:102480.

Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia. Circ Res. 2019;124(7):1094-112.

Amaral LM, Wallace K, Owens M, LaMarca B. Pathophysiology and Current Clinical Management of Preeclampsia. Curr Hypertens Rep. 2017;19(8):61.

Ives CW, Sinkey R, Rajapreyar I, Tita ATN, Oparil S. Preeclampsia—Pathophysiology and Clinical Presentations. J Am Coll Cardiol. 2020;76(14):1690-702.

Wang H tian, Hong P ping, Li H yang, Zhou W, Li T. Use of a new set of key performance indicators for evaluating the performance of an in vitro fertilization laboratory in which blastocyst culture and the freeze-all strategy are the primary treatment in patients with in vitro fertilization. J Int Med Res. 2021;49(9):030006052110443.

von Wolff M, Haaf T. In Vitro Fertilization Technology and Child Health. Dtsch Arztebl Int. 2020;117(3):23-30.

Sha T, Wang X, Cheng W, Yan Y. A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod Biomed Online. 2019;39(2):281-93.

Bourdon M, Maignien C, Pocate-Cheriet K, Plu Bureau G, Marcellin L, Patrat C, et al. The freeze-all strategy after IVF: which indications? Reprod Biomed Online. 2021;42(3):529-45.

Bourdon M, Alwohaibi A, Maignien C, Marcellin L, Chargui A, Pocate Cheriet K, et al. IVF/ICSI Outcomes After a Freeze-All Strategy: an Observational Cohort Study. Reprod Sci. 2023;30(7):2283-91.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Chen ZJ, Shi Y, Sun Y, Zhang B, Liang X, Cao Y, et al. Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome. N Engl J Med. 2016;375(6):523-33.

Shi Y, Sun Y, Hao C, Zhang H, Wei D, Zhang Y, et al. Transfer of Fresh versus Frozen Embryos in Ovulatory Women. N Engl J Med. 2018;378(2):126-36.

Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, et al. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393(10178):1310-8.

Zhang B, Wei D, Legro RS, Shi Y, Li J, Zhang L, et al. Obstetric complications after frozen versus fresh embryo transfer in women with polycystic ovary syndrome: results from a randomized trial. Fertil Steril. 2018;109(2):324-9.

Maheshwari A, Bell JL, Bhide P, Brison D, Child T, Chong HY, et al. Elective freezing of embryos versus fresh embryo transfer in IVF: a multicentre randomized controlled trial in the UK (E-Freeze). Hum Reprod. 2022;37(3):476-87.

Stormlund S, Sopa N, Zedeler A, Bogstad J, Prætorius L, Nielsen HS, et al. Freeze-all versus fresh blastocyst transfer strategy during in vitro fertilisation in women with regular menstrual cycles: multicentre randomised controlled trial. BMJ. 2020;370:m2519.

Vuong LN, Dang VQ, Ho TM, Huynh BG, Ha DT, Pham TD, et al. IVF Transfer of Fresh or Frozen Embryos in Women without Polycystic Ovaries. N Engl J Med. 2018;378(2):137-47.

Roque M, Valle M, Guimarães F, Sampaio M, Geber S. Freeze-all policy: fresh vs. frozen-thawed embryo transfer. Fertil Steril. 2015;103(5):1190-3.

Venetis CA. Pro: Fresh versus frozen embryo transfer. Is frozen embryo transfer the future? Hum Reprod. 2022;37(7):1379-87.

Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021;2021(2).

Santos-Ribeiro S, Polyzos NP, Lan VTN, Siffain J, Mackens S, Van Landuyt L, et al. The effect of an immediate frozen embryo transfer following a freeze-all protocol: a retrospective analysis from two centres. Hum Reprod. 2016;31(11):2541-8.

Ozgur K, Bulut H, Berkkanoglu M, Humaidan P, Coetzee K. Frozen embryo transfer can be performed in the cycle immediately following the freeze-all cycle. J Assist Reprod Genet. 2018;35(1):135-42.