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IVF for Infertile Women

By: Ahaana Chadha

Summarised By: Saisha Sikka

Diagram is not representative of the process of IVF
Diagram is not representative of the process of IVF

Introduction

This research paper evaluates in vitro fertilisation (IVF), a process implemented when a woman is infertile. This means that she is unable to reproduce successfully, even after trying for over a year. In this case, an embryo is produced in a laboratory by stimulating the woman’s ovaries to retrieve egg cells and taking sperm from the father. 

However, this isn’t an easy process for many women, especially those who have a low prognosis for IVF. This means that even after the process of IVF, they have low chances of a successful live birth (in which the baby shows definite signs of life like breathing, heart beating, etc). This means nearly 40% of women have a 50% lower chance of having a child.

After IVF, the embryo is either frozen at sub-zero temperatures for an extended period (also known as cryopreservation and is done across multiple medical fields). This process of cryopreservation of embryos is referred to as Frozen embryo transfer or the Freeze-all strategy. Alternatively, the embryo can be freshly implanted in the woman’s uterus within 3 to 5 days after fertilisation, which is called Fresh embryo transfer.

Although the initial concept of embryo cryopreservation was intended for storing surplus embryos (in case the couple wishes to have more children in the future), after selecting the best one for implantation. Now, scientists have developed a new method called the Freeze-all strategy. This is because fresh embryo transfer can lead to ovarian hyperstimulation syndrome. In contrast, frozen embryo transfer is shown to prevent it by delaying the transfer to a later, non-stimulated cycle, during which the surge of human chorionic gonadotropin can be avoided. Gonadotropin is a hormone produced by the placenta during pregnancy to stop menstruation. A rise in this can be harmful as it increases the permeability of the ovarian blood vessels, causing them to leak a protein-rich fluid that can invade several body cavities. 

This research paper analyses which method is better, frozen or fresh, for a woman with a low prognosis for IVF.

 Ovarian hyperstimulation syndrome is when the ovaries, due to a fertility treatment (like IVF), swell and begin to leak fluid which can be extremely painful. 

Human chorionic gonadotropin:   A hormone produced by the placenta during pregnancy to stop menstruation. A surge of this can be harmful.


The Study

A study was conducted in China to analyse this. 878 women were randomly assigned to a group between the fresh transfer and frozen transfer groups. The women’s oocytes (egg cells) were fertilised by sperm, and then the embryos were either placed in the uterus after a few days or frozen first, then thawed and transferred later. They were then monitored throughout their pregnancy. 

The Results

The Frozen group showcased 32% of the women who had live births, and the Fresh group showed 40% of the women who had live births. Clinical pregnancy (confirmed pregnancy through ultrasound) rates were also lower in the frozen group (39% vs 47%), while miscarriages were more common in frozen transfers (31% vs 23%). The Frozen group had fewer twin births (5% vs 9%), but no significant differences in the birth weight of the babies. Singletons (birth of a single offspring) weighed around 3.3 kg on average in both cases. 

As for maternal complications like gestational diabetes, high blood pressure, bleeding after birth, etc., they were similar in both groups, with no risks attributed to any method. Cumulative Live Birth showed Fthe resh group with a greater likelihood of live birth (51% vs 44%). It has been analysed that frozen transfers still do not perform better than fresh. 

These results are attributed to several factors, including the freezing and thawing process damaging the embryos, and the uterine environment in the fresh cycle being more conducive to embryo implantation than the environment in a subsequent frozen embryo transfer.

Conclusion

According to the trial, for women with a low IVF prognosis, fresh embryo transfer performed better than frozen transfer. However, freezing embryos yields better outcomes for women with a favourable prognosis. Freezing and thawing may cause minor damage to the embryo. However, the uterus still accepts it in fresh cycles in women with low ovarian reserve (low number of oocytes in the ovaries). 

However, it must be noted that the outcomes might have been affected by treatment decisions such as the quantity of embryos transferred or the way the uterus was prepared. The frozen group received more single embryo transfers than the fresh group, which may have an impact on the rates of twin and live births.

Overall, we can conclude that Fresh Embryo transfer is the more viable option for women with a low IVF prognosis. 


Works Cited

  1. Betz, Danielle, and Kathleen Fane. “Human Chorionic Gonadotropin (HCG).” National Library of Medicine, StatPearls Publishing, 14 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK532950/.

  2. Bose, Doel. “Ovarian Rejuvenation for Restoring Fertility - Reviving Lost Fertility.” Get Best Solution on IVF at IVF Center Indore| #1 Indore IVF Center, 20 June 2023, www.indoreinfertilityclinic.com/ovarian-rejuvenation-prp-therapy/. Accessed 21 Sept. 2025.

  3. Bourdon, Mathilde, et al. “The Freeze-All Strategy after IVF: Which Indications?” Reproductive BioMedicine Online, vol. 42, no. 3, Mar. 2021, pp. 529–45, https://doi.org/10.1016/j.rbmo.2020.11.013.

  4. Canada,. “Classification of Births - 1 - Live Births.” Statcan.gc.ca, 2019, www23.statcan.gc.ca/imdb/p3VD.pl?Function=getVD&TVD=508482&CVD=508482&CLV=0&MLV=1&D=1. Accessed 21 Sept. 2025.

  5. Celada, Paula, and Ernesto Bosch. “Freeze-All, for Whom, When, and How.” Upsala Journal of Medical Sciences, vol. 125, no. 2, Apr. 2020, pp. 104–11, https://doi.org/10.1080/03009734.2020.1746870.

  6. Cleveland Clinic. “IVF (in Vitro Fertilization): Procedure & How It Works.” Cleveland Clinic, 2 Mar. 2022, my.clevelandclinic.org/health/treatments/22457-ivf.

  7. Frellick, Marcia. “Fresh Embryo Transfer May Be the Best Option for Women with Low IVF Odds.” Medscape, 10 Feb. 2025, www.medscape.com/viewarticle/fresh-embryo-transfer-may-be-best-option-women-low-ivf-odds-2025a10003bj. Accessed 28 Sept. 2025.

  8. “Implantation Symptoms in IVF | Early Signs after Embryo Transfer.” Iswarya Fertility Centre, 11 Mar. 2025, iswaryafertility.com/implantation-symptoms-in-ivf-what-to-expect-after-embryo-transfer/. Accessed 21 Sept. 2025.

  9. Mayo Clinic. “In Vitro Fertilization (IVF).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Sept. 2023, www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 .

  10. ---. “Ovarian Hyperstimulation Syndrome - Symptoms and Causes.” Mayo Clinic, 9 Nov. 2021, www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697.

  11. “Prevention and Treatment of Moderate and Severe Ovarian Hyperstimulation Syndrome: A Guideline (2016).” Www.asrm.org, www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/.

  12. Rossi, Brook. “Fresh and Frozen Embryo Transfers.” Www.sart.org, www.sart.org/patients/fyi-videos/fresh-and-frozen-embryo-transfers/.

  13. sridevifertility. “Cryopreservation and Its Applications.” BYJUS, byjus.com/biology/cryopreservation/.

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