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Related Experiment Video

Updated: May 1, 2026

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Comparison between two protocols for thawed embryo transfer: natural cycle versus exogenous hormone replacement.

Jacob Levron1, Gil M Yerushalmi, Masha Brengauz

  • 1IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel and.

Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology
|March 28, 2014
PubMed
Summary

The natural Frozen Embryo Transfer (FET) protocol resulted in higher pregnancy rates compared to the E2&P4 replacement protocol. Natural cycles also showed improved endometrial thickness and implantation rates.

Keywords:
Embryo cryopreservationFrozen-thawed embryo transferendometrial preparationendometrial thickness

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Area of Science:

  • Reproductive endocrinology and infertility treatments.

Background:

  • Two primary protocols exist for Frozen Embryo Transfer (FET): natural cycles and hormone replacement cycles (E2&P4).
  • The comparative effectiveness of these FET protocols remains a subject of ongoing debate.

Purpose of the Study:

  • To compare the clinical outcomes of FET cycles utilizing natural endometrial preparation versus those using exogenous estrogen and progesterone (E2&P4) administration.

Main Methods:

  • A retrospective analysis of 1235 FET cycles over 12 years.
  • Group A (798 cycles) employed the natural cycle protocol.
  • Group B (437 cycles) utilized the E2&P4 exogenous hormone administration protocol.

Main Results:

  • Patients in the natural cycle group (A) exhibited significantly greater endometrial thickness (9.54 ± 0.11 mm) compared to the E2&P4 group (B) (8.95 ± 0.13 mm).
  • Implantation rates (6.47% vs 4.26%), clinical pregnancy rates (12.91% vs 8.47%), and ongoing pregnancy rates (10.4% vs 5.95%) were significantly higher in the natural cycle group (A).
  • Peak serum estradiol (E2) levels were higher in the E2&P4 group (B) (250.78 ± 33.67 pg/mL) compared to the natural cycle group (A) (162.51 ± 8.97 pg/mL).

Conclusions:

  • Natural endometrial preparation for FET cycles is associated with superior outcomes compared to exogenous E2&P4 administration.
  • The natural protocol demonstrates advantages in achieving higher endometrial thickness, implantation rates, and clinical pregnancy rates.