in vitro fertilisation (ivf)

Natural Cycle Frozen Embryo Transfer vs. Medicated Frozen Embryo Transfer (FET)

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Natural Cycle Frozen Embryo Transfer and Medicated Frozen Embryo Transfer are extended techniques of In vitro Fertilization (IVF) where a frozen embryo transfer (FET) is performed in two different ways. Learn more about the ways, reasons, advantage and disadvantages, success rate of types of FET.

Let’s Discuss in More Detail About Natural Cycle FET and Medicated FET:

Thousands of women have benefited greatly from both frozen and medicated embryo transfer (FET) cycles to achieve pregnancy. Pregnancy is achieved following either successful IVF (In Vitro Fertilization) or medicated Frozen Embryo Transfer (FET) cycles. Additionally, FET also helps in preventing certain IVF complications like multiple birth defects and Hyperstimulation syndrome. If a woman has regular menstrual cycles, FET is the valid treatment without the use of any hormone preparation. Pregnancy with natural FET cycles is equivalent to that of hormone prepared cycles. For both natural and medicated FET to be successful, the embryos must be transferred when uterine lining is most receptive. This can be done by monitoring closely, assisted by the clinic either through blood tests, ultrasounds or with the use of ovulation kits. Embryo transfer is a process of Assisted Reproductive Technology in which embryos are placed into the uterus of a female with the intent of establishing a pregnancy.

Two Ways to Perform a Frozen Embryo Transfer

1. Natural cycle frozen embryo transfer:

Natural cycle frozen embryo transfer (FET) is available to women with regular ovulation and monthly menstrual cycles. In this case, a woman’s own hormones are utilized in the process of normal follicular development for ovulation and preparation of the lining of the endometrium for implantation.

For those women with predictable menstrual cycles, FET can be performed carefully after monitoring the cycle to determine the precise timing of ovulation. Alternatively, ovulation can be produced with the help of an HCG injection. Once the date of ovulation is fixed, then the uterine lining should be ready for embryo transfer five days later to it. In this way, the natural cycle of frozen embryos transfer takes place when they would normally be arriving in the uterus.

2. Medicated frozen embryo transfer:

It refers to the use of certain medications to suppress ovulation and prepare the uterus lining for implantation. A medicated FET helps in avoiding some of the disadvantages associated with a Natural cycle frozen embryo transfer. There is the use of a medication called Lupron, which is administered to the patient in order to suppress the natural ovarian cycle. It is followed by dosages of estrogen and progesterone in a synchronized fashion. Estrogen administration is started at the beginning of the cycle, which causes endometrial development along with suppression of the dominant follicle. Estrogen administration is continued until the endometrium reaches a thickness of 8mm (determined by using an ultrasound examination). Medicated FET is usually prepared with estrogen pills, shots, or patches for endometrium, which is used for embryo implantation. Three days before embryo transfer, patients, are given progesterone to modify the endometrial lining so that the chances of spontaneous ovulation are reduced. After this, progesterone is combined to start the changes related to secretions. This is done to mimic the physiological mid-cycle estrogen-progesterone transition. This develops the uterine lining so that it is prepared for the implanting embryo.

medicated frozen embryo transfer

Reason for one preferred over the other

  • Out of two, medicated FET is used in women who do not ovulate on their own or in situations where one needs to control the actual day of transfer of an embryo
  • Some patients may not have an adequate thick lining for optimal implantation or they may ovulate late or early in a cycle. In such situations, we prefer to control the cycle in order to obtain high pregnancy rates.

Advantages and Disadvantages of Natural Cycle FET and Medicated FET

Advantages of Natural Cycle FET

  • The advantage of Natural cycle FET is that it is a simpler process with no injections (besides the use of HCG trigger shots) and it requires minimal medications. There is an overall cost saving compared to a Medicated FET. Fresh cycles have been used successfully for IVF treatment and have a long history of success.
  • Another advantage of natural cycle FET is that, if a woman was successful in her first attempt, then she does not have to go through the intensive hormone injection treatment again unless she wants to use the frozen embryos. In short, Natural Cycle FET medications are less intense as compared to medicated FET.

Disadvantages of Natural Cycle FET

  • The optimal time for implantation may fall at an unpredictable time during the laboratory work schedule, so some clinics choose not to offer NC-FET. 
  • NC-FET demands frequent patient monitoring around the time of ovulation. If a cycle is suboptimal in terms of estrogen level and endometrial development, then the embryos should not be thawed and the cycle should be canceled.
  • Women those who have not undergone an ovarian stimulation cannot undergo a frozen cycle procedure to develop embryos.

Advantages of Medicated FET

  • Medicated FET avoids certain drawbacks associated with natural cycle FET. Medicated FET is suitable for those women who want to take full control of the cycle rather than the unpredictability of a natural cycle, even if the normal cycle is regular.
  • It ensures an orderly and monitored development and maturation of the eggs for preparation of the endometrium, which is critical for optimal embryo implantation.
  • Another reason to perform medicated FET is patient and the physician convenience and scheduling.
  • Medications are much less expensive than the Natural Cycle FET.
  • Fewer potential side effects.
  • One can schedule the date of the transfer months in advance and plan for it.

Success Rate of Natural Cycle (NC) FET and Medicated FET:

The success rates for both Natural cycle FET and Medicated FET differ by only two percent. Medicated FET has a success rate of 60% while natural has a 58% success rate.

Recent studies have shown that there are advantages to both natural cycle FET (lack of medication costs and injections) and medicated FET (flexibility). Still, natural cycle FET and medicated FET are equally effective in terms of pregnancy outcomes.

However, the choice of the procedure should be based on patient assessment, ovulation cycle, preference, and suitability.

The chances of success with a Natural cycle FET and Medicated FET are almost the same as they were when the embryos were first frozen because freezing keeps them from aging. Although a further study is still required, both of the methods have proven to be more successful for women under the age group of 35 years and over. Pregnancy rates have been signed the same between NC-FET and medicated FET. However, both patients and physicians find Medicated FET attractive because of its advanced scheduling feature. On the other side, many patients and doctors opt for NC-FET because of its simplicity with no injections (besides the HCG trigger shot) and minimal additional medications with overall cost savings compared with a medicated FET.

For those patients who think they may need an additional IVF attempt to become pregnant, or if you are looking for the best gynecologist in Delhi, elawoman.com can help you in your search. For complete information on normal delivery, you can consult Ela. Feel free to call on +917899912611 for any inquiry or advice on infertility treatments including IVF, IUI, and surrogacy.

Dr. Somna Goyal Mittal

About The Author

Obstetrician, Endoscopic Surgeon Dr. Somna Goyal Mittal
Ghaziabad

Dr. Somna Goyal Mittal is a gynecologist and obstetrician specializing in IUI, IVF, High-risk pregnancy care, Normal Vaginal Delivery, Cesarean section delivery, Pregnancy diseases, Endoscopy and Gynecology surgeries. Dr. Somna completed MBBS and MD in Obstetrics and Gynecology from M.G.I.M.S., Wardha in 1990 and 1994 respectively. She is a member of Association of Gynecologists and Obstetricians (AOGD). Dr. Somna Goyal Mittal is practicing at Yashoda Super Specialty Hospital branches located in Kaushambi and Vaishali in Ghaziabad.

6 Comments

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Sonu Uttam

The advantage of medicated Frozen Embryo Transfer is that you can schedule the date of the transfer in advance and then make your plans according to that. You will not be time bounded here.

Nov. 26, 2018, 6:58 p.m. 5.0

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Sarvika Khere

The success rate of medicated frozen embryo transfer and naturally frozen embryo transfer are almost the same. I think it depends on the person who is going to be diagnosed.

Nov. 24, 2018, 9:30 p.m. 4.5

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Ritika Chawla

There are many advantages of medicated frozen embryo transfer. I would suggest my sister opt it as she is not able to conceive naturally due to some infertility issue.

Nov. 24, 2018, 12:03 a.m. 5.0

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Sunita Baranwal

The doctor suggested me to go for frozen embryo transfer as I had the regular menstrual cycle and there were also some complications with me if I get treated with IVF.

Nov. 23, 2018, 8:45 p.m. 5.0

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Himanshu Pandey

Natural cycle Frozen Embryo Transfer is a simpler process. Here no injections are needed and no medication is required except the HCG trigger shots.

Nov. 22, 2018, 4:43 p.m. 4.5

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Jagjeevan Surekha

I think everyone is different. One should follow a treatment procedure after discussing with their doctor in detail.

Nov. 21, 2018, 1:05 p.m. 4.5

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