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FROZEN embryo transfer was associated with a higher risk of pregnancy induced hypertension, despite showing similar perinatal complication rates to fresh embryo transfer in ongoing pregnancies conceived IVF and intracytoplasmic sperm injection.
In a prospective cohort study conducted within a hypothetical randomised controlled trial framework, investigators analysed outcomes among 2,856 pregnant women recruited during the first trimester from 50 sites across 17 provinces in China between 2017 and 2021.
All participants conceived through in vitro fertilisation or intracytoplasmic sperm injection and were allocated in a 1:1 ratio to either frozen embryo transfer or fresh embryo transfer strategies.
Comparable Perinatal Complications with Frozen Embryo Transfer
The primary outcome was perinatal complications, defined as perinatal death or birth defects. Rates were similar between groups: 5.0% in the frozen embryo transfer group and 4.6% in the fresh embryo transfer group, with a risk ratio of 1.09; 95% confidence interval: 0.79–1.51.
Secondary neonatal outcomes also did not differ significantly. Risks of preterm birth, small for gestational age, large for gestational age, low birth weight, and macrosomia were comparable between strategies. These data suggest that, with regard to major perinatal outcomes, frozen embryo transfer offers a similar safety profile to fresh embryo transfer in ongoing pregnancies achieved through assisted reproductive technology.
Increased Risk of Pregnancy Induced Hypertension
However, important differences emerged in maternal safety outcomes. Frozen embryo transfer was associated with an increased risk of pregnancy induced hypertension compared with fresh embryo transfer: risk ratio: 2.18; 95% confidence interval: 1.10–4.62. No significant differences were reported for abortion, gestational diabetes mellitus, or gestational thyroid dysfunction.
Clinical Implications for Embryo Transfer Strategy
The findings indicate that while perinatal complications do not appear to differ between strategies, frozen embryo transfer may confer a higher risk of pregnancy induced hypertension. For clinicians involved in assisted reproductive technology, these results underscore the importance of individualised counselling when selecting an embryo transfer approach.
Decision making regarding fresh versus frozen embryo transfer should therefore involve careful consideration of potential maternal risks alongside comparable neonatal outcomes.
Reference:
Yan R et al. Perinatal complications of frozen vs. fresh embryo transfer among ongoing pregnancies: a cohort study conducted within the framework of a hypothetical trial. Fertil Steril. 2026;125(2):287-97.