Fresh vs. Frozen Embryo Transfers: What You Need To Know

The fertility process involves many choices—choices you probably didn’t anticipate making about things you didn’t ever really consider. It certainly opened my eyes to...
Kristin Diversi •Sep 14, 2022

The fertility process involves many choices—choices you probably didn’t anticipate making about things you didn’t ever really consider. It certainly opened my eyes to a new, vast education I had never thought about, let alone been made vaguely aware of at any point during Sex Ed. With in vitro fertilization (IVF), some of the processes begin more or less the same way: You, or a donor, start with a medication protocol, you, or a surrogate, receive an embryo for transfer, and you, or a surrogate, hopefully, have a live birth. 

Along the way, of course, there are dozens of variables to consider. One of the most significant options faced by those in the fertility and assisted reproductive technology (ART) process is: Fresh or frozen?

Of course, we’re not talking about vegetables, but embryos. As ART becomes more advanced and the freezing process—known as vitrification—improves, it has become increasingly popular to freeze embryos. Whereas in the early days of IVF, it was more likely to receive a fresh embryo for transfer. But is one better than the other? Like most things fertility and ART-related, it depends.

Is it better to have a fresh or frozen embryo transfer?

No one technique or protocol is right for everyone, and speaking with a medical professional that you trust is the best option. We do know that a retrospective study of over 80,000 IVF patients shed light on some interesting findings. Those who respond to ovarian stimulation on the “lower” side, producing 14 eggs or fewer, had slightly higher birth rates48%with fresh transfers, while “higher” responders saw birth rates of 52% with frozen transfers. 

Cost is another important consideration. According to CNY Fertility, one single round of IVF with a fresh transfer is less expensive than an egg retrieval followed by a frozen transfer since a frozen transfer will require another round of medication to prepare the uterine environment and increase receptivity. With the majority of IVF patients paying out-of-pocket for treatment, for some, this could be the decision-maker in and of itself. 

However, it should be noted that not everyone is ready to receive an embryo right after egg retrieval. Sometimes—especially in high-responders—hormones need to rebalance, and the uterine environment needs to be prepared for optimal receptivity of the embryo. In these cases, a frozen embryo transfer provides extra time for those processes to occur. 

Fresh and Frozen Embryo Transfers: What's the Difference?

Factor

Fresh

Frozen

Time to transfer after retrieval

3-5 days after retrieval

Once fertilized and frozen, can occur years after retrieval 

Recovery after retrieval

Almost none

As much as needed/wanted

Donor eggs/embryos

Can be used

Can be used

Possible pregnancy outcomes

 

Possibly less likely to be ectopic

Possible effects on birth outcome

 

Possibly less likely to be early, low birth weight (possibly due to extra preparation of uterine environment)

Likelihood of implantation/pregnancy

Roughly the same

Roughly the same

Deciding Whether A Fresh or Frozen Embryo Transfer Is Best For You

When looking at the overall picture, the decision between a fresh or frozen embryo transfer seems to come down to personal considerations like maternal health—including ovarian response rate and the uterine environment—expense, as well as other factors. 

For example, The New England Journal of Medicine published a study in 2018 that found women whose infertility issues were associated with polycystic ovary syndrome (PCOS) had greater success—higher live birth rates—when they utilized frozen embryo transfers. 

We can’t forget the other piece of the embryo pie: sperm quality, which is also important in determining embryo quality. One study found that higher quality embryos are associated with a 79% live birth rate with good quality at 64% and poor quality at only 28%.  

Another consideration: even if you decide on a fresh transfer, it’s dependent on your uterine environment. If you have a polyp, your lining isn’t optimal, or something else is going on, you may need to freeze all anyway. Ultimately, you or your surrogate’s overall health should be the greatest consideration when it comes to either type of transfer. 

At the end of the day, the right choice between a fresh or frozen embryo transfer depends on your personal fertility experience and should be discussed at length with your Reproductive Endocrinologist or other trusted medical professional. There are many factors to consider for your lifestyle, health, and ultimate desired experience. Whatever you decide, here’s to hoping it leads to a healthy baby!


Kristin Diversi is a writer and versatile creative. She is passionate about reproductive health and justice and lives in Longmont, Colorado, with her husband and their son.