Effect of the types of transferred embryo on clinical outcomes of frozen-thawed embryo transfer among patients with thin endometrium
10.3760/cma.j.cn101441-20200602-00325
- VernacularTitle:冻融周期薄型子宫内膜移植胚胎类型对临床结局的影响
- Author:
Shaodi ZHANG
1
;
Yisha YIN
1
;
Qiuyuan LI
1
;
Xiao HAN
1
;
Meng LI
1
;
Cuilian ZHANG
1
Author Information
1. 河南省人民医院（河南大学人民医院）生殖医学中心，郑州 450003
- Publication Type:Journal Article
- Keywords:
Hormone replacement;
Frozen-thawed embryo transfer;
Endometrial thickness;
Clinical pregnancy rate;
Live birth rate
- From:
Chinese Journal of Reproduction and Contraception
2022;42(2):132-141
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical strategies to improve the clinical outcomes of patients with thin endometrium.Methods:A retrospective cohort study was conducted to analyze 1924 frozen-thawed embryo transfer (FET) cycles of 2452 patients with thin endometrium at the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2013 to December 2019. According to the type of embryos transferred, they were divided into the embryo group at cleavage stage (cleavage embryo group) and embryo group at blastocyst stage (blastocyst group). Univariate analysis, multivariate regression analysis, curve fitting and threshold effect analysis were used to compare the clinical outcomes of the cycles transferring cleavage stage embryo and blastocyst.Results:The percentage of cycles with two embryos transferred [87.17% (1298/1489)], the rate of ectopic pregnancy [3.35% (16/477)] and the rate of multiple births [23.32% (73/313)] in cleavage embryo transfer cycle were higher than those of blastocyst transfer cycle [40.71% (392/963), P<0.001; 0.76% (4/524), P=0.003; 16.27% (55/338), P=0.024]. The clinical pregnancy rate [54.41% (524/963)] and the live birth rate [35.10% (338/963)] in blastocyst transfer cycle were significantly higher than those of cleavage embryo transfer cycle [32.03% (477/1489), P<0.001; 21.02% (313/1489), P<0.001]. After adjusting for confounders, the clinical pregnancy rate ( OR=3.42, 95% CI=2.71-4.31, P<0.001) and the live birth rate ( OR=2.35, 95% CI=1.84-3.00, P<0.001) of blastocyst transfer cycle were higher than those of cleavage stage embryo transfer cycle. The results of stratified analysis showed that the clinical pregnancy rate (<6 mm: OR=2.94, 95% CI=1.32-6.51, P=0.008; 6-7 mm: OR=3.41; 95% CI=2.13-5.45, P<0.001; >7 mm: OR=3.56, 95% CI=2.67-4.74, P<0.001) and the live birth rate (<6 mm: OR=2.50, 95% CI=1.01-6.22, P=0.049; 6-7 mm: OR=2.56, 95% CI=1.56-4.21, P<0.001; >7 mm: OR=2.30, 95% CI=1.71-3.10, P<0.001) of blastocyst transfer cycle in different endometrial thickness stratifications were higher than those of cleavage stage embryo transfer cycle. The results of stratified curve fitting analysis showed that with increasing endometrial thickness among patients with thin endometrium, the clinical pregnancy rate and the live birth rate of both cleavage stage embryo cycle and blastocyst transfer cycle increased, and in all of the different endometrial thickness stratifications, the clinical pregnancy rate and the live birth rate in blastocyst transfer cycle were higher than those of cleavage embryo transfer cycle. Compared with the blastocyst transfer cycle, the slope of curve fitting between endometrial thickness and clinical pregnancy rate was larger in cleavage embryo transfer cycle. Conclusion:The clinical pregnancy rate and the live birth rate of the blastocyst transfer cycle in FET were higher than those of cleavage stage embryo transfer cycle. The increasement of endometrial thickness on the first day of progesterone administration can improve the clinical pregnancy rate and the live birth rate in patients with thin endometrium.
