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. 2020 Aug 21;18(1):89.
doi: 10.1186/s12958-020-00636-6.

Effect of endometrial thickness and embryo quality on live-birth rate of fresh IVF/ICSI cycles: a retrospective cohort study

Hong Lv  1   2 , Xiuzhu Li  1 , Jiangbo Du  1   2 , Xiufeng Ling  3 , Feiyang Diao  4 , Qun Lu  1   2 , Shiyao Tao  1   2 , Lei Huang  1   2 , Shiyao Chen  1 , Xiumei Han  1 , Kun Zhou  1 , Bo Xu  1 , Xiaoyu Liu  1 , Hongxia Ma  1   2 , Yankai Xia  1 , Hongbing Shen  1   2 , Zhibin Hu  1   2 , Guangfu Jin  5   6 , Yichun Guan  7 , Xinru Wang  8
Affiliations

Effect of endometrial thickness and embryo quality on live-birth rate of fresh IVF/ICSI cycles: a retrospective cohort study

Hong Lv et al. Reprod Biol Endocrinol. .

Abstract

Background: Successful implantation and delivery require both the functional embryo and receptive endometrium in assisted reproductive technology (ART) cycles. However, little is known about embryo-endometrial interaction on live-birth. We aimed to investigate the independent effect and interaction of endometrial thickness (EMT) and embryo quality on live-birth in fresh embryo transfer (ET) cycles.

Methods: We conducted a retrospective cohort study including 15,012 ART cycles between 2013 and 2016 in three centers in China. Poisson regression with generalized estimating equations was employed to calculate relative risks (RRs) and 95% confidence intervals (CIs). We estimated the interaction of embryo quality and EMT on live-birth rate (LBR).

Results: The LBR per cycle was 42.8% overall. LBR increased with increasing EMT and reached a plateau (50.6 to 54.2%) when EMT was 11 mm or thicker. Embryo quality represented by cumulative score was associated with LBR independently of number of embryos transferred and EMT. LBR was not increased with thicker EMT when only Q1 cleavage-stage embryo transferred (aRR 0.95, 95%CI 0.61-1.46). LBR was not increased significantly with thicker EMT with transfer of two good-quality cleavage-stage embryos and any blastocyst combination except Q1 group. There was significant interaction between EMT and embryo quality on LBR for cleavage-stage ETs (P=0.023).

Conclusions: This study demonstrated the nonlinear EMT-LBR association and the EMT cut-off value of 11 mm which may be of more clinical significance for predicting live-birth. Embryo quality is an independent prognostic tool for LBR. Our finding of significant embryo-endometrial interaction indicates combination of EMT and embryos quality might improve the prognostic value in clinical practice for live-birth in patients undergoing transfer of 1-2 fresh cleavage-stage embryos.

Keywords: Embryo quality; Endometrial thickness; IVF/ICSI; Interaction; Live-birth rate per cycle.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of included and excluded cycles
Fig. 2
Fig. 2
Adjusted relative risk for live-birth according to EMT categories. Analysis Adjusted for maternal age, maternal BMI, basal FSH, basal LH, basal T, basal PRL, duration of infertility, infertility type, male factor of infertility, anovulation factor of infertility, Gn dosage, Gn duration, cycle protocols, E2 on hCG day, year of transfer, oocytes retrieved, location of fertility centers, number of embryos transferred and embryo score. Abbreviations: LBR, live-birth rate; aRR, adjusted relative risk; CI, confidence interval
See this image and copyright information in PMC

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