Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study

Abstract

The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.

Fig 1. Interval of HSC-P to FET and biochemical pregnancy.

Scatter plot of the intervals between HSC-P and FET, stratified by biochemical pregnancy outcome (A). The ROC curve for the probability of achieving chemical pregnancy at each different interval between HSC-P and FET (B). The point with the greatest trade-off between sensitivity and specificity, as determined by the Youden index, is at an interval of 120 days (AUC = 0.585, SE = 0.063, 95% CI from 0.462 to 0.708).

Fig 2. Pregnancy outcomes of frozen-thawed blastocyst transfer grouped by a cutoff of 120 days between HSC-P and FET.

There is a significant increase in biochemical pregnancy rate and clinical pregnancy rate in those who received FBT within 120 days. ** P< .01; * P< .05.