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. 2021 May;9(10):856.
doi: 10.21037/atm-21-1922.

Thicker endometrium on hCG trigger day improves the live birth rate of fresh cleavage embryo transfer in GnRH-agonist regimen of normogonadotrophic women

Xi Luo  1   2   3   4 , Yunxiu Li  1   2 , Haishan Zheng  1   2 , Lei Ding  1   2 , Manqin Zhang  1   2 , Yonggang Li  1   2 , Ze Wu  1   2
Affiliations

Thicker endometrium on hCG trigger day improves the live birth rate of fresh cleavage embryo transfer in GnRH-agonist regimen of normogonadotrophic women

Xi Luo et al. Ann Transl Med. 2021 May.

Abstract

Background: Luteinizing hormone (LH) and progesterone (PROG) on human chorionic gonadotropin (hCG) trigger day are significantly correlated with assisted reproductive technology (ART) outcome. Moreover, LH and PROG are also involved in the functional preparation of the endometrium during the implantation window; however, whether they are related to endometrial thickness (EMT) is still unknown. The aim of the present study was to assess whether EMT has a positive correlation on the live birth rate following fresh embryo transfer (ET), and whether LH and PROG have an impact on EMT.

Methods: A total of 2,260 normogonadotrophic women were treated with a GnRH agonist for in vitro fertilization (IVF)/intracytoplasmic sperm injection. Patients with advanced age and poor ovarian reserve were excluded. The levels of LH, PROG, and EMT on the hCG trigger day were divided into binary variables, respectively, by the cutoff values, and which were obtained based on receiver operating characteristic curve analysis of live birth among LH, PROG and EMT levels on the hCG trigger day, respectively. Multivariate binary logistic regression was used to confirm the role of LH, PROG, and EMT on the live birth, and stratified analysis was used to determine whether LH and PROG have an impact on EMT.

Results: EMT and LH were protective factors for live births, with odds ratios (OR) of 1.11 [95% confidence interval (CI): 1.066-1.157] and 1.696 (95% CI: 1.345-2.139), respectively. However, PROG was a risk factor for live birth, with an OR of 0.635 (95% CI: 0.526-0.766). The hierarchical cross-table analysis indicated that EMT had no significant difference for live birth in the combination of low LH and high PROG group. In the other subgroups, thick EMT was associated with a higher live birth rate (P<0.05).

Conclusions: On hCG trigger day, EMT, LH, and PROG all were independent factors that affected the live birth of fresh ETs. Thick EMT can significantly increase the live birth rate. However, multivariate logistic regression analysis showed that EMT does not affect the live birth rate in combination of low LH and high PROG environment.

Keywords: Live birth rate; endometrial thickness (EMT); in vitro fertilization (IVF); luteinizing hormone (LH); progesterone (PROG).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-21-1922). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Box and whisker plot analysis of the luteinizing hormone (LH), progesterone (PROG), and endometrial thickness (EMT) on human chorionic gonadotropin (hCG) trigger day between the groups of live birth and no live birth. Box chart represents the 25th–75th percentiles. Middle line represents the median. whisker represent 10–90 percentile. ****P<0.0001.
Figure 2
Figure 2
Correlation analysis between luteinizing hormone (LH), progesterone (PROG), or endometrial thickness (EMT) and live birth on the receiver-operating characteristic (ROC) curve. LH and EMT had a positive correlation with live birth, and PROG had a negative correlation. AUC, area under the curve; CI, confidence interval.
Figure 3
Figure 3
Adjusted odds ratio (95% confidence interval) (thick versus thin in EMT) for live births in stratified groups of luteinizing hormones (LH) and progesterone (PROG) on human chorionic gonadotropin (hCG) trigger day.
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