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

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 cutoff 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.

The Effect of Endometrial Thickness on Pregnancy, Maternal, and Perinatal Outcomes of Women in Fresh Cycles After IVF/ICSI: A Systematic Review and Meta-Analysis

“…Hence, sensitivity analysis was conducted to detect the stability of result by removing each study and reanalyzing the remaining studies, which did not change the direction of the effect. When one study (21) was excluded, the substantial heterogeneity was decreased (I 2 declined from 62 to 0%). Women with thick endometrium (EMT >14 mm), had no significant higher LBR than those with medium EMT (7-14 mm) in fresh cycles (OR 1.08, 95%CI: 0.68, 1.72, P = 0.74, low heterogeneity: I 2 = 29%) (Figure 2B).…”

“…Similarly, this study was only for systematic review as well (20). Therefore, 22 studies were included for final meta-analysis (5,7,11,13,16,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37).…”

Postoperative pregnancy outcome prediction model based on 3-dimensional ultrasound for intrauterine adhesion

“…In this study, patients with a wider intercornual distance (greater endometrial volume) were more likely to have a favorable pregnancy outcome (P = 0.0000). Some studies have reported a significant correlation between endometrial thickness and pregnancy rate [27,28]. A thin endometrium, usually associated with reduced blood flow, may fail to respond to hormone stimulation, leading to implantation failure or early miscarriage [29].…”

Investigating the correlation between AMH and the number of high-quality embryos from IVF/ICSI in 30-44 year-old infertile women

“…The studies from Lv Hong and Chen Shiping both showed that embryo quality and quantity are the main predictors for successful implantation and live birth [14,15]. Therefore, embryo quality is also critical for the outcome of ART [16,17].…”