Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles

Liu, Hongfang; Zhang, Jie; Wang, Bian; Kuang, Yanping

doi:10.1016/j.fertnstert.2019.09.003

Cited by 46 publications

(64 citation statements)

References 53 publications

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“…In AC-FET cycles, EMT was recorded from the last ultrasound scan before starting P administration. The maximum distance between two outer edges in the endometrial image of a longitudinal section of the uterus observed by vaginal ultrasound was used to measure (12).…”

Section: Observational Indicators and Main Cycle Outcomesmentioning

confidence: 99%

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

2020

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Background: Nowadays, the choice of frozen embryo transfer (FET) regimens is mainly guided by personal convenience. Clinicians prefer the predictability and reliability of artificial cycle (AC) FET and have extended its usage to general in vitro fertilization population. More recent primary studies are beginning to challenge the comparability of AC-FET and suggest reduced clinical pregnancy rate and live birth rate (LBR) compared with those in modified natural cycle (mNC) FET (ovulation triggered by human chorionic gonadotrophin) and stimulated cycle (SC) FET. Objective: To assess the pregnancy outcomes within matched mNC-FET, SC-FET, and AC-FET cycles by using propensity score matching (PSM) in a larger cohort. Methods: A total of 16,946 women who underwent their first autologous FET cycle between July 2014 and July 2017 were evaluated. PSM, using the nearest neighbor matching, were established to adjust the baseline features within the three protocols in proportion of 1:1 (mNC-FET vs. SC-FET, mNC-FET vs. AC-FET, SC-FET vs. AC-FET). Furthermore, there were 3,567, 2,917, and 3,964 cycles compared between matched mNC-FET and SC-FET, mNC-FET and AC-FET, and SC-FET and AC-FET after the PSM, respectively. Results: LBR was significant lower in the AC-FET group than that in the mNC-FET (40.0 vs. 43.3%) and SC-FET groups (40.9 vs. 46.5%). The adjusted odds ratios (95% CIs) were 1.11 (1.00, 1.24) for mNC/AC (P = 0.044) and 0.84 (0.76, 0.92) for AC/SC (P < 0.001), which indicated that the AC-FET group was associated with lowest LBR. The LBR was comparable between matched mNC-FET and SC-FET after adjusting for endometrial thickness. Moreover, a lower clinical pregnancy rate and a higher risk of early pregnancy loss were discovered in AC-FET cycles compared with those in SC-FET. Conclusion: In view of our data, AC used for scheduling FET was associated with lower LBR compared with SC and modified natural cycle. This interpretation requires Wang et al. Abnormal Implantation in AC future verification from well-designed prospective multicenter randomized clinical trials, although the comparisons in our study were conducted in the homogenous population after the PSM.

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Section: Observational Indicators and Main Cycle Outcomesmentioning

confidence: 99%

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

2020

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“…In recent years, ultrasonic parameters, molecular markers in endometrial tissue and uterine secretions, endometrial microstructure, and hysteroscopy have been applied to evaluate endometrial receptivity ( 8 ). The preferred method for assessing endometrial receptivity is transvaginal ultrasound, and multiple ultrasonic indicators have been used to assess endometrial receptivity ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Wang

et al. 2021

Front. Endocrinol.

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ObjectiveNumerous studies have reported on ovulation and pregnancy rates in patients with polycystic ovary syndrome (PCOS). However, relevant data on endometrial receptivity are limited. This study was conducted to compare endometrial receptivity during implantation windows among letrozole (LE), clomiphene citrate (CC), and natural cycle, and to assess the predictive value for pregnancy of observed indicators.MethodsThis randomized controlled trial study enrolled 270 patients with PCOS. Patients were given LE (n=90) at a dose of 2.5mg/day or CC (n=90) at a dose of 50 mg/day on cycle days 5–9 for ovulation induction. Patients in the natural cycle group (n=90) did not receive any drug for ovulation induction. Endometrial ultrasonic parameters, integrin αvβ3, and vascular endothelial growth factor (VEGF) concentrations in uterine secretion were detected during the implantation window. The endometrial receptivity, ovulation rate, pregnancy rates, and predictive value of observed indicators for pregnancy were analyzed.ResultsThe successful ovulation rate did not differ between the LE group and CC group (P>0.05). Endometrial ultrasonic parameters [endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), vascularization flow index (VFI)], integrin αvβ3, and VEGF concentrations in uterine fluid were significantly higher in the LE group compared with the CC group and natural cycle group (P<0.05). The clinical pregnancy and ongoing pregnancy rates of the LE group were significantly higher than in the CC group (P<0.05). Endometrial ultrasonic parameters (VI, FI, and VFI), integrin αvβ3, and VEGF concentrations in uterine fluid of all pregnancy groups were significantly higher compared with the no pregnancy group (P<0.05), and the above parameters in ongoing pregnancy were significantly higher than in biochemical pregnancy (P<0.05). The endometrial FI during the implantation window had the highest predictive value for pregnancy (AUC=0.889). The integrin αvβ3 in uterine fluid had better predictive value (AUC=0.876) than VEGF.ConclusionsEndometrial receptivity during the implantation window of LE is superior to CC in PCOS women, which may be related to higher clinical pregnancy and ongoing pregnancy rates. Endometrial FI examined by 3-D power Doppler, and integrin αvβ3 in uterine secretion during the implantation window, could be preferable non-invasive predictor markers for pregnancy.Clinical Trial Registrationwww.chictr.org.cn, ChiCTR1900023423.

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“…At present, ultrasonic imaging and expression of related biochemical markers in endometrium have been used to assess endometrial receptivity [5]. Transvaginal ultrasound is the first-line method to observe follicular development and endometrial growth because of its noninvasive characteristics, and ultrasonic parameters, including endometrial thickness, classification and blood flow, have been confirmed to reflect endometrial receptivity [6,7]. This study aimed to assess ovarian reserve function, follicular development and endometrial receptivity in older women and to evaluate the predictive value for endometrial receptivity of different ultrasonic parameters during the implantation window.…”

Section: Introductionmentioning

confidence: 99%

Fecundity disorders in older women: declines in follicular development and endometrial receptivity

Wang

Mao

et al. 2020

BMC Women's Health

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Background: Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods: For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results: The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions: Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.

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Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles

Abstract: Objective: To investigate whether endometrial thickness (EMT) influences the incidence of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. Design: Retrospective cohort study. Setting: Academic tertiary-care medical center.

Cited by 46 publications

References 53 publications

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

Pregnancy Outcomes After Different Cycle Regimens for Frozen-Thawed Embryo Transfer: A Retrospective Study Using Propensity Score Matching

Letrozole Versus Clomiphene Citrate and Natural Cycle: Endometrial Receptivity During Implantation Window in Women With Polycystic Ovary Syndrome

Fecundity disorders in older women: declines in follicular development and endometrial receptivity

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