Introduction
Materials and methods
Patient population and study design
Ovarian stimulation and oocyte extraction
Endometrial preparation and assessment protocol
Outcome indicators
Statistical analysis
Results
Baseline characteristics
Group1 | Group2 | P | |
---|---|---|---|
n | 421 | 999 | |
Age (y) | 32.45 ± 4.45 | 32.43 ± 4.29 | 0.343 |
Type of infertility | |||
Primary infertility (%) | 43.9% (185/421) | 40.0% (400/999) | 0.172 |
Secondary infertility (%) | 56.1% (236/421) | 60.0% (599/999) | 0.172 |
Years of infertility(y) | 3.63 ± 2.61 | 3.47 ± 2.42 | 0.120 |
Infertility factors | |||
Fallopian tube factor (%) | 98.6% (415/421) | 98.8% (987/999) | 0.730 |
Male factor (%) | 9.0% (38/421) | 9.9% (99/999) | 0.606 |
Immunological factors (%) | 0.2% (1/421) | 0.1% (1/999) | 0.528 |
Unspecified reasons (%) | 0.5% (2/421) | 0.1% (1/999) | 0.160 |
Repeated implant failure (%) | 6.7% (28/421) | 7.3% (73/999) | 0.660 |
Recurrent spontaneous abortion (%) | 0.00 | 0.6% (6/999) | 0.188 |
BMI (kg/m2) | 24.15 ± 3.80 | 24.00 ± 3.66 | 0.183 |
AMH(ng/ml) | 5.33 ± 3.20 | 5.36 ± 3.15 | 0.064 |
FSH (mIU/ml) | 6.91 ± 2.94 | 7.09 ± 2.79 | 0.844 |
LH (mIU/ml) | 6.37 ± 4.09 | 6.59 ± 4.58 | 0.690 |
E2 (pg/ml) | 36.92 ± 14.55 | 37.95 ± 12.67 | 0.182 |
P (ng/ml) | 0.38 ± 0.18 | 0.35 ± 0.18 | 0.656 |
T (ng/ml) | 0.49 ± 0.35 | 0.48 ± 0.30 | 0.577 |
Basal endometrial thickness (mm) | 5.37 ± 1.33 | 5.33 ± 1.21 | 0.130 |
Number of embryos transferred | 1.66 ± 0.47 | 1.68 ± 0.47 | 0.139 |
Number of quality embryos transferred | 0.58 ± 0.61 | 0.54 ± 0.60 | 0.806 |
Previous embryo transfer times | 0.68 ± 1.07 | 0.79 ± 1.20 | 0.285 |
Group 1A | Group 1B | Group 1C | P | |
---|---|---|---|---|
n | 185 | 95 | 141 | |
Age (y) | 32.55 ± 4.62 | 31.99 ± 4.42 | 32.62 ± 4.26 | 0.516 |
Type of infertility | ||||
Primary infertility (%) | 46.5% (86/185) | 47.4% (45/95) | 38.3% (54/141) | 0.251 |
Secondary infertility (%) | 53.5% (99/185) | 52.6% (50/95) | 61.7% (87/141) | 0.251 |
Years of infertility(y) | 3.67 ± 2.69 | 3.61 ± 2.38 | 3.60 ± 2.67 | 0.969 |
Infertility factors | ||||
Fallopian tube factor (%) | 98.9% (183/185) | 100.0% (95/95) | 97.2% (137/141) | 0.171 |
Male factor (%) | 9.2% (17/185) | 6.3% (6/95) | 10.6% (15/141) | 0.521 |
Immunological factors (%) | 0.00 | 0.00 | 0.7% (1/141) | 0.561 |
Unspecified reasons (%) | 0.00 | 0.00 | 1.4% (2/141) | 0.162 |
Repeated implant failure (%) | 7.6% (14/185) | 7.4% (7/95) | 5.0% (7/141) | 0.614 |
BMI (kg/m2) | 24.34 ± 3.73 | 23.49 ± 3.80 | 24.33 ± 3.87 | 0.158 |
AMH (ng/ml) | 5.19 ± 3.05 | 5.10 ± 3.12 | 5.68 ± 3.42 | 0.281 |
FSH (mIU/ml) | 6.87 ± 2.53 | 7.08 ± 2.77 | 6.85 ± 3.51 | 0.821 |
LH (mIU/ml) | 6.36 ± 4.34 | 6.71 ± 3.78 | 6.17 ± 3.96 | 0.608 |
E2 (pg/ml) | 37.02 ± 13.67 | 38.47 ± 17.72 | 35.76 ± 13.25 | 0.374 |
P (ng/ml) | 0.37 ± 0.18 | 0.40 ± 0.17 | 0.39 ± 0.18 | 0.316 |
T (ng/ml) | 0.48 ± 0.40 | 0.51 ± 0.30 | 0.49 ± 0.31 | 0.727 |
Basal endometrial thickness (mm) | 5.28 ± 1.17 | 5.32 ± 1.50 | 5.52 ± 1.38 | 0.248 |
Number of embryos transferred | 1.65 ± 0.48 | 1.66 ± 0.48 | 1.66 ± 0.47 | 0.928 |
Number of quality embryos transferred | 0.62 ± 0.59 | 0.59 ± 0.61 | 0.55 ± 0.62 | 0.511 |
Previous embryo transfer times | 0.63 ± 0.96 | 0.60 ± 1.12 | 0.76 ± 1.12 | 0.384 |
3A | 3B | 5A | 5B | P | |
---|---|---|---|---|---|
n | 306 | 792 | 115 | 207 | |
Age (y) | 32.55 ± 4.45 | 32.45 ± 4.26 | 32.19 ± 4.47 | 32.35 ± 4.38 | 0.884 |
Type of infertility | |||||
Primary infertility (%) | 45.1% (138/306) | 41.5% (329/792) | 40.9% (47/115) | 34.3% (71/207) | 0.110 |
Secondary infertility (%) | 54.9% (168/306) | 58.5% (463/792) | 59.1% (68/115) | 65.7% (136/207) | 0.110 |
Years of infertility (y) | 3.71 ± 2.66 | 3.55 ± 2.40 | 3.44 ± 2.48 | 3.19 ± 2.47 | 0.130 |
Infertility factors | |||||
Fallopian tube factor (%) | 98.4% (301/306) | 98.5% (780/792) | 99.1% (114/115) | 100.0% (207/207) | 0.272 |
Male factor (%) | 9.5% (29/306) | 11.1% (88/792) | 7.8% (9/115) | 5.3% (11/207) | 0.070 |
Immunological factors (%) | 0 | 0.1% (1/792) | 0.9% (1/115) | 0 | 0.286 |
Unspecified reasons (%) | 0.3% (1/306) | 0.1% (1/792) | 0.9% (1/115) | 0 | 0.231 |
Repeated implant failure (%) | 6.2% (19/306) | 7.7% (61/792) | 7.8% (9/115) | 5.8% (12/207) | 0.700 |
Recurrent spontaneous abortion (%) | 0 | 0.5% (4/792) | 0 | 1.0% (2/207) | 0.363 |
BMI (kg/m2) | 24.22 ± 3.79 | 24.08 ± 3.68 | 23.95 ± 3.84 | 23.70 ± 3.56 | 0.466 |
AMH (ng/ml) | 5.21 ± 3.21 | 5.28 ± 3.01 | 5.65 ± 3.15 | 5.67 ± 3.64 | 0.253 |
FSH (mIU/ml) | 6.90 ± 3.21 | 7.10 ± 2.42 | 6.94 ± 2.05 | 7.04 ± 3.90 | 0.750 |
LH (mIU/ml) | 6.37 ± 4.33 | 6.51 ± 4.15 | 6.38 ± 3.38 | 6.88 ± 5.96 | 0.620 |
E2 (pg/ml) | 37.10 ± 13.40 | 38.01 ± 12.69 | 36.45 ± 17.28 | 37.72 ± 12.58 | 0.560 |
P (ng/ml) | 0.38 ± 0.18 | 0.36 ± 0.18 | 0.38 ± 0.18 | 0.35 ± 0.18 | 0.083 |
T (ng/ml) | 0.49 ± 0.36 | 0.49 ± 0.31 | 0.48 ± 0.32 | 0.46 ± 0.28 | 0.693 |
Basal endometrial thickness (mm) | 5.28 ± 1.21 | 5.31 ± 1.20 | 5.60 ± 1.57 | 5.37 ± 1.25 | 0.111 |
Number of quality embryos transferred | 0.64 ± 0.63 | 0.58 ± 0.62 | 0.43 ± 0.50 | 0.39 ± 0.49 | 0.001 |
Previous embryo transfer times | 0.68 ± 1.01 | 0.76 ± 1.13 | 0.68 ± 1.22 | 0.92 ± 1.42 | 0.125 |
Cycle characteristics
Group 1 | Group 2 | P | |
---|---|---|---|
Number | 421 | 999 | |
E2 on the day of P administration start (pg/ml) | 266.83 ± 364.02 | 295.34 ± 283.83 | 0.767 |
P on the day of P administration start (ng/ml) | 0.90 ± 1.85 | 0.73 ± 0.93 | 0.006 |
EMT on the day of P administration start (mm) | 10.52 ± 1.71 | 9.55 ± 1.62 | 0.185 |
Endometrial pattern on the day of P administration start | |||
A endometrium on the day of P administration start (%) | 72.9% (307/421) | 79.5% (794/999) | 0.007 |
B endometrium on the day of P administration start (%) | 25.2% (106/421) | 20.1% (201/999) | 0.034 |
C endometrium on the day of P administration start (%) | 1.9% (8/421) | 0.4% (4/999) | 0.005 |
E2 on embryo transfer day (pg/ml) | 257.88 ± 219.15 | 316.42 ± 304.95 | 0.001 |
P on embryo transfer day (ng/ml) | 10.66 ± 6.05 | 10.54 ± 6.27 | 0.976 |
EMT on embryo transfer day (mm) | 9.11 ± 1.48 | 10.17 ± 1.67 | 0.016 |
Endometrial pattern | |||
A endometrium on embryo transfer day (%) | 1.4% (6/421) | 0.7% (7/999) | 0.190 |
B endometrium on embryo transfer day (%) | 27.8% (117/421) | 29.0% (290/999) | 0.637 |
C endometrium on embryo transfer day (%) | 70.8% (298/421) | 70.3% (702/999) | 0.846 |
Days of estrogen administration before P | 11.93 ± 3.34 | 11.85 ± 3.32 | 0.644 |
Group 1A | Group 1B | Group 1C | P | |
---|---|---|---|---|
Number | 185 | 95 | 141 | |
E2 on the day of P administration start (pg/ml) | 292.61 ± 365.65* | 307.85 ± 510.54* | 205.37 ± 202.44 | 0.046 |
P on the day of P administration start (ng/ml) | 0.89 ± 2.42 | 0.90 ± 1.21 | 0.91 ± 1.23 | 0.998 |
EMT on the day of P administration start (mm) | 10.12 ± 1.57** | 10.45 ± 1.77** | 11.11 ± 1.70 | 0.001 |
Endometrial pattern on the day of P administration start | ||||
A endometrium on the day of P administration start (%) | 75.1% (139/185) | 72.6% (69/95) | 70.2% (99/141) | 0.610 |
B endometrium on the day of P administration start (%) | 24.3% (45/185) | 25.3% (42/95) | 26.2% (37/141) | 0.925 |
C endometrium on the day of P administration start (%) | 0.5% (1/185) | 2.1% (2/95) | 3.5% (5/141) | 0.110 |
E2 on embryo transfer day (pg/ml) | 284.78 ± 219.74 | 245.72 ± 228.34 | 230.78 ± 209.31 | 0.073 |
P on embryo transfer day (ng/ml) | 10.64 ± 6.20 | 10.99 ± 5.74 | 10.47 ± 6.09 | 0.811 |
EMT on embryo transfer day (mm) | 9.44 ± 1.47** | 9.21 ± 1.54** | 8.61 ± 1.34 | 0.001 |
Endometrial pattern | ||||
A endometrium on embryo transfer day (%) | 1.6% (3/185) | 1.1% (1/95) | 1.4% (2/141) | 0.999 |
B endometrium on embryo transfer day (%) | 23.2% (43/185) | 29.5% (28/95) | 32.6% (46/141) | 0.159 |
C endometrium on embryo transfer day (%) | 75.1% (139/185) | 69.5% (66/95) | 66.0% (93/141) | 0.186 |
Days of estrogen administration before P | 11.98 ± 3.28 | 11.80 ± 3.52 | 11.94 ± 3.31 | 0.909 |
3A | 3B | 5A | 5B | P | |
---|---|---|---|---|---|
n | 306 | 792 | 115 | 207 | |
E2 on day of start P administration (pg/ml) | 258.38 ± 369.29 | 291.83 ± 275.06 | 289.30 ± 350.19 | 308.73 ± 315.50 | 0.281 |
P on day of start P administration (ng/ml) | 0.94 ± 2.08 | 0.71 ± 0.84 | 0.79 ± 1.00 | 0.79 ± 1.23 | 0.067 |
Endometrial thickness on day of start P administration (mm) | 10.60 ± 1.75 | 9.60 ± 1.65 | 10.31 ± 1.59 | 9.41 ± 1.52 | 0.001 |
Endometrial pattern on day of start P administration | |||||
A endometrium on the day of P administration start (%) | 74.8% (229/306) | 80.2% (635/792) | 67.8% (78/115) | 76.8% (159/207) | 0.013 |
B endometrium on the day of P administration start (%) | 24.2% (74/306) | 19.6% (155/792) | 27.8% (32/115) | 22.2% (46/207) | 0.121 |
C endometrium on the day of P administration start (%) | 1.0% (3/306) | 0.3% (2/792) | 4.3% (5/115) | 1.0% (2/207) | 0.001 |
E2 on embryo transfer day (pg/ml) | 257.68 ± 209.40 | 322.34 ± 314.42* | 258.43 ± 244.19 | 293.74 ± 265.10 | 0.002 |
P on embryo transfer day (ng/ml) | 10.81 ± 5.92 | 10.60 ± 6.50 | 10.27 ± 6.40 | 10.27 ± 5.26 | 0.739 |
Endometrial thickness on embryo transfer day (mm) | 9.19 ± 1.50 | 10.15 ± 1.68** | 8.90 ± 1.43 | 10.28 ± 1.67 | 0.001 |
Endometrial pattern | |||||
A endometrium on embryo transfer day (%) | 1.3% (4/306) | 0.8% (6/792) | 1.7% (2/115) | 0.5% (1/207) | 0.378 |
B endometrium on embryo transfer day (%) | 26.1% (80/306) | 28.2% (223/792) | 32.2% (37/115) | 32.4% (67/207) | 0.364 |
C endometrium on embryo transfer day (%) | 72.5% (222/306) | 71.1% (563/792) | 66.1% (76/115) | 67.1% (139/207) | 0.396 |
Days of estrogen administration before P | 11.97 ± 3.34 | 11.84 ± 3.30 | 11.80 ± 3.34 | 11.88 ± 3.40 | 0.940 |
Comparison of pregnancy outcomes
Relationship between clinical pregnancy outcomes and endometrial compaction
aOR | 95% confidence interval | P | |
---|---|---|---|
Age | 0.960 | [0.935, 0.986] | 0.003 |
BMI | 0.999 | [0.971, 1.029] | 0.962 |
AMH | 1.066 | [1.026, 1.107] | 0.001 |
Number of high-quality embryos transferred | 1.278 | [1.062, 1.539] | 0.009 |
Total number of embryos transferred | 1.355 | [1.066, 1.722] | 0.013 |
Groups | |||
Group 1 | 1.000 (reference) | ||
Group 2 | 0.617 | [0.488, 0.779] | 0.001 |