Background
Methods
Study design and subject screening
Ovarian stimulation
Embryo culture
Definition of clinical outcomes
Statistical analysis
Results
Patient characteristics
PCOS | P-value | Tubal | P-value | |||||
---|---|---|---|---|---|---|---|---|
n = 242 | n = 1422 | |||||||
D3 | D4 | D5 | D3 | D4 | D5 | |||
Cycles | 81 | 117 | 44 | 486 | 768 | 168 | ||
Age (years) | 28.46 ± 3.97 | 29.00 ± 3.97 | 28.25 ± 3.50 | 0.421 | 30.26 ± 4.08* | 30.83 ± 3.86** | 30.01 ± 4.19 | 0.009 |
Type of infertility | 0.100 | 0.317 | ||||||
Primary | 69.14(56/81) | 59.83(70/117) | 72.73(32/44) | 27.78(135/486) | 26.95(207/768) | 32.74(55/168) | ||
Secondary | 30.86(25/81) | 40.17(47/117) | 27.27(12/44) | 72.22(351/486) | 73.05(561/768) | 67.26(113/168) | ||
Infertility duration (year) | 4.32 ± 2.93 | 4.63 ± 2.76 | 5.30 ± 2.98 | 0.192 | 3.48 ± 2.54 | 3.85 ± 2.90 | 3.52 ± 2.78 | 0.050 |
BMI (kg/m2) | 25.06 ± 3.10 | 25.71 ± 3.16 | 25.96 ± 2.92 | 0.217 | 23.37 ± 3.08 | 23.77 ± 3.21 | 23.60 ± 2.94 | 0.089 |
FSH (mIU/mL) | 6.01 ± 1.66 | 6.15 ± 1.79 | 5.93 ± 1.45 | 0.734 | 6.72 ± 2.25 | 6.71 ± 2.28 | 6.57 ± 1.70 | 0.730 |
AMH (ng/ mL) | 7.55 ± 4.82 | 7.77 ± 3.92 | 7.91 ± 3.20 | 0.884 | 3.21 ± 2.12* | 3.80 ± 2.28 | 3.93 ± 2.22*** | 0.000 |
Clinical characteristics and outcomes
PCOS | P-value | Tubal factor Infertility | P-value | |||||
---|---|---|---|---|---|---|---|---|
n = 242 | n = 1422 | |||||||
D3 | D4 | D5 | D3 | D4 | D5 | |||
Cycles | 81 | 117 | 44 | 486 | 768 | 168 | ||
Gn(day) | 11.84 ± 2.80 | 11.88 ± 2.91 | 11.41 ± 2.71 | 0.628 | 11.60 ± 1.61 | 11.59 ± 1.82 | 11.63 ± 1.46 | 0.954 |
Gn amount (IU) | 2076.85 ± 767.48* | 2530.41 ± 1016.26** | 2114.77 ± 932.45 | 0.001 | 2511.86 ± 697.67 | 2537.42 ± 740.79 | 2451.04 ± 654.43 | 0.356 |
Number of oocytes | 14.68 ± 5.06 | 13.87 ± 4.80** | 16.98 ± 5.92*** | 0.003 | 11.44 ± 5.25* | 12.64 ± 4.73** | 14.63 ± 5.37*** | 0.000 |
Fertilization method | 0.500 | 0.775 | ||||||
IVF | 66.67(54/81) | 65.81(77/117) | 56.82(25/44) | 81.48(396/486) | 82.03(630/768) | 83.93(141/168) | ||
ICSI | 33.33(27/81) | 34.19(40/117) | 43.18(19/44) | 18.52(90/486) | 17.97(138/768) | 16.07(27/168) | ||
Available embryo rate, % | 43.86(325/741) | 42.61(496/1164) | 43.62(236/541) | 0.846 | 45.00(1599/3553) | 46.59(3222/6915) | 46.02(873/1897) | 0.303 |
E2 of HCG (pg/mL) | 3276.37 ± 1569.93 | 3141.89 ± 1363.39** | 3884.80 ± 1351.19*** | 0.014 | 2958.84 ± 1603.28* | 3142.54 ± 1436.51** | 3726.75 ± 1599.49*** | 0.000 |
P of HCG (ng/mL) | 0.64 ± 0.31 | 0.59 ± 0.22 | 0.63 ± 0.25 | 0.351 | 0.81 ± 0.31 | 0.79 ± 0.27 | 0.83 ± 0.30 | 0.216 |
Endometrium thickness(mm) | 10.49 ± 2.19* | 11.82 ± 2.10** | 11.37 ± 2.07*** | 0.000 | 11.29 ± 2.22 | 11.43 ± 2.14 | 11.7 ± 2.21 | 0.106 |
No. Of embryos per ET cycle | 2.00 ± 0.00* | 1.71 ± 0.46** | 1.55 ± 0.50*** | 0.000 | 1.98 ± 0.16* | 1.72 ± 0.45** | 1.57 ± 0.50*** | 0.000 |
Pregnancy rate, % | 51.85(42/81)* | 76.92(90/117)** | 61.36(27/44) | 0.001 | 60.91(296/486) | 63.02(484/768) | 61.31(103/168) | 0.735 |
Implantation rate, % | 35.19(57/162)* | 60(120/200) | 55.88(38/68)*** | 0.000 | 41.88(402/960)* | 49.01(646/1318) | 53.41(141/264)*** | 0.000 |
Ectopic pregnancy rate, % | 4.76(2/42) | 1.11(1/90) | 3.70(1/27) | 0.418 | 1.69(5/296) | 0.41(2/484) | 1.94(2/103) | 0.139 |
Miscarriage rate, % | 35.71(15/42)* | 13.33(12/90) | 25.93(7/27) | 0.011 | 15.54(46/296) | 14.46(70/484) | 16.50(17/103) | 0.837 |
Multiple pregnancy rate, % | 35.71(15/42) | 33.33(30/90) | 40.74(11/27) | 0.777 | 35.47(105/296) | 33.26(161/484) | 36.89(38/103) | 0.701 |
Live birth rate, % | 32.10(26/81)* | 65.81(77/117)** | 43.18(19/44) | 0.000 | 50.41(245/486) | 53.65(412/768) | 50.00(84/168) | 0.452 |
Subgroup analysis
PCOS | P-value | Tubal factor Infertility | P-value | |||||
---|---|---|---|---|---|---|---|---|
n = 170 | n = 705 | |||||||
D3 | D4 | D5 | D3 | D4 | D5 | |||
Cycles | 58 | 80 | 32 | 257 | 351 | 97 | ||
Age (years) | 26.48 ± 2.50 | 27.11 ± 2.63 | 26.56 ± 2.21 | 0.295 | 27.06 ± 2.31 | 27.42 ± 2.40 | 27.06 ± 2.66 | 0.137 |
Infertility duration (year) | 3.79 ± 1.86 | 4.15 ± 2.13 | 4.38 ± 2.46 | 0.885 | 3.17 ± 2.01 | 3.34 ± 2.14 | 3.39 ± 2.56 | 0.550 |
BMI (kg/m2) | 25.05 ± 3.14 | 25.25 ± 3.10 | 25.56 ± 3.04 | 0.648 | 23.26 ± 3.25 | 23.55 ± 3.34 | 23.50 ± 3.21 | 0.549 |
Endometrium thickness(mm) | 10.43 ± 2.08* | 11.84 ± 2.01 | 11.05 ± 1.94 | 0.000 | 11.28 ± 2.16 | 11.48 ± 2.05 | 11.69 ± 2.26 | 0.216 |
Pregnancy rate, % | 46.55(27/58)* | 78.75(63/80) | 62.50(20/32) | 0.000 | 62.26(160/257) | 66.10(232/351) | 68.04(66/97) | 0.489 |
Implantation rate, % | 31.90(37/116)* | 60.87(84/138) | 56.25(27/48)*** | 0.000 | 44.34(227/512)* | 51.72(315/609) | 57.05(89/156)*** | 0.006 |
Ectopic pregnancy rate, % | 7.41(2/27) | 1.59(1/63) | 5.00(1/20) | 0.376 | 2.50(4/160) | 0.86(2/232) | 1.52(1/66) | 0.430 |
Miscarriage rate, % | 29.63(8/27)* | 7.94(5/63) | 20.00(4/20) | 0.027 | 16.88(27/160) | 14.66(34/232) | 15.15(10/66) | 0.834 |
Multiple pregnancy rate, % | 37.04(10/27) | 33.33(21/63) | 35.00(7/20) | 0.943 | 41.25(66/160) | 35.34(82/232) | 34.85(23/66) | 0.446 |
Live birth rate, % | 31.03(18/58)* | 71.25(57/80)** | 46.88(15/32) | 0.000 | 50.19(129/257) | 55.84(196/351) | 56.70(55/97) | 0.323 |
PCOS | P-value | Tubal factor Infertility | P-value | |||||
---|---|---|---|---|---|---|---|---|
n = 72 | n = 717 | |||||||
D3 | D4 | D5 | D3 | D4 | D5 | |||
Cycles | 23 | 37 | 12 | 229 | 417 | 71 | ||
Age (years) | 33.86 ± 2.20 | 33.70 ± 2.12 | 34.04 ± 1.91 | 0.383 | 33.43 ± 2.25 | 33.08 ± 1.62 | 32.75 ± 1.91 | 0.578 |
Infertility duration (year) | 3.82 ± 2.99 | 4.28 ± 3.35 | 3.70 ± 3.06 | 0.136 | 5.65 ± 4.43 | 5.68 ± 3.60 | 7.75 ± 2.93 | 0.228 |
BMI (kg/m2) | 23.50 ± 2.87 | 23.96 ± 3.09 | 23.74 ± 2.56 | 0.169 | 25.10 ± 3.08 | 26.71 ± 3.10 | 27.03 ± 2.39 | 0.086 |
Endometrium thickness(mm) | 10.59 ± 2.38 | 11.76 ± 2.23 | 12.23 ± 2.24 | 0.084 | 11.26 ± 2.29 | 11.35 ± 2.24 | 11.60 ± 2.26 | 0.550 |
Pregnancy rate, % | 65.22(15/23) | 72.97(27/37) | 58.33(7/12) | 0.601 | 59.39(136/229) | 60.43(252/417) | 52.11(37/71) | 0.419 |
Implantation rate, % | 43.48(20/46) | 58.06(36/62) | 55.00(11/20) | 0.314 | 39.06(175/448)* | 46.69(331/709) | 48.15(52/108) | 0.027 |
Ectopic pregnancy rate, % | 0.00(0/15) | 0.00(0/27) | 0.00(0/7) | -- | 0.74(1/136) | 0.00(0/252) | 2.70(1/37) | 0.070 |
Miscarriage rate, % | 46.67(7/15) | 25.93(7/27) | 42.86(3/7) | 0.355 | 13.97(19/136) | 14.29(36/252) | 18.92(7/37) | 0.735 |
Multiple pregnancy rate, % | 33.33(5/15) | 33.33(9/27) | 57.14(4/7) | 0.481 | 28.68(39/136) | 31.35(79/252) | 40.54(15/37) | 0.386 |
Live birth rate, % | 34.78(8/23) | 54.05(20/37) | 33.33(4/12) | 0.240 | 50.66(116/229) | 51.80(216/417) | 40.85(29/71) | 0.232 |
PCOS | P-value | Tubal factor Infertility | P-value | |||||
---|---|---|---|---|---|---|---|---|
n = 242 | n = 1422 | |||||||
≤ 10 oocytes | D3 | D4 | D5 | D3 | D4 | D5 | ||
Cycles | 17 | 33 | 5 | 231 | 287 | 39 | ||
Pregnancy rate, % | 35.29(6/17) | 60.61(20/33) | 60.00(3/5) | 0.178 | 60.17(139/231) | 63.76(183/287) | 51.28(20/39) | 0.285 |
Implantation rate, % | 23.53(8/34)* | 50.00(28/56) | 57.14(4/7) | 0.032 | 40.18(182/453) | 47.64(242/508) | 45.76(27/59) | 0.065 |
Live birth rate, % | 29.41(5/17) | 54.55(18/33)** | 0.00(0/5) | 0.032 | 51.08(118/231) | 53.31(153/287) | 38.46(15/39) | 0.219 |
11–15 oocytes | ||||||||
Cycles | 29 | 41 | 18 | 156 | 277 | 66 | ||
Pregnancy rate, % | 58.62(17/29) | 75.61(31/41) | 55.56(10/18) | 0.196 | 62.18(97/156) | 61.01(169/277) | 68.18(45/66) | 0.557 |
Implantation rate, % | 43.10(25/58) | 61.11(44/72) | 53.57(15/28) | 0.123 | 42.07(130/309) | 47.33(230/486)** | 58.18(64/110)*** | 0.014 |
Live birth rate, % | 27.59(8/29)* | 65.85(27/41) | 38.89(7/18) | 0.005 | 47.44(74/156) | 52.35(145/277) | 60.61(40/66) | 0.195 |
16–20 oocytes | ||||||||
Cycles | 25 | 34 | 9 | 70 | 161 | 40 | ||
Pregnancy rate, % | 52.00(13/25)* | 91.18(31/34) | 77.78(7/9) | 0.003 | 70.00(49/70) | 69.57(112/161) | 55.00(22/40) | 0.186 |
Implantation rate, % | 32.00(16/50)* | 65.52(38/58) | 75.00(12/16)*** | 0.000 | 52.86(74/140) | 55.30(146/264) | 49.15(29/59) | 0.669 |
Live birth rate, % | 36.00(9/25)* | 73.53(25/34) | 55.56(5/9) | 0.016 | 60.00(42/70) | 60.87(98/161) | 40.00(16/40) | 0.051 |
>20 oocytes | ||||||||
Cycles | 10 | 9 | 12 | 29 | 43 | 23 | ||
Pregnancy rate, % | 60.00(6/10) | 88.89(8/9) | 58.33(7/12) | 0.272 | 37.93(11/29) | 46.51(20/43) | 69.57(16/23) | 0.067 |
Implantation rate, % | 40.00(8/20) | 71.43(10/14) | 41.18(7/17) | 0.144 | 27.59(16/58)* | 46.67(28/60) | 58.33(21/36)*** | 0.009 |
Live birth rate, % | 40.00(4/10) | 77.78(7/9) | 58.33(7/12) | 0.249 | 37.93(11/29) | 37.21(16/43) | 56.52(13/23) | 0.274 |
D3 | P-value | D4 | P-value | D5 | P-value | ||||
---|---|---|---|---|---|---|---|---|---|
n = 100 | n = 271 | n = 97 | |||||||
PCOS | Tubal factor | PCOS | Tubal factor | PCOS | Tubal factor | ||||
Cycles | 22 | 78 | 54 | 217 | 27 | 70 | |||
Age (years) | 25.64 ± 2.52 | 26.13 ± 2.05 | 0.365 | 26.94 ± 2.82 | 27.24 ± 2.49 | 0.457 | 26.30 ± 2.16 | 27.21 ± 2.59 | 0.106 |
Infertility duration (year) | 4.45 ± 2.18 | 2.55 ± 1.64 | 0.000 | 3.98 ± 1.95 | 3.31 ± 2.06 | 0.028 | 3.93 ± 2.38 | 3.23 ± 2.02 | 0.151 |
BMI (kg/m2) | 24.95 ± 3.33 | 22.90 ± 3.35 | 0.015 | 25.41 ± 3.02 | 23.49 ± 3.25 | 0.000 | 25.58 ± 3.12 | 23.57 ± 3.21 | 0.007 |
Endometrium thickness(mm) | 9.97 ± 2.05 | 10.93 ± 2.27 | 0.085 | 12.08 ± 2.00 | 11.58 ± 1.98 | 0.093 | 11.14 ± 2.07 | 11.85 ± 2.09 | 0.139 |
Pregnancy rate, % | 54.55(12/22) | 70.51(55/78) | 0. 160 | 83.33(45/54) | 70.51(153/217) | 0.057 | 62.96(17/27) | 70.00(49/70) | 0.505 |
Implantation rate, % | 40.91(18/44) | 55.13(86/156) | 0.095 | 72.09(62/86) | 59.25(205/346) | 0.028 | 57.89(22/38) | 61.68(66/107) | 0.681 |
Ectopic pregnancy rate, % | 16.67(2/12) | 1.82(1/55) | 0.080 | 2.22(1/45) | 0.65(1/153) | 0.355 | 5.88(1/17) | 2.04(1/49) | 0.426 |
Miscarriage rate, % | 33.33(4/12) | 16.36(9/55) | 0 0.228 | 8.89(4/45) | 16.99(26/153) | 0.183 | 17.65(3/17) | 14.29(7/49) | 0.739 |
Multiple pregnancy rate, % | 50.00(6/12) | 56.36(31/55) | 0.688 | 37.78(17/45) | 33.99(52/153) | 0.639 | 29.41(5/17) | 34.69(17/49) | 0.691 |
Live birth rate, % | 31.82(7/22) | 57.69(45/78) | 0. 032 | 74.07(40/54) | 58.06(126/217) | 0.031 | 48.15(13/27) | 58.57(41/70) | 0.354 |
OR | 95%CI | P-value | OR | 95%CI | P-value | ||||
---|---|---|---|---|---|---|---|---|---|
PCOS | Crude | Tubal | Crude | ||||||
D5 | 1.000 | D5 | 1.000 | ||||||
D4 | 2.533 | 1.247–5.143 | 0.010 | D4 | 1.157 | 0.829–1.616 | 0.319 | ||
D3 | 0.622 | 0.292–1.326 | 0.219 | D3 | 1.017 | 0.716–1.444 | 0.927 | ||
Adjusted | Adjusted | ||||||||
D5 | 1.000 | D5 | 1.000 | ||||||
D4 | 3.328 | 1.532–7.229 | 0.002 | D4 | 1.194 | 0.851–1.675 | 0.304 | ||
D3 | 0.679 | 0.300-1.535 | 0.352 | D3 | 1.032 | 0.721–1.478 | 0.863 |