Abstract
ObjectiveTo investigate the impact of luteinized unruptured follicles (LUF) on clinical outcomes of frozen/thawed embryo transfer (FET) of blastocysts.MethodsIn this retrospective cohort study, 2,192 patients who had undergone blastocyst FET treatment with natural cycles from October 2014 to September 2017 were included. Using propensity score matching, 177 patients diagnosed with LUF (LUF group) were matched with 354 ovulating patients (ovulation group). The LUF group was further stratified by the average LH peak level of 30 IU/L. Clinical pregnancy rate and live birth rate were retrospectively analyzed between the LUF and ovulation groups, as well as between LUF subgroups.ResultsAfter propensity score matching, general characteristics were similar in the LUF and ovulation groups. Clinical pregnancy rate in the LUF group was significantly lower than that in the ovulation group (47.46 vs. 58.76%, respectively, adjusted P = 0.01, OR 0.60, 95% CI 0.42–0.87). However, no significant difference was detected in live birth rate, although it was lower in the LUF group (43.50 vs. 50.00%, adjusted P = 0.19, OR 0.76, 95% CI 0.51–1.14). In the LUF subgroup analysis, both clinical pregnancy rate (43.02 vs. 62.30%, adjusted P = 0.02, OR 0.45, 95% CI 0.23–0.87) and live birth rate (37.21 vs. 59.02%, adjusted P = 0.01, OR 0.40, 95% CI 0.20–0.78) in the LH <30 IU/L subgroup were significantly lower than those in the LH ≥30 IU/L subgroup.ConclusionLUF negatively affected clinical outcomes of frozen/thawed embryo transfer of blastocysts, particularly when the LH surge was inadequate.
Highlights
With the increasing application of assisted reproductive technology (ART) worldwide, the advantages and disadvantages of various methods related to ART have been widely discussed [1]
After propensity score matching, general characteristics were similar in the luteinized unruptured follicle (LUF) and ovulation groups
No significant difference was detected in live birth rate, it was lower in the LUF group (43.50 vs. 50.00%, adjusted P = 0.19, OR 0.76, 95% CI 0.51–1.14)
Summary
With the increasing application of assisted reproductive technology (ART) worldwide, the advantages and disadvantages of various methods related to ART have been widely discussed [1]. In frozen/thawed embryo transfer (FET) cycles, either a hormone replacement therapy cycle (HRT) or natural ovulation cycle (NC) is used for endometrial preparation. Recent studies demonstrate that the absence of a corpus luteum has a negative impact on vascular health, leading to insufficient cardiovascular adaptation in early pregnancy, and contributing to an increased risk of preeclampsia [6, 7]. From this point of view, endometrial preparation in natural ovulation cycles with a corpus luteum present appear to be safer. The impact of LUF on FET clinical outcome is still uncertain
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