Abstract
ObjectiveTo investigate the effects of endometrial thickness (EMT) on pregnancy outcomes on hCG trigger day in fresh in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles.MethodsA total of 42,132 fresh cycles between 1 January 2013 and 31 December 2019 were included in this retrospective cohort study. Data were collected from five reproductive centers of large academic or university hospitals in China. All patients were divided into different groups according to their endometrial thickness on hCG trigger day. Multivariate regression analysis, curve fitting and threshold effect analysis were performed.ResultsAfter adjusting for age, body mass index, infertility type, number of embryos transferred, number of retrieved oocytes and COS (controlled ovarian stimulation) protocols, significant associations were found between endometrial thickness and clinical pregnancy rate (adjusted odds ratio [aOR]: 1.05; 95% confidence interval [CI]: 1.06–1.08, P < 0.0001), live birth rate (aOR: 1.04; 95% CI: 1.03–1.05, P < 0.0001) as well as miscarriage rate(aOR: 0.96; 95% CI: 0.94 – 0.98, P < 0.0001). When the endometrial thickness was less than 12mm, the clinical pregnancy rate and live birth rate were increased significantly by 10% and 9%(OR:1.10; 95%CI: 1.08-1.12, OR:1.09; 95%CI: 1.07-1.11), respectively, along with the increase of each millimeter increment of endometrial thickness. However, when the EMT ranged from 12-15 mm, were stable at the ideal level, that were not significantly associated with EMT growth. Additionally, clinical pregnancy rate and live birth rate were slightly reduced by 6% and 4% when EMT was ≥15mm. Meanwhile, the miscarriage rate was significantly declined by 8% (OR:0.92; 95%CI: 0.90-0.95)with each millimeter increment of EMT. And when EMT was thicker than 12mm, the miscarriage rate didn’t change any more significantly.ConclusionsEndometrial thickness exhibits a curvilinear relationship with pregnancy outcomes in fresh embryo transfer cycles. Clinical pregnancy rate, live birth rate and miscarriage rate may achieve their optimal level when EMT ≥ 12 mm, but some adverse pregnancy outcomes would be observed when EMT ≥15 mm especially for clinical pregnancy.
Highlights
Steroid hormones secreted from the ovaries regulate cell division, differentiation and degeneration in human endometrium
A total of 42,132 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) fresh embryo transfer cycles were included in our study
To the best of our knowledge, this is the largest multi-center study to demonstrate the relationship between endometrial thickness (EMT) and pregnancy outcomes such as clinical pregnancy rate, live birth rate and miscarriage rate
Summary
Steroid hormones secreted from the ovaries regulate cell division, differentiation and degeneration in human endometrium. A woman’s menstrual cycle is divided into menstrual phase, proliferation phase, and secretory phase [1]. The endometrium increases in preparation for embryo implantation [2]. The functional layer of the endometrium thickens in preparation for embryo implantation [3]. Ultrasound examination is carried out as routine method of endometrium evaluation in IVF cycles in most reproductive medicine agencies due to its convenient and noninvasive property [4]. Sonographic parameters, such as endometrial thickness (EMT), endometrial pattern, endometrial volume and endometrial or sub-endometrial blood flow are used to identify endometrial receptivity [5]
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