Analysis Of Factors Affecting Pregnancy Outcome Of Fresh Embryo Transfer Cycle With Antagonist Protocol

Part I Analysis of the factors affecting clinical pregnancy in patients undergoing fresh embryo transfer cycle with antagonist protocolBackgroundControlled ovarian hyperstimulation(COH)is one of the key steps in assisted reproductive technology(ART).The gonadotropin-releasing hormone(GnRH)antagonist protocol can adjust the medication in time according to the development of the patients’follicles.Because of its advantages of no advance pituitary inhibition,safety and high cost performance,it has developed into one of the most widely used protocols for COH in the current assisted reproductive therapy.However,there are few reports on the factors affecting clinical pregnancy in patients with fresh transplantation cycle of antagonist protocol.ObjectiveTo analyze the influencing factors of clinical pregnancy in patients with fresh transplantation cycle of antagonist protocol,and to provide reference for improving the clinical pregnancy rate of patients.Methods1.A retrospective analysis of data from patients treated with ART at Reproductive Medicine Centre of Qilu Hospital of Shandong University from March 2015 to November 2022.After screening by inclusion criteria and exclusion criteria,1226 eligible patients were divided into clinical pregnancy group(623 cases)and non-clinical pregnancy group(603 cases)according to clinical pregnancy conditions.2.Compare the basic clinical data of patients with clinical pregnancy and non-clinical pregnancy,such as female age,body mass index(BMI),type of infertility,duration of infertility,basal estradiol(E2),basal progesterone(Pbasal),basal follicle stimulating hormone(FSH)and anti-Mullerian hormone(AMH).Clinical data of COH,such as total days of Gn,total dose of gonadotropin(Gn),E2 on the day of administration of human chorionic gonadotropin(hCG),progesterone on the day of hCG(PhCG),Luteinizing hormone(LH)on the day of hCG,PhCG/Pbasal,PhCG/number of oocyte retrieved(PhCG/O).Laboratory related data such as O,number of mature oocytes,number of bipronuclear(2PN)embryos,number of transferable embryos,number of high-quality embryos,and related data on the day of transplantation such as endometrial thickness,type of transferred embryos and number of transferred embryos.3.A multi-factor logistic regression analysis was performed on statistically significant indicators between the two groups.After exclusion of confounding factors,the independent protective factors and independent risk factors affecting the clinical pregnancy of patients in the fresh transplantation cycle of the antagonist protocol were determined respectively.Results1.There was no significant difference in BMI,AMH,duration of infertility,type of infertility,basal E2,Pbasal,basal FSH,total Gn dose,or total Gn days,E2on hCG day,PhCG,PhCG/Pbasal,PhCG/O,O,endometrial thickness and type of transferred embryos between clinical pregnancy group and non-clinical pregnancy group(P>0.05).2.The female age of clinical pregnancy group was significantly lower than that of nonclinical pregnancy group(P<0.05).The LH on hCG day,number of mature occytes,2PN embryos,transferable embryos,high-quality embryos and transferred embryos in the clinical pregnancy group were significantly higher than those in the non-clinical pregnancy group(P<0.05).3.Multi-factor logistic regression analysis was conducted for indicators with statistically significant differences between groups in the clinical data.The results showed that there was no significant difference in the number of mature oocytes,2PN embryos and transferable embryos between the two groups(P>0.05).There were significant differences between the two groups in female age,the LH on hCG day,number of high-quality embryos and number of transferred embryos(P<0.05).ConclusionThe LH of hCG day,the number of high-quality embryos and the number of transferred embryos are independent protective factors for clinical pregnancy of patients undergoing fresh embryo transfer cycle of antagonist protocol.Female age is an independent risk factor for clinical pregnancy in patients undergoing fresh embryo transfer cycle with antagonist protocol.Part II Analysis of the factors affecting pregnancy loss in patients undergoing fresh embryo transfer cycle with antagonist protocolBackgroundIn the first part of the study,we learned the independent factors that affect the clinical pregnancy outcome of patients in the fresh embryo transfer cycle of the antagonist protocol,which provided some references for improving the rate of clinical pregnancy and the pregnancy outcome.However,at present,there are few studies on the pregnancy loss in the fresh embryo transfer cycle of antagonist protocol,and the relevant influencing factors are not clear.ObjectiveTo analyze the influencing factors of pregnancy loss in patients undergoing fresh embryo transfer cycle with antagonist protocol,and to provide reference for improving the live birth rate of patients and reducing adverse pregnancy outcomes.Methods1.A retrospective analysis of data from patients received ART treatment with antagonist protocol at the Reproductive Medicine Centre of Qilu Hospital of Shandong University from March 2015 to April 2022.After screening by inclusion criteria and exclusion criteria,a total of 794 eligible patients were divided into biochemical pregnancy loss group(105 cases),clinical pregnancy loss group(95 cases)and live birth group(594 cases)according to the pregnancy outcome.2.The basic clinical data of the three groups of patients were compared,such as female age,male age,the type of infertility,BMI,duration of infertility,the basal E2,the basal P,the basal FSH and the endometrium thickness.The medical history data of the patients,such as the male factor,endometriosis,pelvic factors,the history of ectopic pregnancy,polycystic ovary syndrome(PCOS),hydrosalpinx and the history of uterine surgery.And the clinical data of the COH,such as the total days of Gn,the total dose of Gn,PhCG,E2 on hCG day and LH on hCG day.Laboratory related data such as the total number of occytes obtained,the number of mature occytes,the number of 2PN embryos,the number of transferable embryos,the number of high-quality embryos,the number of transferred embryos and the type of transferred embryos.3.Multi-factor logistic regression analysis was performed on the indexes with statistically significant differences between the biochemical pregnancy loss group and the live birth group,the clinical pregnancy loss group and the live birth group.The related factors affecting the biochemical pregnancy loss and the clinical pregnancy loss of the patients in the fresh embryo transfer cycle of the antagonist protocol were determined after the confounding factors were excluded.Results1.There was no significant difference between the biochemical pregnancy loss group and the live birth group in terms of infertility type,BMI,duration of infertility,basal E2,basal FSH,Pbasal,endometrium thickness,total dose of Gn,total days of Gn,E2 on hCG day,LH on hCG day,PhCG,total number of oocytes retrieved,number of mature occytes,number of 2PN embryos,number of transferable embryos,number of transferred embryos and type of transferred embryos(P>0.05).There was no significant difference in the proportion of male factors,endometriosis,pelvic factors,ectopic pregnancy history,PCOS and uterine surgery history(P>0.05).Female age,male age and the proportion of hydrosalpinx in the biochemical pregnancy loss group was significantly higher than that in the live birth group(P<0.05),and the number of high-quality embryos in the biochemical pregnancy loss group was significantly lower than that in the live birth group(P<0.05).2.Multi-factor logistic regression analysis was performed on the indicators included female age,male age,number of high-quality embryos and proportion of hydrosalpinx that had significant differences between the biochemical pregnancy loss group and the live birth group.The results showed that male age,number of high-quality embryos and proportion of hydrosalpinx independently affected the outcome of biochemical pregnancy loss(P<0.05).3.There was no significant difference between the clinical pregnancy loss group and the live birth group in terms of infertility type,BMI,infertility years,basal E2,basal FSH,Pbasal,endometrial thickness,total dose of Gn,total days of Gn,E2 on hCG day,LH on hCG day,Ph CG,total number of oocytes obtained,number of mature occytes,number of 2PN embryos,number of transferable embryos,number of high-quality embryos,number of transferred embryos and type of transferred embryos(P>0.05).There was no significant difference in the proportion of male factors,endometriosis,pelvic factors,PCOS,hydrosalpinx and ectopic pregnancy history(P>0.05).The female age,male age and history of uterine operation in the clinical pregnancy loss group was significantly higher than those in the live birth group(P<0.05).4.Multi-factor logistic regression analysis was performed on the indicators included female age,male age,proportion of uterine operation with significant differences between the clinical pregnancy loss group and the live birth group.The results showed that the female age and proportion of uterine operation independently affected the outcome of clinical pregnancy loss(P<0.05).ConclusionThe male age,the number of high-quality embryos and the proportion of hydrosalpinx independently affected the biochemical pregnancy loss outcome of the patients in the fresh transfer cycle of the antagonist protocol.The female age and the proportion of uterine surgery independently affected the clinical pregnancy loss outcome of the patients in the fresh embryo transfer cycle of the antagonist protocol.