Effect Of Endometrial Thickness On The First Progesterone Day On Clinical Outcomes In Hormone Replacement Therapy Frozen-thawed Embryo Transfer Cycles

Objective: 1.To investigate the effect of endometrial thickness on the first progesterone on clinical outcome of HRT-FET;2.To analyze the optimal endometrial thickness range and threshold for the ideal clinical outcome of HRT-FET patients by statistical analysis methods.3.Compare the clinical outcomes of patients with thin endometrium between the groups of transferring cleavage stage embryo and blastocyst,and explore the embryo transplantation strategy for patients with thin endometrium.Methods: The endometrial preparation protocols of 8476 HRT-FET cycles from January 2013 to December 2017 in the Reproductive Medicine Center of Henan Provincial People's Hospital were studied retrospectively.Univariate analysis,multivariate Logistic regression analysis,curve fitting and threshold effect analysis were used to investigate the effect of endometrial thickness on the first progesterone on clinical outcomes of HRT-FET and explore the embryo transplantation strategy for patients with thin endometrium.The main observation indicator was live birth rate,and the secondary observation indicators were clinical pregnancy rate,early abortion rate and ectopic pregnancy rate.Results: A total of 8476 HRT-FET cycles were included in this study,and the overall clinical pregnancy rate was 65.85%,the early abortion rate was 9.77%,the ectopic pregnancy rate was 1.65%,and the live birth rate was 55.79%.1.Effect of endometrial thickness on the first progesterone on clinical outcome 1.1 Effect of endometrial thickness on clinical pregnancy rate and live birth rate on the first progesterone The results of univariate analysis showed that endometrial thickness,the age,duration of infertility,body mass index(BMI),infertility type and number and type of embryos transferred had significant effects on clinical pregnancy rate and live birth rate(P < 0.05).The results of multivariate logistic regression analysis showed that after adjusted for confounding factors such as the age,duration of infertility,body mass index(BMI),infertility type and number and type of embryos transferred,endometrial thickness on the first progesterone significantly affected the clinical pregnancy rate(a OR: 1.10;95% CI: 1.07,1.14;P < 0.0001)and live birth rate(a OR: 1.09;95% CI: 1.06,1.12;P < 0.001).1.2 Effect of endometrial thickness on ectopic pregnancy rate and early abortion rate on the first progesterone Univariate analysis was used to study the factors affecting early abortion rate and ectopic pregnancy rate,and the results showed that the age,duration of infertility,body mass index(BMI),infertility type and number and type of embryos transferred had significant effects on early abortion rate(P < 0.05).The number and type of embryos transferred had significant effects on the ectopic pregnancy rate(P < 0.05).Endometrial thickness on the first progesterone had no significant effect on early abortion rate and ectopic pregnancy rate(P > 0.05).The results of multivariate logistic regression analysis showed that the endometrial thickness on the first progesterone after adjusting for confounding factors had no significant effect on the early abortion rate and ectopic pregnancy rate.(P > 0.05).2.The optimal range of endometrial thickness in HRT-FET cycle Curve fitting was used to analyze the relationship between endometrial thickness on the first progesterone and clinical pregnancy rate and live birth rate.The results showed that the relationship between endometrial thickness on the first progesterone and clinical pregnancy rate and live birth rate presented a curve(P < 0.05).Threshold effect analysis was used to study the quantitative relationship between endometrial thickness on the first progesterone and clinical pregnancy rate and live birth rate,and the results show: after adjusting confounding factors the endometrial thickness threshold of clinical pregnancy rate and live birth rate is 8.7 mm,When the endometrial thickness is less than 8.7 mm,each1 mm increase in endometrial thickness increases,clinical pregnancy rate increased by 41%(OR = 1.41,95% CI: 1.29 ~ 1.54,P < 0.0001),live-birth rate increased by 49%(OR = 1.49,95% CI: 1.37 ~ 1.62,P < 0.0001).When endometrial thickness was greater than the threshold,clinical pregnancy rate and live birth rate were no longer significantly increased.Think of the live birth rate 55% corresponding to the threshold value as the optimal,and our data showed that the live birth rate would be optimal when the endometrial thickness was within the range of 8.7-14.4 mm by the curve fitting graph.3.Embryo transfer strategy analysis for patients with thin endometrium Multivariate logistic regression analysis adjusted for the confounding factors showed that the clinical pregnancy rate and live birth rate of blastocyst transfer cycle in patients with endometrial thickness under the threshold(endometrial thickness is less than 8.7 mm)and thin endometrium(endometrium thickness < 6 mm,7 mm and 8 mm)were significantly higher than that of the cleavage period embryo transfer cycle,and the early abortion rate were significantly lower than that of e the cleavage period embryo transfer cycle.Conclusion: 1.Endometrial thickness on the first progesterone significantly affected the clinical pregnancy rate and live birth rate of patients with HRT-FET cycle.The relationship between endometrial thickness on the first progesterone and clinical pregnancy rate and live birth rate was inverted "U".Endometrial thickness on the first progesterone had no significant effect on the ectopic pregnancy rate and early abortion rate.2.The threshold of endometrial thickness for both clinical pregnancy rate and live birth rate was 8.7 mm.When the endometrial thickness was less than the threshold,each 1mm increase in endometrial thickness increases,the clinical pregnancy rate increased by 41%(OR=1.41)and the live birth rate increased by 49%.Think of the live birth rate 55% corresponding to the threshold value as the optimal,the live birth rate would be optimal when the endometrial thickness was within the range of 8.7-14.4 mm by the curve fitting graph.3.The clinical pregnancy rate and live birth rate of blastocyst transfer cycle in patients with thin endometrium were significantly higher than that in cleavage stage embryo transfer cycle.The blastocyst transfer is recommended to optimize clinical outcomes for patients with thin endometrium.