The Influences Of The History Of Using Intrauterine Device On Pregnancy Outcomes And Pregnancy Complications In Women Undergoing IVF/ICSI

Background Intrauterine device(IUD)is a widely used reversible contraceptive tool,it is the second most commonly used contraceptive method among women in China after condoms.Previous studies have suggested that previous IUD use in naturally pregnant women is associated with the reduced risk of preeclampsia and preterm birth(PTB),but the influences of the history of using IUD on pregnancy outcomes and pregnancy complications in women who have received assisted reproductive technology(ART)are still uncertain.Objective To investigate whether the previous use of IUD and the change of IUD usage time and IUD removal time have influences on pregnancy outcomes and pregnancy complications in fresh-embryo transfer women and frozen-embryo transfer women after undergoing in-vitro fertilization(IVF)/intrauterine sperm injection(ICSI),and provide evidence for the potential influences of the history of using IUD on the endometrial microenvironment and embryonic development during pregnancy,as well as for the scientific and standardized use of IUD,especially the safe and effective use in women with fertility requirements.Methods This study was a retrospective cohort study.Selectively involved the patients of the fresh-embryo transfer after undergoing the first cycle of IVF/ICSI from egg retrieval during December 2016 to December 2019,according to whether IUD had been used in the past,they were divided into IUD group and the group with no IUD use(control group),and selected the patients with clear IUD usage time and the patients with clear IUD removal time in IUD group,to explore the influences of the history of using IUD on pregnancy outcomes in fresh-embryo transfer patients;And selected the patients with single live birth,to explore the influences of the history of using IUD on pregnancy complications in fresh-embryo transfer patients.Selectively involved the patients of the first frozen-embryo transfer(the frozen-embryo transfer time was set before January 2020)after undergoing the first cycle of IVF/ICSI from egg retrieval during December 2016 to December 2019,according to whether IUD had been used in the past,they were divided into IUD group and control group,and selected the patients with clear IUD usage time and the patients with clear IUD removal time in IUD group,to explore the influences of the history of using IUD on pregnancy outcomes in frozen-embryo transfer patients;And selected the patients with single live birth,to explore the influences of the history of using IUD on pregnancy complications in frozen-embryo transfer patients.Logistic regression model was used to analyze the influences of the previous use of IUD and the change of IUD usage time and removal time on pregnancy outcomes and pregnancy complications in fresh-embryo transfer patients and frozen-embryo transfer patients after undergoing IVF/ICSI.Results After adjusting confounding factors through logistic regression model:as for pregnancy outcomes,there was no statistical difference in the rates of biochemical pregnancy,clinical pregnancy,live birth or the risk of biochemical pregnancy loss,ectopic pregnancy,early spontaneous pregnancy loss,late spontaneous pregnancy loss between IUD group and control group in fresh-embryo transfer patients or frozen-embryo transfer patients.In terms of pregnancy complications,IUD group had lower risk of hypertensive disorders of pregnancy(HDP)[adjusted odds ratio(aOR)0.577,95%confidence interval(CI)0.343-0.969,P=0.038]and gestational diabetes mellitus(GDM)(aOR 0.560,95%CI 0.408-0.767,P<0.001)compared with control group and the differences were statistically significant,and there was no statistical difference in the risk of placenta previa or PTB between IUD group and control group in fresh-embryo transfer patients;IUD group had lower risk of GDM(aOR 0.610,95%CI 0.436-0.852,P=0.004)compared with control group and the difference was statistically significant,and there was no statistical difference in the risk of HDP,placenta previa or PTB between IUD group and control group in frozen-embryo transfer patients.Besides,there was no statistical correlation between IUD usage time or IUD removal time and pregnancy outcome or pregnancy complication in IUD group with the fresh-embryo transfer or IUD group with the frozen-embryo transfer.Conclusion Compared with not using IUD before,the previous use of IUD is related to the reduced risk of GDM in embryo transfer women after undergoing IVF/ICSI;Besides,the previous use of IUD can also reduce the risk of HDP in fresh-embryo transfer women after undergoing IVF/ICSI.The specific mechanism needs further research.This study conclusion is likely to demonstrate the long-term safety of the history of using IUD for female reproduction,and has the possibility to provide clinical evidence for its widespread application.