Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Determining Factors Affecting the Successful Outcome of Fresh Embryo Transfer During In Vitro Fertilization: A Retrospective Cohort Study

Authors
Chanakarn Suebthawinkul 1
Pranee Numchaisrika 1
Akarawin Chaengsawang 2
Vijakhana Pilaisangsuree 2
Sadanan Summat 1
Araya Peawdang 1
Konkanok Patchima 1
Punkavee Tuntiviriyapun 1
Paweena Thuwanut 1
Porntip Sirayapiwat 1
Wisan Sereepapong 1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
2 King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society, Bangkok, Thailand
10.18502/jri.v25i4.18123
Abstract
Background: Fresh embryo transfer has been decreasing because of advancements in vitrification techniques and safety concerns related to ovarian hyperresponse. However, in normal responders, clinical outcomes appear to be comparable with those with frozen embryo transfer. This study aimed to determine factors that influence successful fresh embryo transfer. Methods: This retrospective cohort study included 521 women who underwent in vitro fertilization (IVF) and fresh embryo transfer at King Chulalongkorn Memorial Hospital, Thailand. Patients’ clinical data, embryo details, endometrial characteristics (thickness and pattern), and embryo transfer procedures (tip and flow during transfer, embryo placement location, difficulty of the procedure, and presence of blood and mucous at catheter) were analyzed. Chi-square test, Fisher’s exact test, Student’s t-test, and logistic regression were performed for data analysis. A p-value of <0.05 was considered statistically significant. Results: The overall clinical pregnancy rate was 17.1%. Women aged >40 years were less likely to have a clinical pregnancy than those aged <35 years (adjusted odds ratio [aOR] 0.422; 95% confidence intervals [CI] 0.196-0.908, p=0.027). Day 3 embryo transfer showed a significant decrease in clinical pregnancy compared with blastocyst transfer (aOR 0.514; 95%CI 0.287-0.923, p=0.026). In the subgroup analysis for blastocyst transfer, women with good-quality blastocyst (≥322) were 2.439 times more likely to have a clinical pregnancy than those with poor-quality blastocysts (aOR 2.439; 95%CI 1.199-4.962, p=0.014). Conclusion: Advanced age and day 3 embryo transfer were significantly associated with low clinical pregnancy rates in fresh embryo transfer.
Keywords
Embryo transfer
In vitro fertilization
Infertility
Intracytoplasmic Sperm Injection
Pregnancy Outcomes
  1. Practice committee of the american society for re-productive medicine. Performing the embryo transfer: a guideline. Fertil Steril. 2017;107(4):882-96.
  2. Reshef EA, Robles A, Hynes JS, Turocy JM, Forman EJ. A review of factors influencing the implantation of euploid blastocysts after in vitro fertilization. F&S Rev. 2022;3(2):105-20.
  3. Venetis CA. Pro: fresh versus frozen embryo transfer. Is frozen embryo transfer the future? Hum Reprod. 2022;37(7):1379-87.
  4. Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021;2021(2):CD011184.
  5. Roque M, Haahr T, Geber S, Esteves SC, Humaidan P. Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and metaanalysis of reproductive outcomes. Hum Reprod Update. 2018;25(1):2-14.
  6. Maheshwari A, Bell JL, Bhide P, Brison D, Child T, Chong HY, et al. Elective freezing of embryos versus fresh embryo transfer in IVF: a multicentre randomized controlled trial in the UK (E-Freeze). Hum Reprod. 2022;37(3):476-87.
  7. Vuong LN, Dang VQ, Ho TM, Huynh BG, Ha DT, Pham TD, et al. IVF transfer of fresh or frozen embryos in women without polycystic ovaries. N Engl J Med. 2018;378(2):137-47.
  8. Niederberger C, Pellicer A, Cohen J, Gardner DK, Palermo GD, O'Neill CL, et al. Forty years of IVF. Fertil Steril. 2018;110(2):185-324.e5.
  9. Suebthawinkul C, Numchaisrika P, Chaengsawang A, Pilaisangsuree V, Summat S, Sereepapong W. Determining factors influencing the successful embryo transfer and Pregnancy during the frozen cycle of in vitro fertilization: a retrospective cohort study. Int J Fertil Steril. 2024;18(4):352-61.
  10. Suebthawinkul C, Thaweepolcharoen C, Thuwanut P, Tuntiviriyapun P, Sirayapiwat P, Sereepapong W. Prevalence of empty follicle syndrome in king chulalongkorn memorial hospital. J Med Assoc Thai. 2021;104(6):1005-9.
  11. Magli MC, Jones GM, Lundin K, van den Abbeel E. Atlas of human embryology: from oocytes to preimplantation embryos. Preface. Hum Reprod. 2012;27 Suppl 1:i1.
  12. Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, et al. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393(10178):1310-8.
  13. Çelik S, Turgut NE, Yağmur E, Boynukalın K, Çelik DC, Fındıklı N, et al. The effects of fresh embryo transfers and elective frozen/thawed embryo transfers on pregancy outcomes in poor ovarian responders as defined by the Bologna criteria. Turk J Obstet Gynecol. 2015;12(3):132-8.
  14. Fang R, Cai L, Xiong F, Chen J, Yang W, Zhao X. The effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the first fresh IVF/ICSI cycle. Gynaecol Endocrinol. 2016;32(6):473-6.
  15. Xu J, Zhang S, Jin L, Mao Y, Shi J, Huang R, et al. The effects of endometrial thickness on pregnancy outcomes of fresh IVF/ICSI embryo transfer cycles: an analysis of over 40,000 cycles among five reproductive centers in China. Front Endocrinol (Lausanne). 2022;12:788706.
  16. Chua SJ, Danhof NA, Mochtar MH, van Wely M, McLernon DJ, Custers I, et al. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis. Hum Reprod. 2020;35(8):1808-20.
  17. Suebthawinkul C, Babayev E, Lee HC, Duncan FE. Morphokinetic parameters of mouse oocyte meiotic maturation and cumulus expansion are not affected by reproductive age or ploidy status. J Assist Reprod Genet. 2023;40(5):1197-213.
  18. Katagiri Y, Jwa SC, Kuwahara A, Iwasa T, Ono M, Kato K, et al. Assisted reproductive technology in Japan: a summary report for 2020 by the ethics committee of the Japan society of obstetrics and gynecology. Reprod Med Biol. 2023;22(1):e12494.
  19. Geng L, Lu S, Li S, Chen ZJ, Wei D, Liu P. An appraisal of current embryo transfer strategies. Hum Fertil (Camb). 2023;26(4):815-23.
  20. Li Y, Liu S, Lv Q. Single blastocyst stage versus single cleavage stage embryo transfer following fresh transfer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;267:11-7.
  21. Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, Ciapponi A, Cornelisse S, Blake D. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2022;5(5):CD002118.
  22. Matsumoto H. Molecular and cellular events during blastocyst implantation in the receptive uterus: clues from mouse models. J Reprod Dev. 2017;63(5):445-54.
  23. Neblett 2nd MF, Kim T, Jones TL, Baumgarten SC, Coddington CC, Zhao Y, et al. Is there still a role for a cleavage-stage embryo transfer? F S Rep. 2021;2(3):269-74.
  24. Thompson SM, Onwubalili N, Brown K, Jindal SK, McGovern PG. Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer (eSET): a national study. J Assist Reprod Genet. 2013;30(12):1577-81.
  25. Bakkensen JB, Brady P, Carusi D, Romanski P, Thomas AM, Racowsky C. Association between blastocyst morphology and pregnancy and perinatal outcomes following fresh and cryopreserved embryo transfer. J Assist Reprod Genet. 2019;36 (11):2315-24.
  26. Zhan Q, Sierra ET, Malmsten J, Ye Z, Rosenwaks Z, Zaninovic N. Blastocyst score, a blastocyst quality ranking tool, is a predictor of blastocyst ploidy and implantation potential. F S Rep. 2020;1(2):133-41.
  27. Comstock IA, Diaz-Gimeno P, Cabanillas S, Bellver J, Sebastian-Leon P, Shah M, et al. Does an increased body mass index affect endometrial gene expression patterns in infertile patients? a functional genomics analysis. Fertil Steril. 2017;107(3):740-8.e2.
  28. Snider AP, Wood JR. Obesity induces ovarian inflammation and reduces oocyte quality. Reproduction. 2019;158(3):R79-90.
  29. Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and metaanalysis. Hum Reprod Update. 2019;25(4):439-51.
  30. Tao P, Yan X, Yao Y, Wang Z, Li Y. Pre-pregnancy obesity is not associated with poor outcomes in fresh transfer in vitro fertilization cycles: a retrospective study. BMC Pregnancy Childbirth. 2023;23(1):633.
  31. Romanski PA, Bortoletto P, Magaoay B, Chung A, Rosenwaks Z, Spandorfer SD. Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer. J Assist Reprod Genet. 2021;38(2):347-55.
  32. Peng Y, Ma S, Hu L, Wang X, Xiong Y, Yao M, et al. Effectiveness and safety of two consecutivecycles of single embryo transfer compared with one cycle of double embryo transfer: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:920973.
  33. Mullin CM, Fino ME, Talebian S, Krey LC, Licciardi F, Grifo JA. Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age. Fertil Steril. 2010;93(6):1837-43.
  34. Eum JH, Park JK, Kim SY, Paek SK, Seok HH, Chang EM, et al. Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles. Clin Exp Reprod Med. 2016;43(3):164-8.
  35. Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40000 embryo transfers. Hum Reprod. 2018;33 (10):1883-8.
Journal of Reproduction & Infertility
Volume 25, Issue 4
Autumn 2024
Pages 253-263