A Prospective Study of Factors Affecting Pregnancy Rate Following Fresh Embryo Transfer
K Leeja Samuel, Srijana Mathai, Rachel Mathew, Susan Mathew, NS Sreedevi
Keywords :
Assisted reproductive techniques, Infertility, Fresh embryo transfer
Citation Information :
Samuel KL, Mathai S, Mathew R, Mathew S, Sreedevi N. A Prospective Study of Factors Affecting Pregnancy Rate Following Fresh Embryo Transfer. J South Asian Feder Obs Gynae 2023; 15 (4):451-455.
Background: Couples often want to know their chance of having a positive outcome if they opt for assisted reproductive techniques (ARTs) and hence this prospective study was aimed to examine variable predictor parameters for its success.
Aim: The aim of the study was to assess factors favoring positive outcome following fresh embryo transfer (FrET).
Materials and methods: In this study, 200 couples—both with primary and secondary infertility—undergoing embryo transfer (ET) following controlled ovarian hyperstimulation and those obtaining at least one transferable embryo were included.
In addition to the routine infertility data, the couples underwent long protocol which started on day 21 of menstrual cycle and continued till oocyte retrieval in next cycle. After that either FrET or were planned for “freeze all” embryos followed by frozen embryo transfer (FET). The success was measured in terms of serum beta human chorionic gonadotropin (β-HCG) on day 15 and by transvaginal ultrasonography (TVS) at 6 weeks. The data was analyzed using descriptive and inferential statistical analysis.
Results: Primary infertility was the most common type of infertility (84.5%). Although 42% patients became HCG positive but clinical pregnancy was achieved only in 39.5%. Clinical pregnancy was achieved in 84.8% of cases of primary infertility and 15.20% of cases of secondary infertility. Among the causes of infertility, combined factor infertility (41.5%) was the most common cause. The pregnancy rate was less when very high doses (5.1%) and longer duration (39.2%) of gonadotropins were used. There was a significant association between clinical pregnancy and the total number of oocytes (p = 0.008), the total number of metaphase II (MII) oocytes (p = 0.003), and the total number of embryos (0.002) but not with endometrial thickness (ET) in the range of 8– 14mm (p = 0.702).
Conclusion: Familiarity with the predicting factors can help to prevent overtreatment and balance the decision to achieve pregnancy either through ART or by natural conception.
Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril 2008;90(5 Suppl.):S60. DOI: 10.1016/j.fertnstert.2008.08.065.
Maheshwari A, Hamilton M, Bhattacharya S. Effect of female age on diagnostic categories of infertility. Hum Reprod 2008; 23(3):538–542. DOI: 10.1093/humrep/dem431.
Engmann L, Maconochie N, Tan SL, et al. Trends in the incidence of births and multiple births and the factors that determine the probability of multiple births after IVF treatment. Hum Reprod 2001;16(12):2598–2608. DOI: 10.1093/humrep/16.12.2598.
Elizur SE, Lerner–Geva L, Levron J, et al. Factors predicting IVF treatment outcome: A multivariate analysis of 5310 cycles. Reprod Biomed Online 2005;10(5):645–649. DOI: 10.1016/s1472-6483(10)61673-2.
Rhodes TL, McCoy TP, Higdon HL III, et al. Factors affecting assisted reproductive technology (ART) pregnancy rates: a multivariate analysis. J Assist Reprod Genet 2005;22(9–10):335–346. DOI: 10.1007/s10815-005-6794-1.
Lintsen AM, Eijkemans MJ, Hunault CC, et al. Predicting ongoing pregnancy chances after IVF and ICSI: A national prospective study. Hum Reprod 2007;22(9):2455–2462. DOI: 10.1093/humrep/dem183.
JunHao Y, Wu KL, Tang R, et al. Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Sci China Life Sci 2012;55(8):694–698. DOI: 10.1007/s11427-012-4357-0.
Wang YA, Healy D, Black D, et al. Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002–2005. Human Reprod 2008;23(7):1633–1638. DOI: 10.1093/humrep/den135.
Sarais V, Pagliardini L, Rebonato G, et al. A comprehensive analysis of body mass index effect on in vitro fertilization outcomes. Nutrients 2016;8(3):109. DOI: 10.3390/nu8030109.
Ferlitsch K, Sator MO, Doris M, et al. Body mass index, follicle-stimulating hormone and their predictive value in in vitro fertilization. J Assist Reprod Genet 2004;21(12):431–436. DOI: 10.1007/s10815-004-8759-1.
Jayaprakasan K, Chan Y, Islam R, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril 2012;98(3):657–663. DOI: 10.1016/j.fertnstert.2012.05.042.
Holte J, Brodin T, Berglund L, et al. Antral follicle counts are strongly associated with live-birth rates after assisted reproduction, with superior treatment outcome in women with polycystic ovaries. Fertil Steril 2011;96(3):594–599. DOI: 10.1016/j.fertnstert.2011.06.071.
Sabatini L, Zosmer A, Hennessy EM, et al. Relevance of basal serum FSH to IVF outcome varies with patient age. Reprod Biomed Online 2008;17(1):10–19. DOI: 10.1016/s1472-6483(10)60287-8.
Abdalla H and Thum MY. An elevated basal FSH reflects a quantitative rather than qualitative decline of the ovarian reserve. Human Reprod 2004;19(4):893–898. DOI: 10.1093/humrep/deh141.
Jellad S, Hassine AH, Basly M, et al. Can elevated levels of basal follicle stimulating hormone predict a decrease in fertility in young women undergoing ART cycles? Obstet Gynecol Int J 2016;4(5):00120. DOI: 10.1016/j.jgyn.2016.04.002.
Baker VL, Brown MB, Luke B, et al. Gonadotropin dose is negatively correlated with live birth rate: Analysis of more than 650,000 assisted reproductive technology cycles. Fertil Steril 2015;104(5):1145.e1-5–1152.e1-5. DOI: 10.1016/j.fertnstert.2015.07.1151.
Martin JR, Mahutte NG, Aric A, et al. Impact of duration and dose of gonadotrophins on IVF outcomes. Reprod Biomed Online 2006;13(5):645–650. DOI: 10.1016/s1472-6483(10)60654-2.
Chuang M, Zapantis A, Taylor M, et al. Prolonged gonadotropin stimulation is associated with decreased ART success. J Assist Reprod Genet 2010;27(12):711–717. DOI: 10.1007/s10815-010-9476-6.
Rashidi BH, Sadeghi M, Jafarabadi M, et al. Relationships between pregnancy rates following in vitro fertilization or intracytoplasmic sperm injection and endometrial thickness and pattern. Eur J Obstet Gynecol Reprod Biol 2005;120(2):179–184. DOI: 10.1016/j.ejogrb.2004.08.016.
Ma N-Z, Chen L, Dai W, et al. Influence of endometrial thickness on treatment outcomes following in vitro fertilization/intracytoplasmic sperm. Reprod Biol Endocrinol 2017;15(1):5. DOI: 10.1186/s12958-016-0222-5.
Richter KS, Bugge KR, Bromer JG, et al. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril 2007;87(1):53–59. DOI: 10.1016/j.fertnstert.2006.05.064.
Zhao J, Zhang Q, Li Y. The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reprod Biol Endocrinol 2012;10:100. DOI: 10.1186/1477-7827-10-100.
Spitzer D, Wirleitner B, Corn C, et al. Prediction of oocyte number for take-home baby rate in fresh ART cycles. J Reproduktionsmed Endokrinol 2015;12(1):19–24.
Cai Q, Wan F, Huang K, et al. Does the number of oocytes retrieved influence pregnancy after fresh embryo transfer? PLoS One 2013;8(2):e56189. DOI: 10.1371/journal.pone.0056189.
Rana L, Bavishi H, Bavishi F. Correlation between number of mature eggs retrieved and live birth rate in IVF treatment. Int J Reprod Contracept Obstet Gynecol 2017;6(4):1625–1629. DOI: https://doi.org/10.18203/2320-1770.ijrcog20171440.
Ng EHY, Yung WSB, Lau EYL, et al. High serum estradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen-thawed embryo transfer cycles. Hum Reprod 2000;15(2):250–255. DOI: 10.1093/humrep/15.2.250.
Prasad S, Kumar Y, Singhal M, et al. Estradiol level on day 2 and day of trigger: A potential predictor of the IVF-ET success. J Obstet Gynaecol India 2014;64(3):202–207. DOI: 10.1007/s13224-014-0515-6.
Gahlot A. Predictive value of basal FSH, endometrial thickness, pattern and serum E2 in in vitro fertilization embryo transfer cycles success. Int Res J Medical Sci 2014;2(7):6–11. PMID: 21772737.
Siddhartha N, Reddy NS, Pandurangi M, et al. Correlation of serum estradiol level on the day of ovulation trigger with the reproductive outcome of intracytoplasmic sperm injection. J Hum Reprod Sci 2016;9(1):23–27. DOI: 10.4103/0974-1208.178631.
Huang B, Ren X, Wu L, et al. Elevated progesterone levels on the day of oocyte maturation may affect top quality embryo IVF cycles PLoS One 2016;11(1):e0145895. DOI: 10.1371/journal.pone.0145895.
Kyrou D, Al-Azemi M, Papanikolaou EA, et al. The relationship of premature progesterone rise with serum estradiol levels and number of follicles in GnRH antagonist/recombinant FSH-stimulated cycles. Eur J Obstet Gynecol Reprod Biol 2012;162:165–168. DOI: 10.1016/j.ejogrb.2012.02.025.