State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
Reprod Biol Endocrinol. 2020 Aug 21;18(1):89. doi: 10.1186/s12958-020-00636-6.
Successful implantation and delivery require both the functional embryo and receptive endometrium in assisted reproductive technology (ART) cycles. However, little is known about embryo-endometrial interaction on live-birth. We aimed to investigate the independent effect and interaction of endometrial thickness (EMT) and embryo quality on live-birth in fresh embryo transfer (ET) cycles.
We conducted a retrospective cohort study including 15,012 ART cycles between 2013 and 2016 in three centers in China. Poisson regression with generalized estimating equations was employed to calculate relative risks (RRs) and 95% confidence intervals (CIs). We estimated the interaction of embryo quality and EMT on live-birth rate (LBR).
The LBR per cycle was 42.8% overall. LBR increased with increasing EMT and reached a plateau (50.6 to 54.2%) when EMT was 11 mm or thicker. Embryo quality represented by cumulative score was associated with LBR independently of number of embryos transferred and EMT. LBR was not increased with thicker EMT when only Q1 cleavage-stage embryo transferred (aRR 0.95, 95%CI 0.61-1.46). LBR was not increased significantly with thicker EMT with transfer of two good-quality cleavage-stage embryos and any blastocyst combination except Q1 group. There was significant interaction between EMT and embryo quality on LBR for cleavage-stage ETs (P=0.023).
This study demonstrated the nonlinear EMT-LBR association and the EMT cut-off value of 11 mm which may be of more clinical significance for predicting live-birth. Embryo quality is an independent prognostic tool for LBR. Our finding of significant embryo-endometrial interaction indicates combination of EMT and embryos quality might improve the prognostic value in clinical practice for live-birth in patients undergoing transfer of 1-2 fresh cleavage-stage embryos.
在辅助生殖技术（ART）周期中，成功的着床和分娩需要有功能的胚胎和接受性的子宫内膜。然而，对于胚胎-子宫内膜的相互作用与活产率之间的关系，我们知之甚少。本研究旨在探讨在新鲜胚胎移植（ET）周期中，子宫内膜厚度（EMT）和胚胎质量对活产率的独立影响及其相互作用。
我们进行了一项回顾性队列研究，纳入了 2013 年至 2016 年期间在中国三个中心进行的 15012 个 ART 周期。采用广义估计方程泊松回归计算相对风险（RR）和 95%置信区间（CI）。我们估计了胚胎质量和 EMT 对活产率（LBR）的交互作用。
总体而言，每个周期的活产率为 42.8%。随着 EMT 的增加，LBR 呈上升趋势，当 EMT 厚度达到 11mm 或更厚时达到平台期（50.6%至 54.2%）。以累积评分表示的胚胎质量与 EMT 独立相关，与移植胚胎数量和 EMT 无关。当仅移植 Q1 卵裂期胚胎时，较厚的 EMT 并不会增加 LBR（aRR 0.95，95%CI 0.61-1.46）。当移植两个优质卵裂期胚胎和任何组合的囊胚（除 Q1 组外）时，较厚的 EMT 并不能显著增加 LBR。卵裂期 ETs 的 EMT 和胚胎质量对 LBR 的交互作用具有统计学意义（P=0.023）。
本研究表明 EMT-LBR 之间存在非线性关系，11mm 的 EMT 截断值可能对预测活产率具有更重要的临床意义。胚胎质量是 LBR 的独立预后工具。我们发现 EMT 和胚胎质量之间存在显著的胚胎-子宫内膜相互作用，这表明在移植 1-2 个新鲜卵裂期胚胎的患者中，结合 EMT 和胚胎质量可能会提高临床实践中预测活产率的预后价值。
