Study Of The Effects Of HCG,LMWH And Tamoxifen On Pregnant Outcomes In FET Cycles

Part Ⅰ Intramuscular injection of human chorionic gonadotropin prior to secretory transformation in patients undergoing frozen-thawed embryo transfer[Materials and Methods]This retrospective cohort study was conducted at our Reproductive Medicine Center between January 2016 and December 2018.Infertility patients undergoing hormone replacement treatment-frozen thawed embryo transfer(HRT-FET)were included.The cycles were divided into two groups:(1)The human chorionic gonadotropin,(hCG)group(n=337)received an intramuscular injection of 10,000 IU hCG prior to secretory transformation;(2)the control group(n=364)performed FET without hCG administration.Live birth delivery rate(LBR)was the primary endpoint.[Results]1.The LBR was statistically significantly higher in hCG group as compared with control group.After adjusting the above confounding factors,the use of hCG was still a significant factor predictive of live birth in HRT-FET cycles(adjusted OR 1.549,95%CI 1.170-2.052;P=0.003).2.The LBR was also higher in hCG group compared to control group for women transferred blastocyte,but the difference lacked statistical significance(P>0.05).But significantly higher LBR were observed in hCG administration group(P<0.05).[Conclusion]1.Intramuscular hCG injection before secretory transformation could improve LBR in HRT-FET cycles.2.For women transferred blastocyte,intramuscular hCG injection could remarkably improve LBR,but no statistically significant difference was observed.Part Ⅱ Adjunct low-dose low-molecular-weight heparin in women undergoing frozen-thawed embryo transfer[Materials and Methods]This pilot randomized controlled trial was conducted at our Reproductive Medicine Center during January 2017 and October 2017.Infertility patients undergoing HRT-FET were recruited.Patients were randomized into either group when endometrial thickness reached ≥8 mm:(ⅰ)low-molecular-weight heparin(LMWH)group(n=77),receiving 4100 IU LMWH every other day from the day of secretory phase initiation to the day of checking serum β-hCG levels(totally for 12 days),or(ⅱ)control group(n=77),without adjunct LMWH.No embryos were transferred in one patient in LMWH group as all embryos lysed upon thawing.One cycle of LMWH group and one cycle of control group discontinued FET cycles for personal reason.So,only 75 cycles in LMWH group and 76 cycles in control group were followed and finally analysized.The LBR was the primary endpoint.[Result]1.The LBR was 61.3%in LMWH group versus 51.3%in control group,leading to a relative difference of 19%(odds ratio(OR)1.518,95%confidence interval(CI)0.790-2.914,P=0.209).2.None of participants complained of vaginal bleeding,ecchymosis or other adverse events that related to LMWH and no one discontinued LMWH administration for worring side effects of LWMH.[Conclusion]1.This low dose of LMWH may not induce side effects for patients who performing HRT-FET cycles.2.Adjunct low-dose LMWH might improve pregnancy outcomes.Part Ⅲ The effect of tamoxifen in women undergoing frozen-thawed embryo transfer[Materials and Methods]This retrospective matched case-control study was conducted at our Reproductive Medicine Center between January 2016 and December 2018.The tamoxifen group included 135 cycles and the control group consisted of 135 cycles with matching age at FET cycles,BMI,the number of prevous embryo transfer cycles and the duration of infertility at the ratio of 1:1.The LBR was the primary endpoint.[Result]1.The estradiol levels before secretory transformation was significantly higher in tamoxifen group than in control group(P<0.05),but the endometrial thickness was comparable between the two groups(P>0.05).2.There was no statistically significant difference in LBR between the two groups(P>0.05).[Conclusion]For women without thin endometrial thickness previously,tamoxifen for endometrial preparation could increase estradiol levels,but may not increase the endometrial thickness and improve pregnancy outomes.