| Background:In both natural pregnancy and assisted reproductive technology,embryo implantation success is the beginning and key link of pregnancy,while embryo Recurrent implantation failure(RIF)is hampering the IVF-ET(in vitro fertilization-embryo transfer)to further improve the bottleneck problem of pregnant patients clinical pregnancy rate.At present,there is still a lack of widely accepted definition of RIF in the world.Most experts believe that RIF refers to patients under 40 years old who have experienced at least 3and more IVF cycles and transferred 4-6 high-quality embryos or 3 high-quality blastocysts,but have not achieved clinical pregnancy.RIF brings heavy psychological and economic burden to infertile couples,and affects family harmony and social stability.How to improve the embryo implantation rate is an urgent difficulty and focus in the field of reproductive medicine.In addition to the quality of the embryo itself,the receptivity of the maternal endometrium and the immune balance of the maternal-fetal interface,the number of previous embryo implantation failures is also an independent factor affecting the success of embryo implantation.However,there is a lack of studies on the effect of different number of failed transfer cycles on pregnancy outcome.Purpose:To investigate the effect of different embryo transfer cycles on pregnancy outcomes in patients with in vitro fertilization embryo transfer(IVF-ET)and to provide a theoretical basis for the clinical treatment of these patients.Method:The clinical data of 16975 IVF cycles from 13172 patients,recruited from the Center for Henan Reproductive Hospital from January 1,2015,to December 31,2018,were collected and analyzed.The IVF cycles were divided into four groups based on the number of previous embryo implantation failures:Group A:0 implantation failure(n = 13172);Group B : 1 implantation failure(n = 2989);Group C: 2implantation failures(n = 658);Group D: ≥3 implantation failures(n = 156).The baseline characteristics of assisted reproduction and pregnancy outcomes were compared among the four intergroup,the influence of the number of embryo implantation failures on pregnancy outcomes in IVF-ET patients was investigated by univariate and multiple regression analysis.Results:Univariate logistic regression analysis showed that the number of failed transfers,female age,basal follicle count,endometrial thickness,total number of eggs obtained,cycle type,number of quality embryos transferred and stage of embryo development were all factors influencing implantation,clinical pregnancy,early spontaneous abortion and live birth rates(P<0.05);factors affecting implantation rate,clinical pregnancy rate,and live birth rate,anti-Müllerian hormone basal follicle count(P <0.05).Multi-factor logistic regression analysis showed that after adjusting for the effects of confounding factors such as female age,AMH,basal follicle count,endometrial thickness,total number of eggs obtained,cycle types,transfer rate of good quality embryos and stage of embryo development,it was found that group A as the reference group,the implantation rate of group B(OR=0.57,95% CI: 0.51-0.63,P<0.0001)and group C(OR=0.53,95% CI: 0.0001)and group D(OR=0.33,95% CI: 0.23-0.46,P < 0.0001)had progressively decreased;the clinical pregnancy rate of group B(OR=0.57,95% CI: 0.51-0.63,P < 0.0001),group C(OR=0.53,95% CI.0.44-0.63,P<0.0001),and group D(OR=0.32,95%CI: 0.23-0.46,P<0.0001)had gradually decreased;the live birth rate of groups B(OR=0.56,95%CI: 0.50-0.63,P<0.0001),group C(OR=0.49,95%CI: 0.41-0.58,P < 0.0001),and group D(OR=0.29,95% CI: 0.20～0.42,P < 0.0001)had markedly decreased;Group B(OR=1.40,95% CI: 1.16～1.70,P < 0.0001),Group C(OR=1.84,95% CI: 1.36～2.48,P < 0.0001),and Group D(OR=2.24,95% CI: 1.24-4.02,P=0.0073)had an increased risk of early spontaneous abortion,all with statistically significant differences。Conclusions:1.The number of previous cycles of failed embryo implantation is an independent factor influencing implantation,clinical pregnancy,live birth and early spontaneous abortion rates after repeat assisted reproduction in IVF-ET patients.2.The rates of implantation,clinical pregnancy and live birth decreased significantly,and the risk of early spontaneous abortion increased markedly with the increasing the number of previous cycles of failed embryo implantation compared to patients with no previous history of embryo implantation failure.3.Compared with patients with 0,1 or 2 previous failed embryo implantation cycles,the implantation,clinical pregnancy and live birth rates of patients with ≥3 previous failed embryo implantation cycles decreased dramatically,while the early spontaneous abortion rate increased significantly,which deserved our clinicians’ special attention. |
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