The embryo versus endometrium controversy revisited as it relates to predicting pregnancy outcome in in-vitro fertilization-embryo transfer cycles |
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Authors: | Schwartz LB; Chiu AS; Courtney M; Krey L; Schmidt-Sarosi C |
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Institution: | Department of Obstetrics and Gynecology, New York University Medical Center, NY 10016, USA. |
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Abstract: | To evaluate embryonic and endometrial factors for their value in predicting
pregnancy outcome in in-vitro fertilization (IVF) and embryo transfer, a
retrospective data collection and prospective uterine artery colour Doppler
imaging study was performed in a university-based IVF-embryo transfer
programme setting. A total of 210 patients were included and grouped as
follows: (I) IVF with controlled ovarian stimulation (214 cycles); (II)
frozen-thaw cycle of autologous embryos (30 cycles); (III) oocyte donation,
no cryopreservation (12 cycles); (IV) frozen-thaw cycle with embryos from
donated oocytes (10 cycles). Embryo quality was significantly better in
pregnant than non-pregnant cycles (group I, P = 0.0104; groups II-IV, P =
0.0418). The endometrial echo was significantly thicker in pregnant versus
non-pregnant patients in group I (P = 0.0059), but not in groups II-IV (P =
0.741). Past uterine surgery or abnormalities had no effect on pregnancy
outcome. There were no significant differences in mean uterine artery
resistance index or peak systolic velocity in pregnant versus non-pregnant
patients in groups II-IV. Thus, embryo quality is the most reliable
predictor of pregnancy outcome. Endometrial measurements were significantly
thicker in subsequently pregnant patients only in group I, where the
endometrium reflects the hormonal environment. Doppler parameters were not
useful in predicting pregnancy outcome.
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