As illustrated in Fig. 1, among 998 IVF/ICSI cycles, 431 patients underwent their first IVF-FET cycle at our reproductive center. After excluding 42 patients, the remaining 389 patients were divided into a study group (n = 162) and a control group (n = 227).
Table 1 presents a comparison of the baseline characteristics of the study population. No significant differences were observed in terms of age, infertility duration, previous IVF attempts, type of infertility, cause of infertility, or AMH levels between the two groups. However, a greater BMI was noted in the control group than in the study group.
Table 1
Baseline characteristics of patients who did or did not receive atosiban during frozen embryo transfer
Parameters | Atosiban (n = 162) | Control (n = 227) | p value |
Age (years) | 38.2 ± 4.4 | 38.2 ± 4.5 | 0.923 |
Body mass index (kg/m2) | 23.0 ± 3.4 | 24.1 ± 4.5 | 0.009 |
Infertility duration (years) | 4.4 ± 3.3 | 4.8 ± 3.0 | 0.219 |
Previous IVF attempts(%) | | | 0.414 |
0–1 | 38.3%(62/162) | 32.6%(74/227) | |
2 | 21.0%(34/162) | 20.3%(46/227) | |
≧ 3 | 40.7%(66/162) | 47.1%(107/227) | |
Types of infertility (%) | | | 0.725 |
Primary infertility | 47.5%(77/162) | 49.3%(112/227) | |
Secondary infertility | 52.5%(85/162) | 50.7%(115/227) | |
Causes of infertility (%) | | | 0.218 |
Tubal factor | 4.3%(7/162) | 7.0%(16/227) | |
Male factor | 3.1%(5/162) | 4.8%(11/227) | |
POR | 8.6%(14/162) | 6.2%(14/227) | |
PCOS | 13.0%(21/162) | 8.4%(19/227) | |
Endometriosis | 10.5%(17/162) | 6.6%(15/227) | |
Uterine factor | 9.9%(16/162) | 13.2%(30/227) | |
Unexplained | 13.6%(22/162) | 9.7%(22/227) | |
Multiple | 37.0%(60/162) | 44.1%(100/227) | |
Anti-Müllerian hormone(ng/mL) | 3.16 ± 2.84 | 3.15 ± 3.21 | 0.990 |
The data are presented as the mean ± standard deviation (SD) and %.
IVF, in vitro fertilization; POR, poor ovarian responder; PCOS, polycystic ovarian syndrome
The cycle characteristics and pregnancy outcomes of the study population are presented in Table 2. No significant differences were observed regarding endometrial thickness, FET protocol, day of ET, style used during ET, or percentage of at least one top-quality embryo transferred between the two groups. The biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, live birth rate, and miscarriage rate were similar between the two groups.
Table 2
Cycle characteristics of patients with or without atosiban administration during frozen embryo transfer
Parameters | Atosiban (n = 162) | Control (n = 227) | p value |
Endometrial thickness (mm) | 10.9 ± 2.7 | 10.6 ± 2.6 | 0.401 |
Protocol | | | 0.567 |
Natural cycle | 20.4% (33/162) | 18.1% (41/227) | |
HRT cycle | 79.6% (129/162) | 81.9% (186/227) | |
ET day (%) | | | 0.118 |
Day 3 ET | 55.6% (90/162) | 63.4% (144/227) | |
Day 5 ET | 44.4% (72/162) | 36.6% (83/227) | |
Style use (%) | 13.6% (22/162) | 8.8% (20/162) | 0.135 |
At least one top-quality embryos transferred (%) | 79.0% (128/162) | 78.9% (179/227) | 0.970 |
Biochemical pregnancy rate (%) | 56.2% (91/162) | 49.8% (113/227) | 0.213 |
Clinical pregnancy rate (%) | 43.8% (71/162) | 39.6% (90/227) | 0.409 |
Ongoing pregnancy rate (%) | 40.7% (66/162) | 35.7% (81/227) | 0.310 |
Live birth rate (%) | 40.7% (66/162) | 33.9% (77/227) | 0.169 |
Miscarriage rate (%) | 7.0% (5/71) | 16.7% (15/90) | 0.066 |
The data are presented as the mean ± standard deviation (SD) and %.
HRT, hormone replacement therapy; ET, embryo transfer
The study population was subsequently stratified into three subgroups: patients with RIF, patients with adenomyosis, and patients with myoma. Compared to those in the control group, the study group exhibited significantly greater ongoing pregnancy rates (RIF, 43.9% vs. 28%, P = 0.032; adenomyosis, 37.7% vs. 22.1%, P = 0.039; myoma, 46.3% vs. 20.4%, P = 0.004) and live birth rates (RIF, 43.9% vs. 26.2%, P = 0.016; adenomyosis, 37.7% vs. 22.1%, P = 0.039; myoma, 46.3% vs. 20.4%, P = 0.004). A lower miscarriage rate was observed in the study group within the RIF subgroup (3.3% vs. 20%, P = 0.041) (Table 3).
Table 3
Basic and cycle characteristics of patients with RIF, adenomyosis or myoma who underwent atosiban administration or not during frozen embryo transfer
Parameter | Recurrent implantation failure | Adenomyosis | Myoma |
| Atosiban | Control | p value | Atosiban | Control | p value | Atosiban | Control | p value |
Patients, n | 66 | 107 | | 69 | 77 | | 54 | 54 | |
Age (years) | 40.1 ± 3.6 | 40.1 ± 4.2 | 0.969 | 38.9 ± 4.1 | 39.1 ± 4.4 | 0.760 | 39.5 ± 3.6 | 40.3 ± 4.6 | 0.332 |
Body mass index (kg/m2) | 22.8 ± 3.1 | 24.2 ± 4.6 | 0.013 | 23.1 ± 3.7 | 24.6 ± 4.7 | 0.028 | 23.0 ± 3.3 | 23.3 ± 3.6 | 0.747 |
Infertility duration (years) | 5.7 ± 3.7 | 5.6 ± 3.2 | 0.855 | 4.5 ± 3.5 | 4.8 ± 3.1 | 0.674 | 4.1 ± 3.2 | 5.1 ± 3.3 | 0.147 |
Types of infertility (%) | | | 0.293 | | | 0.706 | | | 0.176 |
Primary infertility | 45.5% (30/66) | 37.4% (60/107) | | 44.9% (31/69) | 48.1% (37/77) | | 48.1% (26/54) | 61.1% (33/54) | |
Secondary infertility | 54.5% (36/66) | 62.6% (67/107) | | 55.1% (38/69) | 51.9% (40/77) | | 51.9% (28/54) | 38.9% (21/54) | |
Anti-Müllerian hormone (ng/mL) | 2.98 ± 2.64 | 2.51 ± 2.45 | 0.233 | 2.78 ± 2.69 | 2.50 ± 2.77 | 0.535 | 2.84 ± 2.43 | 2.31 ± 2.95 | 0.314 |
Endometrial thickness (mm) | 10.6 ± 3.3 | 10.3 ± 2.6 | 0.562 | 10.8 ± 2.4 | 10.1 ± 2.5 | 0.087 | 10.3 ± 2.3 | 10.4 ± 2.4 | 0.958 |
Protocol | | | 0.952 | | | 0.571 | | | 0.653 |
Natural cycle | 25.8% (17/66) | 26.2% (28/107) | | 23.2% (16/69) | 27.3% (21/77) | | 25.9% (14/54) | 22.2% (12/54) | |
HRT cycle | 74.2% (49/66) | 73.8% (79/107) | | 76.8% (53/69) | 72.7% (56/77) | | 74.1% (40/54) | 77.8% (42/54) | |
Rate of ET day (%) | | | 0.157 | | | 0.743 | | | 0.046 |
Day 3 ET | 60.6% (40/66) | 71.0% (76/107) | | 62.3% (43/69) | 64.9% (50/77) | | 53.7% (29/54) | 72.2% (39/54) | |
Day 5 ET | 39.4% (26/66) | 29.0% (31/107) | | 37.7% (26/69) | 35.1% (27/77) | | 46.3% (25/54) | 27.8% (15/54) | |
Rate of at least one top-quality embryos transferred (%) | 80.3% (53/66) | 75.7% (81/107) | 0.482 | 75.4% (52/69) | 72.7% (56/77) | 0.717 | 77.8% (42/54) | 72.2% (39/54) | 0.505 |
Biochemical pregnancy rate (%) | 56.1% (37/66) | 45.8% (49/107) | 0.190 | 60.9% (42/69) | 39.0% (30/77) | 0.008 | 63.0% (34/54) | 35.2% (19/54) | 0.004 |
Clinical pregnancy rate (%) | 45.5% (30/66) | 32.7% (35/107) | 0.093 | 42.0% (29/69) | 23.4% (18/77) | 0.016 | 51.9% (28/54) | 22.2% (12/54) | 0.001 |
Ongoing pregnancy rate (%) | 43.9% (29/66) | 28.0% (30/107) | 0.032 | 37.7% (26/69) | 22.1% (17/77) | 0.039 | 46.3% (25/54) | 20.4% (11/54) | 0.004 |
Live birth rate (%) | 43.9% (29/66) | 26.2% (28/107) | 0.016 | 37.7% (26/69) | 22.1% (17/77) | 0.039 | 46.3% (25/54) | 20.4% (11/54) | 0.004 |
Miscarriage rate (%) | 3.3% (1/30) | 20.0% (7/35) | 0.041 | 10.3% (3/29) | 5.6% (1/18) | 0.567 | 10.7% (3/28) | 8.3% (1/12) | 0.818 |
The data are presented as the mean ± standard deviation (SD) and %.
RIF, recurrent implantation failure; HRT, hormone replacement therapy; ET, embryo transfer
As depicted in Table 4, a binary logistic regression analysis was conducted to assess the impact of atosiban on live birth rates within the RIF, adenomyosis, and myoma subgroups. Age, BMI, infertility duration, type of infertility, AMH level, endometrial thickness, FET protocol, and day of ET were considered confounding factors in this analysis. Multivariate analysis revealed that the use of atosiban was positively associated with live birth rates in women with RIF (adjusted OR 2.17, 95% CI 1.08–4.35; P = 0.030), adenomyosis (adjusted OR 3.44, 95% CI 1.43– 8.28; P = 0.006), and myoma (adjusted OR 3.11, 95% CI 1.23–7.85; P = 0.016).
Table 4
Logistic regression analyses of factors affecting the live birth rate in patients with RIF, adenomyosis, and myoma
| RIF | Adenomyosis | Myoma |
Adjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value |
Atosiban vs. control | 2.17(1.08–4.35) | 0.030 | 3.44(1.43–8.28) | 0.006 | 3.11(1.23–7.85) | 0.016 |
Age (years) | 0.90(0.81–0.99) | 0.035 | 0.80(0.70–0.91) | 0.001 | 0.91(0.79–1.04) | 0.147 |
BMI (kg/m2) | 0.98(0.89–1.07) | 0.616 | 1.15(1.04–1.28) | 0.008 | 1.02(0.89–1.16) | 0.795 |
Infertility duration (years) | 1.09(0.98–1.21) | 0.124 | 1.11(0.97–1.26) | 0.139 | 1.08(0.94–1.25) | 0.271 |
Types of infertility | 1.32(0.63–2.74) | 0.460 | 0.82(0.36–1.87) | 0.634 | 1.80(0.68–4.76) | 0.233 |
AMH (ng/mL) | 1.04(0.90–1.20) | 0.607 | 0.84(0.71–1.01) | 0.056 | 1.06(0.89–1.26) | 0.497 |
Endometrial thickness (mm) | 1.03(0.91–1.17) | 0.632 | 1.06(0.89–1.27) | 0.508 | 1.04(0.85–1.28) | 0.706 |
HRT vs. Natural cycle | 0.75(0.33–1.73) | 0.505 | 0.40(0.15–1.10) | 0.075 | 0.67(0.22–2.09) | 0.489 |
Day 5 vs. Day 3 ET | 1.56(0.76–3.22) | 0.231 | 1.49(0.61–3.61) | 0.379 | 1.17(0.46–2.94) | 0.747 |
RIF, recurrent implantation failure; OR, odds ratio; CI, confidence interval; BMI, body mass index; AMH, anti-Müllerian hormone; HRT, hormone replacement therapy; ET, embryo transfer
*Adjustment for age, BMI, infertility duration, type of infertility, AMH level, endometrial thickness, FET protocol, and day of ET