Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching

BMC Pregnancy and Childbirth

Wei-Lin Zheng¹  Mark Liu¹  Pin-Yao Lin²  Chien-Hong Chen²  Chun-Chia Huang²  Chun-I Lee³  Maw-Sheng Lee³  Han-Chih Hsieh⁴  Jia-Ying Su⁴  En-Yu Lai⁴  Yen-Tsung Huang⁴  Yi-Ting Huang⁵ 

[1] Binflux Inc, 4F.-1, No. 9, Dehui St., 104, Taipei, Taiwan;Division of Infertility, Lee Women’s Hospital, No. 30-6, Section 1, Changping Road, 406, Taichung, Taiwan;Institute of Medicine, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., 40201, Taichung, Taiwan;Department of Obstetrics and Gynecology, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., 40201, Taichung, Taiwan;Division of Infertility, Lee Women’s Hospital, No. 30-6, Section 1, Changping Road, 406, Taichung, Taiwan;Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, 11529, Taipei, Taiwan;Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, 11529, Taipei, Taiwan;Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, 100, Taipei, Taiwan;

关键词: Blastocyst;    Cleavage-stage transfer;    In vitro fertilization;    Embryo transfer;    Indication bias;   

DOI  :  10.1186/s12884-021-04013-y

来源: Springer

【 摘 要 】

BackgroundFor women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication.MethodsWe conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women’s Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH).ResultsOur analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant.ConclusionsWe conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.

【 授权许可】

CC BY