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Clinical outcomes after single-versus double-embryo transfers in women with adenomyosis: a retrospective study

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



Adenomyosis affects the outcomes of spontaneous fertility and assisted reproductive technology. The single blastocyst embryo transfer (SBT) policy is an effective strategy known to minimize the risk of multiple pregnancy for non-adenomyosis women. However, little is known about its applicability to women with adenomyosis. The purpose of this study is to compare pregnancy outcomes between SBT, double-blastocyst embryo transfer (DBT), single-cleavage-stage embryo transfer (SET) and double-cleavage-stage embryo transfer (DET) in the frozen–thawed embryo transfer cycles among adenomyosis patients.


This retrospective study was conducted in all frozen–thawed autologous embryo transfer cycles. 393 frozen–thawed embryo transfer cycles performed in adenomyosis patients were enrolled. The major clinical outcomes were implantation rate (IR), clinical pregnancy rate (CPR), miscarriage rate (MR), multiple pregnancy rate (MPR) and live birth rate (LBR).


 The SBT and DBT groups achieved higher IR (P < 0.001), CPR (P = 0.017), LBR (P = 0.040) and lower MR (P = 0.020) than the SET and DET groups. But the SBT and DBT groups achieved similar CPR and LBR. The SBT and SET groups achieved lower MPR (P < 0.001) than the DBT and DET groups. The average birth weight (BW) of SBT groups was higher than the DBT and DET groups (P = 0.016). When compared with SBT group, low-birth-weight infants were significantly higher with DBT and DET.


When performing frozen–thawed embryo transfer cycles among adenomyosis patients, the SBT group has similar IR, CPR, MR, LBR but lower MPR compared to the DBT group. Therefore, SBT might be offered as standard practice.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



Anti-Mullerian hormone


The American Society for Reproductive Medicine


Body mass index


Biochemical pregnancy rate


Birth weight


Controlled ovarian hyperstimulation


Controlled ovarian stimulation


Clinical pregnancy rate


Double-blastocyst embryo transfer


Double-cleavage-stage embryo transfer


Endothelial nitric oxide synthase


Gonadotropin-releasing hormone agonist


Human chorionic gonadotropin


Hormone replacement treatment


Intracytoplasmic sperm injection


Implantation rate


In vitro fertilization


Live birth rate


Multiple pregnancy rate


Miscarriage rate


Preterm birth rate


Single-blastocyst embryo transfer


Single-cleavage-stage embryo transfer


Vascular endothelial growth factor


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This work was supported by the Science and Technology Program of Guangdong Province (2014A020213002) and the Free Application Project of Guangdong Natural Science Foundation (2015A030313131).

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Authors and Affiliations



JG and ZZ designed the study. ML and JH were responsible for the data collection and checking. JG performed the data analysis and manuscript drafting. JP, MW and XL dealt with data visualization. HZ supervised the project administration.

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Correspondence to Haitao Zeng.

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The authors have no conflicts of interest to declare.

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This study was approved by the ethics committee of the Sixth Affiliated Hospital of Sun Yat-sen University.

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The requirement of informed consent was waived by the ethics committee because of the retrospective nature of the study.

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Guo, J., Zeng, Z., Li, M. et al. Clinical outcomes after single-versus double-embryo transfers in women with adenomyosis: a retrospective study. Arch Gynecol Obstet 304, 263–270 (2021).

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