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Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study

  • Assisted Reproduction Technologies
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Abstract

Purpose

To identify the independent predictors of live birth following IVF, and to assess the role of cohort-specific parameters, including antral follicle count (AFC), the number of oocytes retrieved, the total number of embryos, and the total number of good-quality embryos, in fresh IVF cycles.

Methods

A retrospective cohort study of 2,525 infertile women undergoing IVF between 2002 and 2007. The hypothesis that the number and quality of embryos transferred capture the effects previously attributed to cohort-specific variables was examined using mediation analysis and spline analysis. Independent predictors were identified by a bootstrap algorithm. Multivariable logistic regression was performed and the proportion of explained variation was measured to compare the relative importance of transfer-specific vs. cohort-specific predictors.

Results

The number of good-quality embryos transferred and progesterone level on the day of hCG administration ranked as the two most important predictors of live birth. Prospects of pregnancy started to decrease after progesterone level exceeded 0.6 ng/ml. The achievement of live birth in a fresh IVF cycle is primarily determined by the number and quality of embryos transferred, rather than by embryo cohort-specific variables.

Conclusions

The associations between cohort-specific variables and live birth in a fresh IVF cycle are completely mediated by the quality of embryos transferred. Progesterone level on the day of hCG administration is an independent predictor of pregnancy and merits further investigation.

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Acknowledgments

All authors report no conflicts of interest and no financial support.

Conflict of interest and sources of funding statement

All authors report no financial and other conflict of interest and no funding support relevant to the subject of this article.

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Authors and Affiliations

  1. Reproductive Medicine Center, Women and Children’s Hospital of Guangdong Province, 13 GuangYuanXi RD, Guangzhou, China, 510000

    Qianfang Cai

  2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Fei Wan & Dina Appleby

  3. Reproductive Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 450052

    Linli Hu

  4. Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430030

    Hanwang Zhang

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  1. Qianfang Cai
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  2. Fei Wan
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  4. Linli Hu
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Correspondence to Qianfang Cai.

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Authors’ roles

Qianfang Cai: substantial contributions to conception and design, acquisition of data, drafting and revising the article and final approval of the version to be published.

Fei Wan: substantial contributions to analysis and interpretation of data, manuscript drafting and final approval of the version to be published.

Dina Appleby: substantial contributions to revising the article critically for important intellectual content and final approval of the version to be published.

Linli Hu: substantial contributions to revising the article critically for important intellectual content and final approval of the version to be published.

Hanwang Zhang: substantial contributions to revising the article critically for important intellectual content and final approval of the version to be published.

Capsule This retrospective study identified nine predictors of live birth in fresh IVF cycles and determined that the two most important predictors were the number of good-quality embryos transferred and progesterone level on the day of hCG administration.

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Cai, Q., Wan, F., Appleby, D. et al. Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study. J Assist Reprod Genet 31, 185–194 (2014). https://doi.org/10.1007/s10815-013-0129-4

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  • DOI: https://doi.org/10.1007/s10815-013-0129-4

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