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Objective <p>To identify the key factors associated with biochemical pregnancy loss (BPL) following single blastocyst transfer in frozen embryo transfer (FET) cycles utilizing hormone replacement therapy (HRT).</p> Methods <p>This retrospective cohort study included 18,937 HRT-FET cycles conducted at the Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between January 2012 and November 2024. Pregnancy outcomes were determined by serum β-human chorionic gonadotropin (β-hCG) levels and transvaginal ultrasound. A total of 630 BPL cases and 9,644 clinical pregnancies (CP) were analyzed. Univariate analysis and smooth curve fitting were performed on factors such as patient age, Body Mass Index (BMI) , antral follicle count (AFC), anti-Müllerian hormone (AMH), baseline Follicle-Stimulating Hormone (FSH), embryo quality, blastocyst grading, endometrial thickness (EMT), and hormonal levels prior to endometrial transformation. Multivariate logistic regression was used to identify independent predictors of BPL, adjusting for potential confounders including age, BMI, FSH, and number of transfer cycles.</p> Results <p>Univariate analysis revealed that increased maternal and paternal age, higher BMI, elevated estradiol levels, and Day 6 or poor-quality blastocyst transfers were positively associated with BPL (P &lt; 0.05). Conversely, greater AFC, thicker endometrium, and higher Luteinizing Hormone (LH) levels prior to transformation were associated with lower BPL risk. After adjustment, endometrial thickness emerged as a significant independent predictor (OR = 0.86, 95% CI: 0.79–0.93, P = 0.0002). A threshold of 10 mm was identified, below which the incidence of BPL significantly increased.</p> Conclusion <p>In HRT-FET single blastocyst transfer cycles, insufficient endometrial thickness is a critical risk factor for biochemical pregnancy loss. Optimization of endometrial preparation may improve clinical outcomes.</p>

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Analysis of related factors of biochemical pregnancy loss in single blastocyst transfer in the hormone replacement protocol frozen-thawed cycle

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月17日

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  • Jie Mei,
  • Dajun Dong,
  • Qi Fu,
  • Lijuan Li,
  • Chenyang Huang,
  • Yingchun Zhu

摘要

Objective

To identify the key factors associated with biochemical pregnancy loss (BPL) following single blastocyst transfer in frozen embryo transfer (FET) cycles utilizing hormone replacement therapy (HRT).

Methods

This retrospective cohort study included 18,937 HRT-FET cycles conducted at the Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University between January 2012 and November 2024. Pregnancy outcomes were determined by serum β-human chorionic gonadotropin (β-hCG) levels and transvaginal ultrasound. A total of 630 BPL cases and 9,644 clinical pregnancies (CP) were analyzed. Univariate analysis and smooth curve fitting were performed on factors such as patient age, Body Mass Index (BMI) , antral follicle count (AFC), anti-Müllerian hormone (AMH), baseline Follicle-Stimulating Hormone (FSH), embryo quality, blastocyst grading, endometrial thickness (EMT), and hormonal levels prior to endometrial transformation. Multivariate logistic regression was used to identify independent predictors of BPL, adjusting for potential confounders including age, BMI, FSH, and number of transfer cycles.

Results

Univariate analysis revealed that increased maternal and paternal age, higher BMI, elevated estradiol levels, and Day 6 or poor-quality blastocyst transfers were positively associated with BPL (P < 0.05). Conversely, greater AFC, thicker endometrium, and higher Luteinizing Hormone (LH) levels prior to transformation were associated with lower BPL risk. After adjustment, endometrial thickness emerged as a significant independent predictor (OR = 0.86, 95% CI: 0.79–0.93, P = 0.0002). A threshold of 10 mm was identified, below which the incidence of BPL significantly increased.

Conclusion

In HRT-FET single blastocyst transfer cycles, insufficient endometrial thickness is a critical risk factor for biochemical pregnancy loss. Optimization of endometrial preparation may improve clinical outcomes.