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Background <p>Pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles are still unsatisfactory in assisted reproductive technology, and poor endometrial receptivity is a core barrier. The efficacy, effect modifiers and mechanisms of growth hormone (GH) intrauterine perfusion for FET remain unclear. This study aimed to investigate the association of GH intrauterine perfusion with pregnancy outcomes, identify key beneficiaries and preliminarily explore the potential clinical pathway for clinical precise application.</p> Methods <p>A single-center retrospective cohort study was performed with 4060 FET cycles from January 2023 to December 2024. Cycles were divided into GH perfusion group and control group. One-to-one propensity score matching was used to balance 13 covariates, and 900 cycles were included. Generalized estimating equations, interaction tests, subgroup analyses, exploratory factor analysis and Bootstrap mediation analysis were adopted, and sensitivity analysis was conducted to verify result stability.</p> Results <p>Baseline covariates were well balanced after matching. The GH perfusion group had significantly higher clinical pregnancy rate and live birth rate, and lower spontaneous abortion rate. GH perfusion was independently associated with higher odds of clinical pregnancy and live birth. Patients younger than 35 years, with BMI ≥ 24&#xa0;kg/m², AMH ≤ 1.1 ng/ml, thin endometrium and blastocyst transfer benefited more. Endometrial thickness-blood flow factor played a partial mediating role, and sensitivity analysis supported the robustness of results.</p> Conclusions <p>GH intrauterine perfusion was associated with better pregnancy outcomes among FET patients in this cohort. Overweight/obese patients, those with diminished ovarian reserve or thin endometrium, and blastocyst transfer recipients appeared to gain greater relative benefit. Correlation analysis suggested this intervention might be associated with higher live birth rates through changes in endometrial thickness and blood flow profiles, while full underlying mechanisms require further investigation.</p>

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Growth hormone intrauterine perfusion improves pregnancy outcomes in frozen-thawed embryo transfer cycles and identifies effect modifiers: a propensity score-matched single-center retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Qian Zhang,
  • Sihua Li,
  • Zhongyu Zhao,
  • Tingting Yu,
  • Kaixuan Sun,
  • Bolun Wang,
  • Yuexin Yu

摘要

Background

Pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles are still unsatisfactory in assisted reproductive technology, and poor endometrial receptivity is a core barrier. The efficacy, effect modifiers and mechanisms of growth hormone (GH) intrauterine perfusion for FET remain unclear. This study aimed to investigate the association of GH intrauterine perfusion with pregnancy outcomes, identify key beneficiaries and preliminarily explore the potential clinical pathway for clinical precise application.

Methods

A single-center retrospective cohort study was performed with 4060 FET cycles from January 2023 to December 2024. Cycles were divided into GH perfusion group and control group. One-to-one propensity score matching was used to balance 13 covariates, and 900 cycles were included. Generalized estimating equations, interaction tests, subgroup analyses, exploratory factor analysis and Bootstrap mediation analysis were adopted, and sensitivity analysis was conducted to verify result stability.

Results

Baseline covariates were well balanced after matching. The GH perfusion group had significantly higher clinical pregnancy rate and live birth rate, and lower spontaneous abortion rate. GH perfusion was independently associated with higher odds of clinical pregnancy and live birth. Patients younger than 35 years, with BMI ≥ 24 kg/m², AMH ≤ 1.1 ng/ml, thin endometrium and blastocyst transfer benefited more. Endometrial thickness-blood flow factor played a partial mediating role, and sensitivity analysis supported the robustness of results.

Conclusions

GH intrauterine perfusion was associated with better pregnancy outcomes among FET patients in this cohort. Overweight/obese patients, those with diminished ovarian reserve or thin endometrium, and blastocyst transfer recipients appeared to gain greater relative benefit. Correlation analysis suggested this intervention might be associated with higher live birth rates through changes in endometrial thickness and blood flow profiles, while full underlying mechanisms require further investigation.