Complex Uterine Cavity Abnormalities Increase the Risk of Miscarriage in In Vitro Fertilization/Intracytoplasmic Sperm Injection in Fresh Cycle-Assisted Pregnancies

Study Objective: Any abnormality of the uterine cavity can result in reduced endometrial receptivity, which negatively affects embryo implantation and leads to lower clinical pregnancy rates. The effects of improved uterine cavity environment on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) treatment outcome are unclear. This study aimed to investigate the impact of improved uterine cavity abnormalities on the pregnancy outcomes of infertile patients undergoing IVF/ICSI-ET. Design: Retrospective study. Setting: Single-center. Patients: Women with infertility who underwent fresh cycles of IVF/ICSI-ET. Interventions: We retrospectively analyzed the clinical data of 31 057 cycles of women with infertility undergoing IVF/ ICSI-ET with hysteroscopy and treated at the First Affiliated Hospital of Zhengzhou University Reproductive Medicine Center from August 2009 to May 2018. According to the previous condition of their uterine cavity, patients were divided into the normal uterine cavity, single uterine cavity abnormality, and complex uterine cavity abnormality groups. Differences in general conditions and pregnancy-assisted outcomes were compared among the groups, which were screened according to propensity score matching. Measurements and Main Results: In 3005 cycles after propensity score matching screening, there were no statistically significant differences in the implantation and clinical pregnancy rates of patients with successfully treated uterine cavity abnormalities and lesions (p > .05). The miscarriage rate was significantly higher in the complex uterine cavity abnormality group than in the normal (p = .001) and single uterine cavity abnormality groups (p = .002). Logistic regression analysis showed that the female partner's age (adjusted odds ratio, 1.12; 95% confidence interval, 1.05-1.19; p = .001) and history of intrauterine adhesions (adjusted odds ratio, 1.44; 95% confidence interval, 1.12-1.85; p = .005) were independent risk factors for miscarriage. Conclusion: The age of the female partner and history of intrauterine adhesions increased the miscarriage rate in patients undergoing IVF/ICSI-ET. (C) 2022 AAGL.

Automated summary

Improving uterine cavity abnormalities has little impact on the pregnancy outcomes of patients undergoing IVF/ICSI-ET, but the miscarriage rate is higher in the complex uterine cavity abnormality group. Female partner's age and history of intrauterine adhesions are independent risk factors for miscarriage.