Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching

doi:10.1186/s12884-021-04013-y

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/23297

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/23297

Title:	Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching
Authors:	Hsieh, HC;Lee, CI;Lai, EY;Su, JY;Huang, YT;Zheng, WL;Chen, CH;Huang, CC;Lin, PY;Lee, MS;Liu, M;Huang, YT
Keywords:	Blastocyst;Cleavage-stage transfer;In vitro fertilization;Embryo transfer;Indication bias
Date:	2021
Issue Date:	2022-08-05T09:35:01Z (UTC)
Publisher:	BMC
Abstract:	Background For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication. Methods We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women's Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH). Results Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant. Conclusions We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.
URI:	http://dx.doi.org/10.1186/s12884-021-04013-y https://www.webofscience.com/wos/woscc/full-record/WOS:000685133400001 https://ir.csmu.edu.tw:8080/handle/310902500/23297
Relation:	BMC PREGNANCY AND CHILDBIRTH ,2021,v21,issue 1
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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