Objective: To assess the relationship between endometrial thickness and live birth rates in fresh embryo transfer and frozen embryo transfer with and without preimplantation genetic testing.
Design: Retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS).
Subjects: Autologous IVF fresh and frozen embryo transfer cycles initiated in 2019-2020.
Exposure: Endometrial thickness measured in millimeters.
Main Outcome Measure: Live birth rate.
Results: A total of 244,001 embryo transfer cycles met inclusion criteria (100,419 frozen embryo transfer (FET) cycles with preimplantation genetic testing (PGT), 96,249 FET cycles without PGT, and 47,333 fresh embryo transfer cycles). An increase in endometrial thickness was associated with an increase in live birth rate among all cycle types until a threshold of 9mm, after which there was minimal increase in live birth rate. Prior to 9mm, each 1mm increase in endometrial thickness was associated with a relative increase in the odds of live birth by 19% for frozen embryo transfer with PGT (aOR: 1.19, 95% CI: 1.66-1.22), 13% for frozen embryo transfer without PGT (aOR: 1.13, 95% CI: 1.09-1.16), and 15% for fresh embryo transfer (aOR: 1.15, 95% CI: 1.09-1.20).
Conclusion: Live birth rate increased with an increase in endometrial thickness for fresh and frozen transfer with or without PGT until a threshold of 9mm, beyond which the live birth rate plateaued. There was no thickness above 9mm associated with a decrease in live birth.
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