Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes

Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes Shahryar Kavoussi, Amelia Azadi, Kelley Yiling You, Negar Farzaneh, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8157479/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background To determine whether hysteroscopic polypectomy with a tissue removal system affects frozen embryo transfer outcomes among a study population that underwent euploid single frozen blastocyst transfer with endometrial preparation via exogenous estradiol administration when compared with those without endometrial polyps who underwent single frozen blastocyst transfer with same type of endometrial preparation. Methods Retrospective chart review. Data from first frozen embryo transfer charts were reviewed. After inclusion and exclusion criteria, data abstracted from 218 cases. Group A: women who underwent hysteroscopic polypectomy via a tissue removal system within 5 months preceding a first euploid single frozen embryo transfer cycle (n = 60). Group B: women who did not have hysteroscopic polypectomy since endometrial polyps were ruled out prior to a first euploid single frozen embryo transfer cycle (n = 158). The primary outcome was live birth rate (LBR). Secondary outcome measures were positive pregnancy test rate (PPR), clinical pregnancy rate (CPR), and spontaneous miscarriage (SAB) rate via bivariate associations and multivariable logistic regression analyses. Results Bivariate analyses showed no differences between groups in LBR (A: 58.3%, 35/60 and B: 51.3%, 81/158, p-value = 0.43), PPR (A: 75.0%, 45/60 and 74.1%, 117/158; p-value = 0.98), CPR (A: 71.7%, 43/60 and B: 62.0%, 98/158; p-value = 0.24), or SAB rate (A: 22.2%, 10/45 and 30.8%, 36/117; p = 0.38). Multivariate multivariable analysis showed no difference in primary and secondary outcomes. Conclusions In patients undergoing single frozen embryo transfer with trophectoderm-tested euploid blastocysts, hysteroscopic polypectomy via a tissue removal system did not impact PPR, SAB rate, CPR, and LBR. Among patients with a positive pregnancy test resulting from euploid single frozen embryo transfer, previous hysteroscopic polypectomy via the tissue removal system predicted CPR but was not a predictor of LBR. Plain Engligh Summary: Our study indicates that hysteroscopic polyp removal, specifically with a tissue removal system, does not affect subsequent frozen embryo transfer outcomes when compared with cases of frozen embryo transfer in women without endometrial polyps when one chromosomally normal blastocyst stage embryo is transferred to the uterus within a short period of time thereafter. Hysteroscopy Polypectomy Tissue removal system Morcellator Frozen embryo transfer Background Endometrial polyps (EP) are lesions within the uterine cavity that originate from endometrial glands and stromal cells. Although the number, size, and shape of EP within the uterine cavity can vary from case to case, these endometrial lesions, in general, have been found to be associated with decreased pregnancy rates and increase spontaneous miscarriage (SAB) rates [ 1 ]. Mechanisms of action of EP impeding embryo implantation include the space-occupying nature of some lesions, local inflammation, and aberrant glycodelin production [ 2 ], any or all of which may alter endometrial receptivity [ 3 , 4 ]. Hysteroscopic polypectomy is associated with optimization of natural pregnancy attempts and intrauterine insemination cases [ 5 , 6 ] and in the realm of assisted reproductive technologies, previous studies have shown that removal of EP via hysteroscopy before an in vitro fertilization (IVF) cycle improves fresh embryo transfer (ET) outcomes as well as frozen embryo transfer (FET) outcomes [ 7 ]. In addition, the time interval between hysteroscopic polypectomy and embryo transfer does not affect outcomes in cases of fresh ET or FET [ 8 – 11 ]. The hysteroscopic polypectomies in the overwhelming majority of these publications were performed with monopolar resectoscopes or hysteroscopic mechanical graspers. A previous study by our group explored FET outcomes after hysteroscopic polypectomy specifically via the use of a tissue removal system (TRS) which morcellates EP, to determine if the use of a TRS had any positive or negative effect on outcomes as compared with women without EP who underwent FET [ 12 ]. There was no difference in the live birth rate (LBR) primary outcome or secondary outcomes such as implantation rate (IR), clinical pregnancy rate (CPR), and SAB rate between the study group of those who had hysteroscopic morcellation of EP prior to FET when compared with those who did not have EP and underwent FET. In that study, both untested blastocysts and preimplantation genetic testing for aneuploidy (PGT-A)-tested euploid blastocysts were included. In addition, single and double FET cases as well as FET cycles with different endometrial preparation protocols were included. A more recent publication compared the use of a TRS as compared with the use of scissors or graspers for hysteroscopic removal of EP and found no differences in IVF outcomes [ 13 ]; however, cases with different endometrial preparation protocols for FET were included, both fresh ET and FET cases were included together in analyses, 1–2 embryos were transferred, and both cleavage stage and blastocyst stage embryos were transferred in cases. To our knowledge, the aforementioned two studies are the only articles in the literature that examine the effects of TRS on ET outcomes, and the aim of the current validation study was to further and more precisely evaluate the potential effects of hysteroscopic polypectomy with a TRS modality on FET outcomes among a more homogenous study population that specifically underwent euploid single frozen blastocyst transfer, thereby accounting for some of the limitations in previous studies. Methods Data collection was via retrospective chart review, consisting of first FET cycles (n = 218) between January 2021 and May 2024 at one fertility center. Criteria for inclusion in the study were female patients ages 18 to 44 years, any causes for infertility, autologous oocytes for IVF, and single embryo transfer cases with euploid results from trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A). Cases of donor oocyte-derived embryos, donor embryos, low-mosaic PGT-A results, as well as cases of hysteroscopic lysis of intrauterine adhesions, myomectomy, and/or those with congenital uterine anomalies were excluded from the study. The study protocol was submitted to St. David’s Healthcare-Institutional Board (IRB), which granted IRB exemption due to the de-identified retrospective nature of the data collected. Subjects in Group A were those with a history of hysteroscopic polypectomy via a TRS modality (TruClear Soft Tissue Shaver Mini, Medtronic) within the 5 months preceding a first FET cycle (n = 60). Those in Group B were subjects who did not have hysteroscopic polypectomy since they had EP ruled out prior to a first FET cycle (n = 158). FET protocol for patients included in this study involved endometrial preparation with exogenous estradiol (E2) in the form of E2 patches, E2 tablets administered orally or vaginally for two to three weeks, or a combination thereof, after which midcycle transvaginal sonogram (TVS) was performed to measure endometrial thickness. Similar to our previous study’s methods [ 12 ], when the midcycle TVS showed an endometrial thickness of 7 mm or greater and if a serum progesterone (P4) level (Roche COBAS® Electrochemiluminescent immunoassay run by Clinical Pathology Laboratories, Austin, TX) was less than 3.0 ng/mL on that day, luteal progesterone supplementation (LPS) commenced in the morning one to two days later in the form of either progesterone in oil (PIO) intramuscular injections at a once daily dose of 50 mg, Endometrin® 100 mg insert per vagina three times daily, or alternatively (in two cases), a combination of PIO 50 mg intramuscular injection every three days and daily Endometrin® 100 mg insert per vagina three times a day. Euploid blastocyst thaw and subsequent single frozen embryo transfer (SFET) were performed on the sixth day of LPS. SFET was performed per the guidelines for number of embryos to transfer, as established by the American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) [ 14 ]. As in our previous study [ 12 ], outcome measures per group were the primary outcome LBR which was the number of live births divided by the number of embryo transfers, and secondary outcomes were positive pregnancy test rate (PPR) which was the number of positive serum quantitative human Chorionic Gonadotropin (hCG) tests resulting from FET divided by the number of embryo transfers, CPR which was the number of gestational sacs at TVS between 6–7 weeks of gestation divided by the sample size, and SAB rate which was the number of patients who had pregnancy loss before 20 weeks of gestation divided by the number of pregnant patients. Statistical analyses for bivariate associations were performed with t-tests for continuous variables and Pearson’s chi-square test was used to examine such associations for categorical variables. Multivariate logistic regression was conducted to identify predictors of primary and secondary outcomes, while adjusting for potential confounders. Predictor variables were selected based on clinical relevance and their potential impact on the outcome. Multivariate analyses were performed using MATLAB version 2024a. P-value < 0.05 was the threshold for statistical significance. Results Characteristics and IVF outcomes of women in Group (A) and (B) are shown in Table 1 . Bivariate analyses showed that there were no differences between Group A and Group B for average female age, parity, body mass index, Anti-Müllerian Hormone (AMH) level, use of progesterone in oil injections versus Endometrin® vaginal inserts, midcycle serum estradiol level, or midcycle serum progesterone level. There was a significant difference in average endometrial thickness at midcycle between groups (Group A: 10.1 mm and Group B: 9.4 mm; p-value = 0.3). In terms of the primary outcome, the LBR for Groups A and B were 58.3% (35/60) and 51.3% (81/158), respectively, which were not statistically different (p-value = 0.43). In terms of secondary outcome measures, there was no difference in PPR between Groups A and B at 45/60 (75.0%) and 117/158 (74.1%), respectively (p-value = 0.98), CPR between Groups A and B at 43/60 (71.7%) and 98/158 (62.0%), respectively (p-value = 0.24), or SAB rate between Groups A and B at 10/45 (22.2%) and 36/117 (30.8%), respectively (p = 0.38). Table 1 Characteristics and pregnancy outcomes of Group (A): women who underwent hysteroscopic polypectomy with tissue removal system prior to a first FET versus Group (B): women who did not have hysteroscopic polypectomy due to no polyps prior to a first FET. Characteristics Group A (n = 60) Group B (n = 158) P-value Female age (years) 37.3 37.0 0.60 Parity 0.4 0.5 0.66 BMI 26.4 26.9 0.63 AMH level (ng/mL) 2.7 3.5 0.07 PIO injections Endometrin vaginal inserts 51 9 138 20 0.82 Endometrial thickness (mm) 10.1 9.4 0.03 Midcycle E2 (pg/mL) 360.3 374.4 0.77 Midcycle P4 (ng/mL) 0.3 0.3 0.89 Live birth rate 35/60 (58.3%) 81/158 (51.3%) 0.43 Positive pregnancy test rate 45/60 (75.0%) 117/158 (74.1%) 0.98 Miscarriage rate 10/45 (22.2%) 36/117 (30.8%) 0.38 Clinical pregnancy rate 43/60 (71.7%) 98/158 (62.0%) 0.24 Means for continuous variables were assessed via t-test. Bivariate analyses P-values were assessed via Pearson’s chi square test with Yates’ correction. AMH = Antimüllerian hormone BMI = Body Mass Index E2 = estradiol FET = frozen embryo transfer PIO = Progesterone in oil P4 = Progesterone Multivariate analyses in Table 2 showed that the covariates age, gravity, parity, height, weight, body mass index (BMI), AMH level, midcycle E2 level, midcycle P4 level, inner cell mass grade, expansion grade, and polyp removed via hysteroscopy did not predict primary or secondary outcomes; however, the following variables trended towards being significant predictors for outcomes: AMH and PPR (p = 0.08), endometrial thickness and CPR (p = 0.06), midcycle P4 and SAB rate (p = 0.09), expansion grade and PPR (p = 0.06), trophectoderm grade and LBR (p = 0.07), as well as polyp removed via hysteroscopy and CPR (p = 0.07). Table 3 showed that among patients in the dataset with a positive pregnancy test (n = 162), trophectoderm grade was a predictor of CPR (p = 0.048) and LBR (p = 0.02); removal of polyps via hysteroscopy predicted CPR (p = 0.04) but was not a predictor of LBR. Further analysis showed that none of the covariates predicted LBR among those with clinical pregnancy, as shown in Table 4 . Table 2 Multivariate analyses of covariates and FET outcomes positive pregnancy test rate (PPR), clinical pregnancy rate (CPR), live birth rate (LBR), and spontaneous miscarriage (SAB) rate. * denotes significant predictors (p-value < 0.05), while + denotes near-significant predictors (p-value < 0.1). PPR CPR LBR SAB Overall sample size 218 218 218 162 Count of positive samples 162 141 116 46 Intercept -3.9804 (0.80) -12.5344 (0.39) -8.3836 (0.55) 4.1095 (0.83) Age 0.0187 (0.68) 0.0184 (0.66) -0.0170 (0.68) 0.0416 (0.42) Gravity -0.0312 (0.82) 0.0138 (0.91) -0.0409 (0.74) 0.0473 (0.78) Parity 0.4083 (0.16) 0.2330 (0.36) 0.1804 (0.44) 0.1266 (0.68) Height (inches) 0.0429 (0.85) 0.1539 (0.47) 0.0828 (0.69) -0.0451 (0.87) Weight (pounds) -0.0184 (0.68) -0.0393 (0.35) -0.0331 (0.42) 0.0299 (0.60) BMI 0.1117 (0.68) 0.2643 (0.30) 0.2242 (0.37) -0.2182 (0.53) AMH (ng/mL) 0.1270 (0.08) + 0.0444 (0.43) 0.0527 (0.33) 0.0198 (0.76) -0.1333 (0.12) -0.1528 (0.06) + -0.1635 (0.04)* 0.1556 (0.14) E2 (pg/mL) -0.0004 (0.43) -0.0003 (0.59) 0.0002 (0.72) -0.0007 (0.29) P4 (ng/mL) -0.0364 (0.98) 1.4242 (0.27) 1.6426 (0.18) -2.9390 (0.09) + Day of Blastocyst Development (Day 5, 6, or 7) -0.0610 (0.87) 0.0268 (0.94) 0.3263 (0.36) -0.5408 (0.25) Expansion Grade 0.4380 (0.06) + 0.2323 (0.28) 0.2710 (0.20) 0.0080 (0.98) Inner Cell Mass (A:1, B:0) 1.0825 (0.26) 1.0541 (0.27) 0.4935 (0.61) 0.7520 (0.60) 0.2177 (0.63) 0.5614 (0.18) 0.7871 (0.07) + -1.2182 (0.02)* Polyp removed via H’Scope 0.2517 (0.50) 0.6366 (0.07) + 0.4593 (0.16) -0.6012 (0.18) AMH = Antimüllerian hormone BMI = Body Mass Index E2 = estradiol FET = frozen embryo transfer P4 = Progesterone Table 3 Multivariate analyses of covariates and FET outcomes clinical pregnancy rate (CPR) as well as live birth rate (LBR) among patients with a positive pregnancy test. * denotes significant predictors. CPR LBR Overall sample size 162 162 Count of positive samples 141 116 Intercept -17.1818 (0.51) -4.1095 (0.83) Age 0.0128 (0.85) -0.0416 (0.42) Gravity 0.0694 (0.77) -0.0473 (0.78) Parity -0.2509 (0.56) -0.1266 (0.68) Height (inches) 0.2615 (0.51) 0.0451 (0.87) Weight (pounds) -0.0603 (0.46) -0.0299 (0.60) BMI 0.4451 (0.37) 0.2182 (0.53) AMH (ng/mL) -0.0751 (0.35) -0.0198 (0.76) Endometrial thickness (mm) -0.1298 (0.36) -0.1556 (0.14) E2 (pg/mL) 0.0002 (0.86) 0.0007 (0.29) P4 (ng/mL) 4.6074 (0.09) 2.9390 (0.09) Day of Blastocyst Development (Day 5, 6, or 7) 0.0184 (0.98) 0.5408 (0.25) Expansion Grade -0.4666 (0.27) -0.0080 (0.98) Inner Cell Mass (A:1, B:0) -0.1500 (0.92) -0.7520 (0.60) Trophectoderm (A:1, B:0) 1.3328 (0.048)* 1.2182 (0.02)* Polyp removed via H’Scope 1.6714 (0.04) * 0.6012 (0.18) AMH = Antimüllerian hormone BMI = Body Mass Index E2 = estradiol FET = frozen embryo transfer P4 = Progesterone Table 4 Multivariate analyses of covariates and FET outcomes live birth rate (LBR) among patients with clinical pregnancy. LBR Overall sample size 141 Count of positive samples 116 Intercept 120.3720 (1.00) Age -0.0830 (0.24) Gravity -0.0527 (0.80) Parity -0.1667 (0.66) Height (inches) -0.2117 (0.55) Weight (pounds) 0.0152 (0.82) BMI -0.0930 (0.83) AMH (ng/mL) 0.0489 (0.64) Endometrial thickness (mm) -0.1437 (0.25) E2 (pg/mL) 0.0009 (0.31) P4 (ng/mL) 1.8807 (0.37) Day of Blastocyst Development (Day 5, 6, or 7) 0.9112 (0.19) Expansion Grade 0.2411 (0.49) Inner Cell Mass (A:1, B:0) -107.7046 (1.00) Trophectoderm (A:1, B:0) 0.9095 (0.17) Polyp removed via H’Scope 0.0202 (0.97) AMH = Antimüllerian hormone BMI = Body Mass Index E2 = estradiol FET = frozen embryo transfer P4 = Progesterone Discussion Hysteroscopic polypectomy has been shown to optimize IVF outcomes in the existing literature [ 12 ]. Previous studies have demonstrated that the time interval between hysteroscopic polypectomy and fresh ET does not impact outcomes [ 9 , 10 ]. Furthermore, other studies have suggested that similar time intervals between hysteroscopic polypectomy and FET do not affect outcomes either [ 11 , 12 , 15 , 16 ]. One of two previous publications which explored hysteroscopic polypectomy with the use of a TRS technology showed no difference in FET outcomes such as IR, CPR, SAB rates, and LBR as compared to FET outcomes in those without EP [ 12 ]. That study had limitations such as the inclusion of untested blastocysts as well as PGT-A tested euploid blastocysts, SFET and double FET cycles, and FET cycles with modified natural protocols as well as those with exogenous estradiol for endometrial preparation. In another publication which compared the use of a TRS as compared with the use of scissors or graspers for hysteroscopic removal of EP which showed no differences in IVF outcomes [ 13 ], different endometrial preparation protocols for FET were included, both fresh ET and FET cases were included together in analyses, 1–2 embryos were transferred per case, and both cleavage stage as well as blastocyst stage embryos were transferred in cases. In this current study, which included only PGT-A tested euploid blastocysts, SFET, and cycles with exogenous E2 for endometrial preparation, we aimed to further and more precisely examine the potential effects of hysteroscopic polypectomy via a TRS, as compared with cases of women with no EP, on FET outcomes and again found no difference in PPR, CPR, SAB rates, and LBR. The significantly thicker endometrial lining at midcycle in the study group may theoretically be due to remodeling of the endometrial lining after polypectomy or simply by chance. Since among patients with a positive pregnancy test in our study, hysteroscopic polypectomy was a predictor of CPR but did not predict LBR, it is possible that polyp removal may lead to clinical pregnancy in cases that otherwise would have been a chemical pregnancy and not progressed further due to potential endometrial enhancement, although the ultimate goal of live birth is not improved. Study limitations include the biases that are inherent to retrospective studies and the small sample sizes of study and control groups. Conclusions To our knowledge, this is the first study to evaluate the effects of hysteroscopic polyp removal with a TRS in cases of euploid SFET. In this validation study of SFET with trophectoderm-tested euploid blastocysts, hysteroscopic polypectomy via a TRS did not impact FET outcomes such as PPR, SAB rate, CPR, and LBR when compared with women who did not have EP and underwent euploid SFET, further and more precisely supporting the concept explored in two previous publications [ 12 , 13 ] that morcellation of endometrial polyps does not impact subsequent FET results. Among patients with a positive pregnancy test resulting from euploid SFET, polyp removal via hysteroscopy predicted a higher CPR but did not affect LBR. Further studies with prospective design and larger sample sizes would be helpful to further evaluate the effects of hysteroscopic polypectomy via a TRS on FET outcomes. Abbreviations AMH Anti-Müllerian Hormone BMI body mass index CPR clinical pregnancy rate E2 estradiol EP Endometrial polyp ET Embryo transfer FET Frozen embryo transfer hCG human Chorionic Gonadotropin IR implantation rate (IR) IVF in vitro fertilization LBR Live birth rate P4 progesterone PIO Progesterone in oil PGT-A preimplantation genetic testing for aneuploidy PPR positive pregnancy test rate SAB spontaneous miscarriage SFET single frozen embryo transfer TRS tissue removal system. Declarations Ethics approval and consent to participate This study’s research, which involved human data, was carried out in compliance with the Helsinki Declaration. This study protocol was submitted to the local Institutional Review Board (IRB), St. David’s Healthcare-IRB, which granted IRB exemption due to the de-identified retrospective nature of the data collected. Consent for publication Not applicable. Competing Interests SKK has received speaker honoraria for Medtronic. Funding statement None. Author Contribution SKK conceptualized the study and wrote the original draft. AA collected data and contributed to writing, reviewing, and editing the manuscript. KYY collected data for the datasets. NF performed formal statistical analysis and participated in writing, reviewing, and editing the manuscript. AF performed formal statistical analysis and participated in writing, reviewing, and editing the manuscript. SHC performed embryology cases and participated in reviewing and editing of the manuscript. JC performed embryology cases and participated in reviewing and editing of the manuscript. PKK participated in the writing, reviewing, and editing of the manuscript. All authors read and approved the final manuscript. Acknowledgements None. Clinical Trial Number : Not applicable. Data Availability The datasets used and/or analyzed during the current study can be available from the corresponding author upon request. References Keltz M, Varasteh N, Levin B, Neuwirth R. 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J Minim Invasive Gynecol. 2019;26(6):1083–e10871. Tu YA, Yang PK, Chen SU, Yang JH. Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study. PLoS ONE. 2020;15(10):e0240882. Kavoussi SK, Esqueda AS, West BT, Chen SH, London K, Lebovic DI, et al. The effects of hysteroscopic morcellation of endometrial polyps on frozen embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol. 2021;267:241–4. Wang C, Peng Y, Wang Q, Dong Y, Liu H, Yao Y, Li Y, Lin G, Gong F, Parry JP, Pereira N, Morgan I, Lindheim SR, Chen H. No differences in IVF pregnancy outcomes following hysteroscopic polypectomy using a manual hysteroscopic tissue removal device versus conventional resection. BMC Surg. 2025;25(1):128. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021;116(3):651–4. Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BW, D'Hooghe TM. Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol Surg. 2013;10(3):165–7. Wang B, Meng N, Zhang W, Kong P, Liu Z, Liu W, et al. Optimal waiting period for frozen embryo transfer after hysteroscopic polypectomy: A propensity score matching analysis. Front Endocrinol (Lausanne). 2022;13:986809. Additional Declarations Competing interest reported. SKK has received speaker honoraria for Medtronic. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviewers invited by journal 19 Dec, 2025 Editor invited by journal 26 Nov, 2025 Editor assigned by journal 24 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 19 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8157479","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563616438,"identity":"f98a48dc-3352-44ae-b99a-7b7f926766f5","order_by":0,"name":"Shahryar 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IVF","correspondingAuthor":false,"prefix":"","firstName":"Parviz","middleName":"","lastName":"Kavoussi","suffix":""}],"badges":[],"createdAt":"2025-11-19 16:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8157479/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8157479/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98888208,"identity":"4d552ffd-c3b7-493e-96f4-074f525f453f","added_by":"auto","created_at":"2025-12-23 15:32:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45541,"visible":true,"origin":"","legend":"","description":"","filename":"HScopicPolypectomyTRSSFETPGTAManuscriptBMCSurgeryREV11222025.docx","url":"https://assets-eu.researchsquare.com/files/rs-8157479/v1/bc35d79419e919221a056c84.docx"},{"id":98888209,"identity":"07a9af10-7a9a-40b8-94e6-f3533443b0c4","added_by":"auto","created_at":"2025-12-23 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SKK has received speaker honoraria for Medtronic.","formattedTitle":"Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes","fulltext":[{"header":"Background","content":"\u003cp\u003eEndometrial polyps (EP) are lesions within the uterine cavity that originate from endometrial glands and stromal cells. Although the number, size, and shape of EP within the uterine cavity can vary from case to case, these endometrial lesions, in general, have been found to be associated with decreased pregnancy rates and increase spontaneous miscarriage (SAB) rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Mechanisms of action of EP impeding embryo implantation include the space-occupying nature of some lesions, local inflammation, and aberrant glycodelin production [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], any or all of which may alter endometrial receptivity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHysteroscopic polypectomy is associated with optimization of natural pregnancy attempts and intrauterine insemination cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and in the realm of assisted reproductive technologies, previous studies have shown that removal of EP via hysteroscopy before an in vitro fertilization (IVF) cycle improves fresh embryo transfer (ET) outcomes as well as frozen embryo transfer (FET) outcomes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, the time interval between hysteroscopic polypectomy and embryo transfer does not affect outcomes in cases of fresh ET or FET [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The hysteroscopic polypectomies in the overwhelming majority of these publications were performed with monopolar resectoscopes or hysteroscopic mechanical graspers.\u003c/p\u003e \u003cp\u003eA previous study by our group explored FET outcomes after hysteroscopic polypectomy specifically via the use of a tissue removal system (TRS) which morcellates EP, to determine if the use of a TRS had any positive or negative effect on outcomes as compared with women without EP who underwent FET [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. There was no difference in the live birth rate (LBR) primary outcome or secondary outcomes such as implantation rate (IR), clinical pregnancy rate (CPR), and SAB rate between the study group of those who had hysteroscopic morcellation of EP prior to FET when compared with those who did not have EP and underwent FET. In that study, both untested blastocysts and preimplantation genetic testing for aneuploidy (PGT-A)-tested euploid blastocysts were included. In addition, single and double FET cases as well as FET cycles with different endometrial preparation protocols were included. A more recent publication compared the use of a TRS as compared with the use of scissors or graspers for hysteroscopic removal of EP and found no differences in IVF outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; however, cases with different endometrial preparation protocols for FET were included, both fresh ET and FET cases were included together in analyses, 1\u0026ndash;2 embryos were transferred, and both cleavage stage and blastocyst stage embryos were transferred in cases. To our knowledge, the aforementioned two studies are the only articles in the literature that examine the effects of TRS on ET outcomes, and the aim of the current validation study was to further and more precisely evaluate the potential effects of hysteroscopic polypectomy with a TRS modality on FET outcomes among a more homogenous study population that specifically underwent euploid single frozen blastocyst transfer, thereby accounting for some of the limitations in previous studies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eData collection was via retrospective chart review, consisting of first FET cycles (n\u0026thinsp;=\u0026thinsp;218) between January 2021 and May 2024 at one fertility center. Criteria for inclusion in the study were female patients ages 18 to 44 years, any causes for infertility, autologous oocytes for IVF, and single embryo transfer cases with euploid results from trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A). Cases of donor oocyte-derived embryos, donor embryos, low-mosaic PGT-A results, as well as cases of hysteroscopic lysis of intrauterine adhesions, myomectomy, and/or those with congenital uterine anomalies were excluded from the study. The study protocol was submitted to St. David\u0026rsquo;s Healthcare-Institutional Board (IRB), which granted IRB exemption due to the de-identified retrospective nature of the data collected.\u003c/p\u003e \u003cp\u003eSubjects in Group A were those with a history of hysteroscopic polypectomy via a TRS modality (TruClear Soft Tissue Shaver Mini, Medtronic) within the 5 months preceding a first FET cycle (n\u0026thinsp;=\u0026thinsp;60). Those in Group B were subjects who did not have hysteroscopic polypectomy since they had EP ruled out prior to a first FET cycle (n\u0026thinsp;=\u0026thinsp;158). FET protocol for patients included in this study involved endometrial preparation with exogenous estradiol (E2) in the form of E2 patches, E2 tablets administered orally or vaginally for two to three weeks, or a combination thereof, after which midcycle transvaginal sonogram (TVS) was performed to measure endometrial thickness. Similar to our previous study\u0026rsquo;s methods [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], when the midcycle TVS showed an endometrial thickness of 7 mm or greater and if a serum progesterone (P4) level (Roche COBAS\u0026reg; Electrochemiluminescent immunoassay run by Clinical Pathology Laboratories, Austin, TX) was less than 3.0 ng/mL on that day, luteal progesterone supplementation (LPS) commenced in the morning one to two days later in the form of either progesterone in oil (PIO) intramuscular injections at a once daily dose of 50 mg, Endometrin\u0026reg; 100 mg insert per vagina three times daily, or alternatively (in two cases), a combination of PIO 50 mg intramuscular injection every three days and daily Endometrin\u0026reg; 100 mg insert per vagina three times a day. Euploid blastocyst thaw and subsequent single frozen embryo transfer (SFET) were performed on the sixth day of LPS. SFET was performed per the guidelines for number of embryos to transfer, as established by the American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs in our previous study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], outcome measures per group were the primary outcome LBR which was the number of live births divided by the number of embryo transfers, and secondary outcomes were positive pregnancy test rate (PPR) which was the number of positive serum quantitative human Chorionic Gonadotropin (hCG) tests resulting from FET divided by the number of embryo transfers, CPR which was the number of gestational sacs at TVS between 6\u0026ndash;7 weeks of gestation divided by the sample size, and SAB rate which was the number of patients who had pregnancy loss before 20 weeks of gestation divided by the number of pregnant patients. Statistical analyses for bivariate associations were performed with t-tests for continuous variables and Pearson\u0026rsquo;s chi-square test was used to examine such associations for categorical variables. Multivariate logistic regression was conducted to identify predictors of primary and secondary outcomes, while adjusting for potential confounders. Predictor variables were selected based on clinical relevance and their potential impact on the outcome. Multivariate analyses were performed using MATLAB version 2024a. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was the threshold for statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCharacteristics and IVF outcomes of women in Group (A) and (B) are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Bivariate analyses showed that there were no differences between Group A and Group B for average female age, parity, body mass index, Anti-M\u0026uuml;llerian Hormone (AMH) level, use of progesterone in oil injections versus Endometrin\u0026reg; vaginal inserts, midcycle serum estradiol level, or midcycle serum progesterone level. There was a significant difference in average endometrial thickness at midcycle between groups (Group A: 10.1 mm and Group B: 9.4 mm; p-value\u0026thinsp;=\u0026thinsp;0.3). In terms of the primary outcome, the LBR for Groups A and B were 58.3% (35/60) and 51.3% (81/158), respectively, which were not statistically different (p-value\u0026thinsp;=\u0026thinsp;0.43). In terms of secondary outcome measures, there was no difference in PPR between Groups A and B at 45/60 (75.0%) and 117/158 (74.1%), respectively (p-value\u0026thinsp;=\u0026thinsp;0.98), CPR between Groups A and B at 43/60 (71.7%) and 98/158 (62.0%), respectively (p-value\u0026thinsp;=\u0026thinsp;0.24), or SAB rate between Groups A and B at 10/45 (22.2%) and 36/117 (30.8%), respectively (p\u0026thinsp;=\u0026thinsp;0.38).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics and pregnancy outcomes of Group (A): women who underwent hysteroscopic polypectomy with tissue removal system prior to a first FET versus Group (B): women who did not have hysteroscopic polypectomy due to no polyps prior to a first FET.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;158)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH level (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePIO injections\u003c/p\u003e \u003cp\u003eEndometrin vaginal inserts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidcycle E2 (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e374.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidcycle P4 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive birth rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35/60 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81/158 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive pregnancy test rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45/60 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117/158 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriage rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/45 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36/117 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43/60 (71.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98/158 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eMeans for continuous variables were assessed via t-test. Bivariate analyses P-values were assessed via Pearson\u0026rsquo;s chi square test with Yates\u0026rsquo; correction.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAMH\u0026thinsp;=\u0026thinsp;Antim\u0026uuml;llerian hormone\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eE2\u0026thinsp;=\u0026thinsp;estradiol\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eFET\u0026thinsp;=\u0026thinsp;frozen embryo transfer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePIO\u0026thinsp;=\u0026thinsp;Progesterone in oil\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eP4\u0026thinsp;=\u0026thinsp;Progesterone\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultivariate analyses in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed that the covariates age, gravity, parity, height, weight, body mass index (BMI), AMH level, midcycle E2 level, midcycle P4 level, inner cell mass grade, expansion grade, and polyp removed via hysteroscopy did not predict primary or secondary outcomes; however, the following variables trended towards being significant predictors for outcomes: AMH and PPR (p\u0026thinsp;=\u0026thinsp;0.08), endometrial thickness and CPR (p\u0026thinsp;=\u0026thinsp;0.06), midcycle P4 and SAB rate (p\u0026thinsp;=\u0026thinsp;0.09), expansion grade and PPR (p\u0026thinsp;=\u0026thinsp;0.06), trophectoderm grade and LBR (p\u0026thinsp;=\u0026thinsp;0.07), as well as polyp removed via hysteroscopy and CPR (p\u0026thinsp;=\u0026thinsp;0.07). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed that among patients in the dataset with a positive pregnancy test (n\u0026thinsp;=\u0026thinsp;162), trophectoderm grade was a predictor of CPR (p\u0026thinsp;=\u0026thinsp;0.048) and LBR (p\u0026thinsp;=\u0026thinsp;0.02); removal of polyps via hysteroscopy predicted CPR (p\u0026thinsp;=\u0026thinsp;0.04) but was not a predictor of LBR. Further analysis showed that none of the covariates predicted LBR among those with clinical pregnancy, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analyses of covariates and FET outcomes positive pregnancy test rate (PPR), clinical pregnancy rate (CPR), live birth rate (LBR), and spontaneous miscarriage (SAB) rate. * denotes significant predictors (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while \u003csup\u003e+\u003c/sup\u003e denotes near-significant predictors (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLBR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSAB\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall sample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCount of positive samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.9804 (0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-12.5344 (0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.3836 (0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1095 (0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0187 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0184 (0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0170 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0416 (0.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0312 (0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0138 (0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0409 (0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0473 (0.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4083 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2330 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1804 (0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1266 (0.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (inches)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0429 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1539 (0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0828 (0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0451 (0.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (pounds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0184 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0393 (0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.0331 (0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0299 (0.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1117 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2643 (0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2242 (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.2182 (0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1270 (0.08)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0444 (0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0527 (0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0198 (0.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1333 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.1528 (0.06)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.1635 (0.04)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1556 (0.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0004 (0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0003 (0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0002 (0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.0007 (0.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0364 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4242 (0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6426 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.9390 (0.09)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay of Blastocyst Development (Day 5, 6, or 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0610 (0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0268 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3263 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.5408 (0.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpansion Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4380 (0.06)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2323 (0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2710 (0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0080 (0.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInner Cell Mass (A:1, B:0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0825 (0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0541 (0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4935 (0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7520 (0.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2177 (0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5614 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7871 (0.07)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.2182 (0.02)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyp removed via H\u0026rsquo;Scope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2517 (0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6366 (0.07)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4593 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.6012 (0.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAMH\u0026thinsp;=\u0026thinsp;Antim\u0026uuml;llerian hormone\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eE2\u0026thinsp;=\u0026thinsp;estradiol\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eFET\u0026thinsp;=\u0026thinsp;frozen embryo transfer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eP4\u0026thinsp;=\u0026thinsp;Progesterone\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analyses of covariates and FET outcomes clinical pregnancy rate (CPR) as well as live birth rate (LBR) among patients with a positive pregnancy test. * denotes significant predictors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLBR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall sample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCount of positive samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-17.1818 (0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.1095 (0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0128 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0416 (0.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0694 (0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0473 (0.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.2509 (0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.1266 (0.68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (inches)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2615 (0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0451 (0.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (pounds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0603 (0.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0299 (0.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4451 (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2182 (0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0751 (0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0198 (0.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1298 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.1556 (0.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0002 (0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0007 (0.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6074 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9390 (0.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay of Blastocyst Development (Day 5, 6, or 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0184 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5408 (0.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpansion Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.4666 (0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.0080 (0.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInner Cell Mass (A:1, B:0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1500 (0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.7520 (0.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrophectoderm (A:1, B:0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3328 (0.048)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2182 (0.02)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyp removed via H\u0026rsquo;Scope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6714 (0.04) *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6012 (0.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAMH\u0026thinsp;=\u0026thinsp;Antim\u0026uuml;llerian hormone\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eE2\u0026thinsp;=\u0026thinsp;estradiol\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFET\u0026thinsp;=\u0026thinsp;frozen embryo transfer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eP4\u0026thinsp;=\u0026thinsp;Progesterone\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analyses of covariates and FET outcomes live birth rate (LBR) among patients with clinical pregnancy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLBR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall sample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCount of positive samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120.3720 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0830 (0.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0527 (0.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1667 (0.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (inches)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.2117 (0.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (pounds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0152 (0.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.0930 (0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0489 (0.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1437 (0.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0009 (0.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8807 (0.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay of Blastocyst Development (Day 5, 6, or 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9112 (0.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpansion Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2411 (0.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInner Cell Mass (A:1, B:0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-107.7046 (1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrophectoderm (A:1, B:0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9095 (0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyp removed via H\u0026rsquo;Scope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0202 (0.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eAMH\u0026thinsp;=\u0026thinsp;Antim\u0026uuml;llerian hormone\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eE2\u0026thinsp;=\u0026thinsp;estradiol\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eFET\u0026thinsp;=\u0026thinsp;frozen embryo transfer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eP4\u0026thinsp;=\u0026thinsp;Progesterone\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHysteroscopic polypectomy has been shown to optimize IVF outcomes in the existing literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous studies have demonstrated that the time interval between hysteroscopic polypectomy and fresh ET does not impact outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, other studies have suggested that similar time intervals between hysteroscopic polypectomy and FET do not affect outcomes either [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. One of two previous publications which explored hysteroscopic polypectomy with the use of a TRS technology showed no difference in FET outcomes such as IR, CPR, SAB rates, and LBR as compared to FET outcomes in those without EP [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. That study had limitations such as the inclusion of untested blastocysts as well as PGT-A tested euploid blastocysts, SFET and double FET cycles, and FET cycles with modified natural protocols as well as those with exogenous estradiol for endometrial preparation. In another publication which compared the use of a TRS as compared with the use of scissors or graspers for hysteroscopic removal of EP which showed no differences in IVF outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], different endometrial preparation protocols for FET were included, both fresh ET and FET cases were included together in analyses, 1\u0026ndash;2 embryos were transferred per case, and both cleavage stage as well as blastocyst stage embryos were transferred in cases.\u003c/p\u003e \u003cp\u003eIn this current study, which included only PGT-A tested euploid blastocysts, SFET, and cycles with exogenous E2 for endometrial preparation, we aimed to further and more precisely examine the potential effects of hysteroscopic polypectomy via a TRS, as compared with cases of women with no EP, on FET outcomes and again found no difference in PPR, CPR, SAB rates, and LBR. The significantly thicker endometrial lining at midcycle in the study group may theoretically be due to remodeling of the endometrial lining after polypectomy or simply by chance. Since among patients with a positive pregnancy test in our study, hysteroscopic polypectomy was a predictor of CPR but did not predict LBR, it is possible that polyp removal may lead to clinical pregnancy in cases that otherwise would have been a chemical pregnancy and not progressed further due to potential endometrial enhancement, although the ultimate goal of live birth is not improved. Study limitations include the biases that are inherent to retrospective studies and the small sample sizes of study and control groups.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo our knowledge, this is the first study to evaluate the effects of hysteroscopic polyp removal with a TRS in cases of euploid SFET. In this validation study of SFET with trophectoderm-tested euploid blastocysts, hysteroscopic polypectomy via a TRS did not impact FET outcomes such as PPR, SAB rate, CPR, and LBR when compared with women who did not have EP and underwent euploid SFET, further and more precisely supporting the concept explored in two previous publications [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] that morcellation of endometrial polyps does not impact subsequent FET results. Among patients with a positive pregnancy test resulting from euploid SFET, polyp removal via hysteroscopy predicted a higher CPR but did not affect LBR. Further studies with prospective design and larger sample sizes would be helpful to further evaluate the effects of hysteroscopic polypectomy via a TRS on FET outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnti-M\u0026uuml;llerian Hormone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eclinical pregnancy rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eE2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eestradiol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndometrial polyp\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmbryo transfer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFrozen embryo transfer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ehCG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman Chorionic Gonadotropin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eimplantation rate (IR)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ein vitro fertilization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLBR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLive birth rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eP4\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eprogesterone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePIO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProgesterone in oil\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePGT-A\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epreimplantation genetic testing for aneuploidy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epositive pregnancy test rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003espontaneous miscarriage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esingle frozen embryo transfer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etissue removal system.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study\u0026rsquo;s research, which involved human data, was carried out in compliance with the Helsinki Declaration. This study protocol was submitted to the local Institutional Review Board (IRB), St. David\u0026rsquo;s Healthcare-IRB, which granted IRB exemption due to the de-identified retrospective nature of the data collected.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eSKK has received speaker honoraria for Medtronic.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding statement\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSKK conceptualized the study and wrote the original draft. AA collected data and contributed to writing, reviewing, and editing the manuscript. KYY collected data for the datasets. NF performed formal statistical analysis and participated in writing, reviewing, and editing the manuscript. AF performed formal statistical analysis and participated in writing, reviewing, and editing the manuscript. SHC performed embryology cases and participated in reviewing and editing of the manuscript. JC performed embryology cases and participated in reviewing and editing of the manuscript. PKK participated in the writing, reviewing, and editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical Trial Number\u003c/b\u003e: Not applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study can be available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKeltz M, Varasteh N, Levin B, Neuwirth R. Pregnancy rates following hysteroscopic polypectomy, myomectomy, and a normal cavity in infertile patients. Prim Care Update Ob Gyns. 1998;5(4):168.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichlin SS, Ramachandran S, Shanti A, Murphy AA, Parthasarathy S. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation. Hum Reprod. 2002;17(10):2742\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunro MG. Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 2019;11(4):629\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRackow BW, Jorgensen E, Taylor HS. Endometrial polyps affect uterine receptivity. Fertil Steril. 2011;95:2690\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;rez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod. 2005;20(6):1632\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalampokas T, Tzanakaki D, Konidaris S, Iavazzo C, Kalampokas E, Gregoriou O. Endometrial polyps and their relationship in the pregnancy rates of patients undergoing intrauterine insemination. Clin Exp Obstet Gynecol. 2012;39(3):299\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLass A, Williams G, Abusheikha N, Brinsden P. The effect of endometrial polyps on outcomes of in vitro fertilization (IVF) cycles. J Assist Reprod Genet. 1999;16(8):410\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H, He X, Tian W, Song X, Zhang H. Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review. J Minim Invasive Gynecol. 2019;26(4):618\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira N, Amrane S, Estes JL, Lekovich JP, Elias RT, Chung PH et al. Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes? Fertil Steril 2016; 105(2): 539\u0026thinsp;\u0026ndash;\u0026thinsp;44.e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAharon D, Sekhon L, Lee JA, Ascher-Walsh C, Copperman AB. Optimal Interval of Time from Operative Hysteroscopy to Embryo Transfer in an In Vitro Fertilization Cycle. J Minim Invasive Gynecol. 2019;26(6):1083\u0026ndash;e10871.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTu YA, Yang PK, Chen SU, Yang JH. Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study. PLoS ONE. 2020;15(10):e0240882.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKavoussi SK, Esqueda AS, West BT, Chen SH, London K, Lebovic DI, et al. The effects of hysteroscopic morcellation of endometrial polyps on frozen embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol. 2021;267:241\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang C, Peng Y, Wang Q, Dong Y, Liu H, Yao Y, Li Y, Lin G, Gong F, Parry JP, Pereira N, Morgan I, Lindheim SR, Chen H. No differences in IVF pregnancy outcomes following hysteroscopic polypectomy using a manual hysteroscopic tissue removal device versus conventional resection. BMC Surg. 2025;25(1):128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePractice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021;116(3):651\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BW, D'Hooghe TM. Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol Surg. 2013;10(3):165\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang B, Meng N, Zhang W, Kong P, Liu Z, Liu W, et al. Optimal waiting period for frozen embryo transfer after hysteroscopic polypectomy: A propensity score matching analysis. Front Endocrinol (Lausanne). 2022;13:986809.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hysteroscopy, Polypectomy, Tissue removal system, Morcellator, Frozen embryo transfer","lastPublishedDoi":"10.21203/rs.3.rs-8157479/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8157479/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo determine whether hysteroscopic polypectomy with a tissue removal system affects frozen embryo transfer outcomes among a study population that underwent euploid single frozen blastocyst transfer with endometrial preparation via exogenous estradiol administration when compared with those without endometrial polyps who underwent single frozen blastocyst transfer with same type of endometrial preparation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eRetrospective chart review. Data from first frozen embryo transfer charts were reviewed. After inclusion and exclusion criteria, data abstracted from 218 cases. Group A: women who underwent hysteroscopic polypectomy via a tissue removal system within 5 months preceding a first euploid single frozen embryo transfer cycle (n\u0026thinsp;=\u0026thinsp;60). Group B: women who did not have hysteroscopic polypectomy since endometrial polyps were ruled out prior to a first euploid single frozen embryo transfer cycle (n\u0026thinsp;=\u0026thinsp;158). The primary outcome was live birth rate (LBR). Secondary outcome measures were positive pregnancy test rate (PPR), clinical pregnancy rate (CPR), and spontaneous miscarriage (SAB) rate via bivariate associations and multivariable logistic regression analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBivariate analyses showed no differences between groups in LBR (A: 58.3%, 35/60 and B: 51.3%, 81/158, p-value\u0026thinsp;=\u0026thinsp;0.43), PPR (A: 75.0%, 45/60 and 74.1%, 117/158; p-value\u0026thinsp;=\u0026thinsp;0.98), CPR (A: 71.7%, 43/60 and B: 62.0%, 98/158; p-value\u0026thinsp;=\u0026thinsp;0.24), or SAB rate (A: 22.2%, 10/45 and 30.8%, 36/117; p\u0026thinsp;=\u0026thinsp;0.38). Multivariate multivariable analysis showed no difference in primary and secondary outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn patients undergoing single frozen embryo transfer with trophectoderm-tested euploid blastocysts, hysteroscopic polypectomy via a tissue removal system did not impact PPR, SAB rate, CPR, and LBR. Among patients with a positive pregnancy test resulting from euploid single frozen embryo transfer, previous hysteroscopic polypectomy via the tissue removal system predicted CPR but was not a predictor of LBR.\u003c/p\u003e\u003ch2\u003ePlain Engligh Summary:\u003c/h2\u003e \u003cp\u003eOur study indicates that hysteroscopic polyp removal, specifically with a tissue removal system, does not affect subsequent frozen embryo transfer outcomes when compared with cases of frozen embryo transfer in women without endometrial polyps when one chromosomally normal blastocyst stage embryo is transferred to the uterus within a short period of time thereafter.\u003c/p\u003e","manuscriptTitle":"Impact of hysteroscopic polypectomy via a tissue removal system on single frozen euploid blastocyst transfer outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 15:32:21","doi":"10.21203/rs.3.rs-8157479/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-06T05:41:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100465452527730747846301941404877655653","date":"2026-01-06T02:51:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-19T10:25:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-26T12:32:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-24T12:49:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-24T12:48:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-11-19T16:38:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be06b147-f599-4a9b-92f3-76910a050cd5","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T15:32:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 15:32:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8157479","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8157479","identity":"rs-8157479","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}