Comparison of pregnancy outcomes in two methods of frozen and fresh embryo transfer in infertile women with endometriosis

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In this study the outcome of pregnancy was compared between two methods of frozen and fresh embryo transfer in infertile women with endometriosis who underwent assisted reproductive treatment in Shariati Hospital from 2013 to 2020. Methods : From 197 patients with endometriosis who received infertility treatment, 105 were assigned to fresh embryo transfer group and 92 were assigned to frozen embryo transfer group. Patient’s data was gathered using archive files. Patients in both groups were matched in terms of age, BMI (Body Mass Index), duration of primary infertility, base FSH (Follicle-Stimulating Hormone) serum levels and number of transferred embryos (P>0.05). The IVF (In Vitro Fertilization) pregnancy outcomes in two groups were compared in terms of live birth rate, clinical pregnancy rate, chemical pregnancy rate, miscarriage rate, ongoing pregnancy rate. Results: Live birth rate, clinical pregnancy rate, ongoing pregnancy rate and chemical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P<0.049). miscarriage rate was not significantly different in both groups (P=0.546). Conclusion: According to the results and parameters in this study frozen embryo transfer is more successful in terms of pregnancy outcomes than fresh embryo transfer. Endometriosis Pregnancy Outcome Infertility Embryo Transfer In Vitro Fertilization What does this study add to the clinical work? This study shows that frozen embryo transfer will have better pregnancy outcomes in clinical work. Therefore, gynecologists can confidently choose from two methods of IVF (fresh and frozen embryo transfer) regarding infertile women with endometriosis. Introduction Infertility is a common problem among 15% of women in reproductive age, of which 40–50% of infertility is related to women [ 1 ]. In recent years, ART (assisted reproductive technology) has made significant progress and significant proportion of patients are successfully treated with IVF. The low cost of this treatment compared to other treatment methods has caused an increase in the desire for IVF treatment [ 2 ]. Although extensive research has been conducted on the outcomes of IVF, the success rate of IVF/ICSI (Intracytoplasmic Sperm Injection) cycles is reported to be low. Among all couples undergoing IVF/ICSI treatment, the live birth rate in each retrieved oocyte is reported to be only 30% [ 3 ]. Disturbance in signaling between mother and baby is the most important cause of pregnancy termination (60% of cases) [ 4 ]. Also, many other factors are being identified that lead to treatment failure of fertilized oocyte implantation in the treatment cycles. The decision on how to transfer the embryo is important. There are two ways of embryo transfer; fresh and frozen. After IVF embryo cell will divide for 3 to 4 days. Then it is transferred to uterus if fresh embryo transfer is chosen. If frozen embryo transfer is chosen the embryo will be frozen for a later date. Endometriosis is an inflammatory and estrogen-dependent disease which has different clinical manifestations, such as pain and infertility [ 5 ]. Endometriosis accounts for 10–15% of all women in reproductive age [ 6 ]. Although the exact cause of endometriosis is unclear the underlying causes of endometriosis are epigenetic defects, aberrant estrogen synthesis, estrogen-induced inflammation and steroid hormone receptor expression changes [ 7 – 11 ]. Risk factors, such as behavioral characteristics, Food habits, physical activity, smoking and alcohol consumption, can affect the occurrence of endometriosis [ 12 ]. Infertility is one of the consequences of endometriosis. Various theories have been proposed in an attempt to explain the relationship between endometriosis and infertility but there has not been a consensus on the matter [ 13 ]. The use of IVF has become very common in improving and increasing the success rate of fertilization for endometriosis patients. A recently published meta-analysis shows that half of women with endometriosis successfully conceive if IVF is used [ 14 ]. In such studies, it has also been shown that the eutopic endometrium in women with endometriosis is significantly different from normal tissue in women without endometriosis in terms of chemical and ultrasonic point of view [ 15 , 16 ]. In addition to the characteristics of endometriosis and the structure and thickness of the endometrium, the IVF methods and the type of embryos transferred may have an effect on the outcome of IVF in these patients, which is considered as a new hypothesis [ 17 ]. In past studies, the difference in the pregnancy rate between two methods of IVF, including frozen embryo transfer and fresh non-frozen embryo transfer, has been observed in patients with endometriosis. In some studies, use of frozen embryo transfer increases the pregnancy rate [ 9 , 17 , 18 ] however, in another study it does not change the pregnancy rate [ 19 ], therefore, fertility outcomes in endometriosis patients receiving IVF needs more evaluation in terms of the type of transferred embryo. The purpose of this study is the comparison of pregnancy outcomes in two methods of IVF, including frozen and fresh embryo transfer, in infertile women with endometriosis. Methods This study is a retrospective matched cohort study and all the data was gathered trough patient’s files. Patient’s data was confidential and each patient was assigned a specific code to keep the data secret. All the steps in this study were according to the declaration of Helsinki. Study samples were women under the age of 40 with endometriosis (Based on sonographic or laparoscopy evidence) who referred to Shariati Hospital Infertility Center with infertility complaint from 2013 to 2020 and their background information was in the hospital archive files. Exclusion criteria were lack of data files, not being able to make phone calls regarding pregnancy outcomes, age above 40, canceled cycles due to the absence of embryo, TESE (Testicular Epididymal Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration) cycles, women with thrombophilia, Immunological underlying disease, uterine abnormality and Uterine myoma above 4 cm. 296 cases of endometriosis received infertility treatment, 99 of which were excluded due to cancelation of embryo transfer cycle. From the remaining 197 patients, 105 were assigned to fresh embryo transfer group and 92 were assigned to frozen embryo transfer group. patient’s information including; age, BMI, cause of infertility excluding endometriosis, duration of primary infertility, base FSH, AMH (Anti-Mullerian Hormone) and CA125 (Cancer Antigen 125) serum levels, ovarian stimulation protocol, number and grade of transferred embryos and canceled cycles was gathered and the pregnancy outcomes were asked from patients by phone calls. Patients in both groups were matched in terms of age, BMI, duration of primary infertility, base FSH serum levels and number of transferred embryos (P > 0.05) and are shown in Table 1 and 2 . The IVF pregnancy outcomes in two groups were compared in terms of live birth rate (LBR), clinical pregnancy rate (live fetus confirmed by ultrasonography in the sixth week), chemical pregnancy rate (BhCG (Beta Human Chorionic Gonadotropin) positive), miscarriage rate (miscarriage confirmed by ultrasonography between the sixth and the twelfth week), ongoing pregnancy rate (pregnancy after the twelfth week). Table 1 Demographic characteristics of endometriosis patients in two matched groups of frozen and fresh embryo transfer groups Frozen embryo transfer (92 patients) Fresh embryo transfer (105 patients) Mean SD Mean SD P value Female age (year) 28.8 4.2 29.1 4.7 0.34 Male age (year) 33.0 4.2 33.8 5.3 0.233 BMI (kg/m 2 ) 23.87 3.94 25.12 4.0 0.066 Primary infertility duration (year) 4.4 3.6 4.1 4.1 0.187 Base FSH serum levels (IU/L) 6.4 2.94 6.5 3.15 0.78 Table 2 Number of transferred embryos in endometriosis patients in two matched groups of frozen and fresh embryo transfer (P > 0.05) Groups Frozen embryo transfer (92 patients) Fresh embryo transfer (105 patients) Total (197) quantity percentage quantity percentage quantity percentage 1 Transferred embryo 11 12.0% 12 11.4% 23 11.7% 2 Transferred embryos 41 44.6% 47 44.8% 88 44.7% 3 Transferred embryos 40 43.5% 46 43.8% 86 43.7% Comparison of the groups was done using one-way ANOVA. Data analysis was done using IBM SPSS 22 and Significance level was less than 0.05. Results Pregnancy outcomes are shown in Table 3 . Live birth rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P = 0.001). clinical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P = 0.001). chemical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P = 0.002). ongoing pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P = 0.001). miscarriage rate in two groups was not significantly different (P = 0.546). Table 3 Pregnancy outcomes of endometriosis patients in two matched groups of frozen and fresh embryo transfer Groups Frozen embryo transfer (92 patients) Fresh embryo transfer (105 patients) Total (197) quantity percentage quantity percentage P value quantity percentage Live birth rate 31 33.7% 12 11.4% 0.001 43 21.8% Chemical pregnancy rate 32 34.8% 14 13.3% 0.002 46 23.3% Clinical pregnancy rate 31 33.7% 14 13.3% 0.001 45 22.8% Ongoing pregnancy rate 28 30.4% 12 11.4% 0.001 40 20.3% Miscarriage rate 3 3.3% 2 1.9% 0.546 5 2.5% Discussion Complex mechanics between endometriosis and infertility are still unknown however, the effect of anatomical changes to uterus, such as adhesion and fibrotic tissue, in endometriosis and its role in infertility is suggested [ 13 ]. Also, Endocrine and immunological abnormalities in endometriosis patients are suggested to affect infertility [ 20 ]. 30–50% of endometriosis patients are suggested to be infertile [ 21 ], however, using ART increases their chance of pregnancy up to 80% [ 22 ]. In fresh embryo transfer method estrogen is used. taking into account that endometriosis is an estrogen-dependent disease, use of estrogen to prepare the endometrium causes the disease to worsen and has an adverse effect on endometrial acceptance and implantation. The time to get pregnant is lower in fresh embryo transfer compared to frozen embryo transfer. Frozen embryo transfer has some advantages over fresh embryo transfer, such as Ability to characterize embryo quality through genetics before implantation, reducing the risk of contracting OHSS (Ovarian Hyperstimulation Syndrome) and adjusting the natural physiological environment for better implantation. Bourdon M et al. did a retrospective cohort study on 270 endometriosis patients. They compared ongoing pregnancy rate and clinical pregnancy rate between two matched groups of fresh and frozen embryo transfer. They found that both clinical pregnancy rate and ongoing pregnancy rate were significantly higher in frozen embryo transfer group [ 9 ], which is similar to the findings in our study. In a retrospective cohort study by Mohamed AMF et al. 415 patients with endometriosis were divided into frozen embryo transfer and fresh embryo transfer. The goal was to compare live birth rate in two matched groups. They found that live birth rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group [ 17 ], which is similar to the results of our study. In a retrospective cohort study by Wu J et al. implantation rate, live birth rate and clinical pregnancy rate were compared between two matched groups of frozen and fresh embryo transfer in 761 endometriosis patients. They found that implantation rate, live birth rate and clinical pregnancy rate were significantly higher in frozen embryo transfer group [ 18 ], which is similar to the results of our study. Tan J et al. enrolled 728 endometriosis patients into a retrospective cohort study. They compared two matched groups of frozen embryo transfer and fresh embryo transfer in terms of implantation rate, clinical pregnancy rate and miscarriage rate. They found that there was no significant difference between two groups [ 19 ]. Contrary to their study our results show clinical pregnancy rate was significantly higher in frozen embryo transfer group, however, miscarriage rate was similar in both groups. In general, some studies show that frozen embryo transfer is more successful than fresh embryo transfer and some studies show no difference. In conclusion more studies need to be conducted on the matter. Conclusion According to the parameters and results in this study, live birth rate, clinical pregnancy rate, chemical pregnancy rate and ongoing pregnancy rate in frozen embryo transfer group were significantly higher than fresh embryo transfer group. miscarriage rate was not significantly different between both groups. Therefore, frozen embryo transfer can lead to the increase of pregnancy chances in patients with endometriosis and it is more successful than fresh embryo transfer. The number of cases was the limitation of this study due to lack of access to more patients. It is suggested for future studies to have more cases. Declarations The authors declare that they have no conflict of interest. This article is based on a thesis submitted as partial fulfillment of the requirements for medical doctorate (MD) degree in gynecology in Tehran University of Medical Sciences. The authors have no relevant financial or non-financial interests to disclose and There were no potential conflicts of interest concerning this study. The first draft of the manuscript was written by Masoumeh Piri. Manuscript editing was done by Sedigheh Hosseinimousa and Reza Pourmahmoudian. Data collection and analysis were performed by Sedigheh Hosseinimousa and Marzieh Talebian. All authors have read and approved the final manuscript. This study is a data-based retrospective cohort study. All the steps in this study were according to the declaration of Helsinki. The TUMS Research Ethics Committee has confirmed that no ethical approval is required for this study. All the data gathered and shown in this study was consensual. Author Contribution: S Hossienimousa: project development, Data collection and analysis, Manuscript editing M Talebian: Data collection and analysis M Piri: project development, Data collection, Manuscript writing R Pourmahmoudian: Manuscript editing Acknowledgments: This study was funded and supported by Tehran University of Medical Sciences (TUMS). References Fritz MA, Speroff L (2011) Clinical gynecologic endocrinology and infertility Malhotra N, Shah D, Pai R, Pai HD, Bankar M (2013) Assisted reproductive technology in India: A 3 year retrospective data analysis. J Hum Reprod Sci 6:235 Society for Assisted Reproductive Technology (2002) Assisted reproductive technology in the United States: 1998 results generated from the American Society for Reproductive Medicine. Fertil Steril 77:18–31 Herrler A, Von Rango U, Beier HM (2003) Embryo-maternal signaling: how the embryo starts talking to its mother to accomplish implantation. Reprod Biomed Online 6:244–256 Burney RO, Giudice LC (2012) Pathogenesis and pathophysiology of endometriosis. Fertil Steril 98:511–519 Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704 Zaret KS, Carroll JS (2011) Pioneer transcription factors: establishing competence for gene expression. Genes Dev 25:2227–2241 Mikhaleva LM, Radzinsky VE, Orazov MR, Khovanskaya TN, Sorokina AV, Mikhalev SA, Volkova SV, Shustova VB, Sinelnikov MY (2021) Current knowledge on endometriosis etiology: a systematic review of literature. Int J Womens Health 525–537 Bourdon M, Santulli P, Maignien C, Gayet V, Pocate-Cheriet K, Marcellin L, Chapron C (2018) The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS ONE 13:e0194800 Turocy J, Farland LV, Yanushpolsky E (2017) Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril 108:e198 Vuong LN, Pham TD, Dang VQ, Ho TM, Ho VN, Norman RJ, Mol BW (2019) Live birth rates with a freeze-only strategy versus fresh embryo transfer: secondary analysis of a randomized clinical trial. Reprod Biomed Online 38:387–396 Hemmert R, Schliep KC, Willis S, Peterson CM, Louis GB, Allen-Brady K, Simonsen SE, Stanford JB, Byun J, Smith KR (2019) Modifiable life style factors and risk for incident endometriosis. Paediatr Perinat Epidemiol 33:19–25 Pellicer A, Oliveira N, Ruiz A, Remohí J, Simón C (1995) Exploring the mechanism (s) of endometriosis-related infertility: an analysis of embryo development and implantation in assisted reproduction. Hum Reprod 10:91–97 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77:1148–1155 Jones CJ, Inuwa IM, Nardo LG, Litta P, Fazleabas AT (2009) Eutopic endometrium from women with endometriosis shows altered ultrastructure and glycosylation compared to that from healthy controls—a pilot observational study. Reprod Sci 16:559–572 Miller DL, Jones CJ, Aplin JD, Nardo LG (2010) Altered glycosylation in peri-implantation phase endometrium in women with stages III and IV endometriosis. Hum Reprod 25:406–411 Mohamed AM, Chouliaras S, Jones CJ, Nardo LG (2011) Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 156:177–180 Wu J, Yang X, Huang J, Kuang Y, Wang Y (2019) Fertility and neonatal outcomes of freeze-all vs. fresh embryo transfer in women with advanced endometriosis. Front Endocrinol 10:770 Tan J, Cerrillo M, Cruz M, Cecchino GN, Garcia-Velasco JA (2021) Early pregnancy outcomes in fresh versus deferred embryo transfer cycles for endometriosis-associated infertility: a retrospective cohort study. J Clin Med 10:344 Garnica AB (2019) The Role of the Molecular Genetic Approach in the Pathogenesis of Endometriosis. In: G Gonçalves (ed) Molecular Bases of Endometriosis-The Integration Between Research and Clinical Practice. pp 9–19 Vannuccini S, Petraglia F (2019) Recent advances in understanding and managing adenomyosis. F1000Research 8 Lee D, Kim SK, Lee JR, Jee BC (2020) Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med 47:1 Cite Share Download PDF Status: Posted Version 1 posted 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. 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Therefore, gynecologists can confidently choose from two methods of IVF (fresh and frozen embryo transfer) regarding infertile women with endometriosis.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eInfertility is a common problem among 15% of women in reproductive age, of which 40\u0026ndash;50% of infertility is related to women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, ART (assisted reproductive technology) has made significant progress and significant proportion of patients are successfully treated with IVF. The low cost of this treatment compared to other treatment methods has caused an increase in the desire for IVF treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although extensive research has been conducted on the outcomes of IVF, the success rate of IVF/ICSI (Intracytoplasmic Sperm Injection) cycles is reported to be low. Among all couples undergoing IVF/ICSI treatment, the live birth rate in each retrieved oocyte is reported to be only 30% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Disturbance in signaling between mother and baby is the most important cause of pregnancy termination (60% of cases) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Also, many other factors are being identified that lead to treatment failure of fertilized oocyte implantation in the treatment cycles.\u003c/p\u003e \u003cp\u003eThe decision on how to transfer the embryo is important. There are two ways of embryo transfer; fresh and frozen. After IVF embryo cell will divide for 3 to 4 days. Then it is transferred to uterus if fresh embryo transfer is chosen. If frozen embryo transfer is chosen the embryo will be frozen for a later date.\u003c/p\u003e \u003cp\u003eEndometriosis is an inflammatory and estrogen-dependent disease which has different clinical manifestations, such as pain and infertility [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Endometriosis accounts for 10\u0026ndash;15% of all women in reproductive age [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although the exact cause of endometriosis is unclear the underlying causes of endometriosis are epigenetic defects, aberrant estrogen synthesis, estrogen-induced inflammation and steroid hormone receptor expression changes [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Risk factors, such as behavioral characteristics, Food habits, physical activity, smoking and alcohol consumption, can affect the occurrence of endometriosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInfertility is one of the consequences of endometriosis. Various theories have been proposed in an attempt to explain the relationship between endometriosis and infertility but there has not been a consensus on the matter [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The use of IVF has become very common in improving and increasing the success rate of fertilization for endometriosis patients. A recently published meta-analysis shows that half of women with endometriosis successfully conceive if IVF is used [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In such studies, it has also been shown that the eutopic endometrium in women with endometriosis is significantly different from normal tissue in women without endometriosis in terms of chemical and ultrasonic point of view [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition to the characteristics of endometriosis and the structure and thickness of the endometrium, the IVF methods and the type of embryos transferred may have an effect on the outcome of IVF in these patients, which is considered as a new hypothesis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn past studies, the difference in the pregnancy rate between two methods of IVF, including frozen embryo transfer and fresh non-frozen embryo transfer, has been observed in patients with endometriosis. In some studies, use of frozen embryo transfer increases the pregnancy rate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] however, in another study it does not change the pregnancy rate [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], therefore, fertility outcomes in endometriosis patients receiving IVF needs more evaluation in terms of the type of transferred embryo. The purpose of this study is the comparison of pregnancy outcomes in two methods of IVF, including frozen and fresh embryo transfer, in infertile women with endometriosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a retrospective matched cohort study and all the data was gathered trough patient\u0026rsquo;s files. Patient\u0026rsquo;s data was confidential and each patient was assigned a specific code to keep the data secret. All the steps in this study were according to the declaration of Helsinki.\u003c/p\u003e \u003cp\u003eStudy samples were women under the age of 40 with endometriosis (Based on sonographic or laparoscopy evidence) who referred to Shariati Hospital Infertility Center with infertility complaint from 2013 to 2020 and their background information was in the hospital archive files. Exclusion criteria were lack of data files, not being able to make phone calls regarding pregnancy outcomes, age above 40, canceled cycles due to the absence of embryo, TESE (Testicular Epididymal Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration) cycles, women with thrombophilia, Immunological underlying disease, uterine abnormality and Uterine myoma above 4 cm.\u003c/p\u003e \u003cp\u003e296 cases of endometriosis received infertility treatment, 99 of which were excluded due to cancelation of embryo transfer cycle. From the remaining 197 patients, 105 were assigned to fresh embryo transfer group and 92 were assigned to frozen embryo transfer group. patient\u0026rsquo;s information including; age, BMI, cause of infertility excluding endometriosis, duration of primary infertility, base FSH, AMH (Anti-Mullerian Hormone) and CA125 (Cancer Antigen 125) serum levels, ovarian stimulation protocol, number and grade of transferred embryos and canceled cycles was gathered and the pregnancy outcomes were asked from patients by phone calls. Patients in both groups were matched in terms of age, BMI, duration of primary infertility, base FSH serum levels and number of transferred embryos (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The IVF pregnancy outcomes in two groups were compared in terms of live birth rate (LBR), clinical pregnancy rate (live fetus confirmed by ultrasonography in the sixth week), chemical pregnancy rate (BhCG (Beta Human Chorionic Gonadotropin) positive), miscarriage rate (miscarriage confirmed by ultrasonography between the sixth and the twelfth week), ongoing pregnancy rate (pregnancy after the twelfth week).\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\u003eDemographic characteristics of endometriosis patients in two matched groups of frozen and fresh embryo transfer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003egroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrozen embryo transfer (92 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFresh embryo transfer (105 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale age (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale age (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary infertility duration (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBase FSH serum levels (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\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\u003eNumber of transferred embryos in endometriosis patients in two matched groups of frozen and fresh embryo transfer (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrozen embryo transfer (92 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFresh embryo transfer (105 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal (197)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 Transferred embryo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 Transferred embryos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 Transferred embryos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComparison of the groups was done using one-way ANOVA. Data analysis was done using IBM SPSS 22 and Significance level was less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePregnancy outcomes are shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Live birth rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P\u0026thinsp;=\u0026thinsp;0.001). clinical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P\u0026thinsp;=\u0026thinsp;0.001). chemical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P\u0026thinsp;=\u0026thinsp;0.002). ongoing pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P\u0026thinsp;=\u0026thinsp;0.001). miscarriage rate in two groups was not significantly different (P\u0026thinsp;=\u0026thinsp;0.546).\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\u003ePregnancy outcomes of endometriosis patients in two matched groups of frozen and fresh embryo transfer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrozen embryo transfer (92 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFresh embryo transfer (105 patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eTotal (197)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003equantity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003epercentage\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\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemical pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.3%\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\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOngoing pregnancy rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.3%\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eComplex mechanics between endometriosis and infertility are still unknown however, the effect of anatomical changes to uterus, such as adhesion and fibrotic tissue, in endometriosis and its role in infertility is suggested [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Also, Endocrine and immunological abnormalities in endometriosis patients are suggested to affect infertility [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. 30\u0026ndash;50% of endometriosis patients are suggested to be infertile [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], however, using ART increases their chance of pregnancy up to 80% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn fresh embryo transfer method estrogen is used. taking into account that endometriosis is an estrogen-dependent disease, use of estrogen to prepare the endometrium causes the disease to worsen and has an adverse effect on endometrial acceptance and implantation. The time to get pregnant is lower in fresh embryo transfer compared to frozen embryo transfer. Frozen embryo transfer has some advantages over fresh embryo transfer, such as Ability to characterize embryo quality through genetics before implantation, reducing the risk of contracting OHSS (Ovarian Hyperstimulation Syndrome) and adjusting the natural physiological environment for better implantation.\u003c/p\u003e \u003cp\u003eBourdon M et al. did a retrospective cohort study on 270 endometriosis patients. They compared ongoing pregnancy rate and clinical pregnancy rate between two matched groups of fresh and frozen embryo transfer. They found that both clinical pregnancy rate and ongoing pregnancy rate were significantly higher in frozen embryo transfer group [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], which is similar to the findings in our study.\u003c/p\u003e \u003cp\u003eIn a retrospective cohort study by Mohamed AMF et al. 415 patients with endometriosis were divided into frozen embryo transfer and fresh embryo transfer. The goal was to compare live birth rate in two matched groups. They found that live birth rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which is similar to the results of our study.\u003c/p\u003e \u003cp\u003eIn a retrospective cohort study by Wu J et al. implantation rate, live birth rate and clinical pregnancy rate were compared between two matched groups of frozen and fresh embryo transfer in 761 endometriosis patients. They found that implantation rate, live birth rate and clinical pregnancy rate were significantly higher in frozen embryo transfer group [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which is similar to the results of our study.\u003c/p\u003e \u003cp\u003eTan J et al. enrolled 728 endometriosis patients into a retrospective cohort study. They compared two matched groups of frozen embryo transfer and fresh embryo transfer in terms of implantation rate, clinical pregnancy rate and miscarriage rate. They found that there was no significant difference between two groups [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Contrary to their study our results show clinical pregnancy rate was significantly higher in frozen embryo transfer group, however, miscarriage rate was similar in both groups.\u003c/p\u003e \u003cp\u003eIn general, some studies show that frozen embryo transfer is more successful than fresh embryo transfer and some studies show no difference. In conclusion more studies need to be conducted on the matter.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to the parameters and results in this study, live birth rate, clinical pregnancy rate, chemical pregnancy rate and ongoing pregnancy rate in frozen embryo transfer group were significantly higher than fresh embryo transfer group. miscarriage rate was not significantly different between both groups. Therefore, frozen embryo transfer can lead to the increase of pregnancy chances in patients with endometriosis and it is more successful than fresh embryo transfer.\u003c/p\u003e \u003cp\u003eThe number of cases was the limitation of this study due to lack of access to more patients. It is suggested for future studies to have more cases.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eThis article is based on a thesis submitted as partial fulfillment of the requirements for medical doctorate (MD) degree in gynecology in Tehran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose and\u0026nbsp;There were no potential conflicts of interest concerning this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe first draft of the manuscript was written by Masoumeh Piri. Manuscript editing was done by Sedigheh Hosseinimousa and Reza Pourmahmoudian. Data collection and analysis were performed by Sedigheh Hosseinimousa and Marzieh Talebian. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eThis study is a data-based retrospective cohort study. All the steps in this study were according to the declaration of Helsinki. The TUMS Research Ethics Committee has confirmed that no ethical approval is required for this study. All the data gathered and shown in this study was consensual.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS Hossienimousa: project development, Data collection and analysis, Manuscript editing\u003c/p\u003e\n\u003cp\u003eM Talebian: Data collection and analysis\u003c/p\u003e\n\u003cp\u003eM Piri: project development, Data collection, Manuscript writing\u003c/p\u003e\n\u003cp\u003eR Pourmahmoudian: Manuscript editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded and supported by Tehran University of Medical Sciences (TUMS).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFritz MA, Speroff L (2011) Clinical gynecologic endocrinology and infertility\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalhotra N, Shah D, Pai R, Pai HD, Bankar M (2013) Assisted reproductive technology in India: A 3 year retrospective data analysis. J Hum Reprod Sci 6:235\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSociety for Assisted Reproductive Technology (2002) Assisted reproductive technology in the United States: 1998 results generated from the American Society for Reproductive Medicine. Fertil Steril 77:18\u0026ndash;31\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerrler A, Von Rango U, Beier HM (2003) Embryo-maternal signaling: how the embryo starts talking to its mother to accomplish implantation. Reprod Biomed Online 6:244\u0026ndash;256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurney RO, Giudice LC (2012) Pathogenesis and pathophysiology of endometriosis. Fertil Steril 98:511\u0026ndash;519\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKennedy S, Bergqvist A, Chapron C, D\u0026rsquo;Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698\u0026ndash;2704\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaret KS, Carroll JS (2011) Pioneer transcription factors: establishing competence for gene expression. Genes Dev 25:2227\u0026ndash;2241\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMikhaleva LM, Radzinsky VE, Orazov MR, Khovanskaya TN, Sorokina AV, Mikhalev SA, Volkova SV, Shustova VB, Sinelnikov MY (2021) Current knowledge on endometriosis etiology: a systematic review of literature. Int J Womens Health 525\u0026ndash;537\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourdon M, Santulli P, Maignien C, Gayet V, Pocate-Cheriet K, Marcellin L, Chapron C (2018) The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS ONE 13:e0194800\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurocy J, Farland LV, Yanushpolsky E (2017) Pregnancy outcomes in frozen embryo transfers in women with endometriosis: a retrospective cohort study. Fertil Steril 108:e198\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVuong LN, Pham TD, Dang VQ, Ho TM, Ho VN, Norman RJ, Mol BW (2019) Live birth rates with a freeze-only strategy versus fresh embryo transfer: secondary analysis of a randomized clinical trial. Reprod Biomed Online 38:387\u0026ndash;396\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemmert R, Schliep KC, Willis S, Peterson CM, Louis GB, Allen-Brady K, Simonsen SE, Stanford JB, Byun J, Smith KR (2019) Modifiable life style factors and risk for incident endometriosis. Paediatr Perinat Epidemiol 33:19\u0026ndash;25\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePellicer A, Oliveira N, Ruiz A, Remoh\u0026iacute; J, Sim\u0026oacute;n C (1995) Exploring the mechanism (s) of endometriosis-related infertility: an analysis of embryo development and implantation in assisted reproduction. Hum Reprod 10:91\u0026ndash;97\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77:1148\u0026ndash;1155\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones CJ, Inuwa IM, Nardo LG, Litta P, Fazleabas AT (2009) Eutopic endometrium from women with endometriosis shows altered ultrastructure and glycosylation compared to that from healthy controls\u0026mdash;a pilot observational study. Reprod Sci 16:559\u0026ndash;572\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller DL, Jones CJ, Aplin JD, Nardo LG (2010) Altered glycosylation in peri-implantation phase endometrium in women with stages III and IV endometriosis. Hum Reprod 25:406\u0026ndash;411\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamed AM, Chouliaras S, Jones CJ, Nardo LG (2011) Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 156:177\u0026ndash;180\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu J, Yang X, Huang J, Kuang Y, Wang Y (2019) Fertility and neonatal outcomes of freeze-all vs. fresh embryo transfer in women with advanced endometriosis. Front Endocrinol 10:770\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan J, Cerrillo M, Cruz M, Cecchino GN, Garcia-Velasco JA (2021) Early pregnancy outcomes in fresh versus deferred embryo transfer cycles for endometriosis-associated infertility: a retrospective cohort study. J Clin Med 10:344\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarnica AB (2019) The Role of the Molecular Genetic Approach in the Pathogenesis of Endometriosis. In: G Gon\u0026ccedil;alves (ed) Molecular Bases of Endometriosis-The Integration Between Research and Clinical Practice. pp\u0026nbsp;9\u0026ndash;19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVannuccini S, Petraglia F (2019) Recent advances in understanding and managing adenomyosis. F1000Research 8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee D, Kim SK, Lee JR, Jee BC (2020) Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med 47:1\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Pregnancy Outcome, Infertility, Embryo Transfer, In Vitro Fertilization","lastPublishedDoi":"10.21203/rs.3.rs-3197418/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3197418/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: infertility is one of the most important complications in patients with endometriosis however, the use of assisted reproductive treatments have resulted in successful fertility and childbearing in a significant proportion of patients. In this study the outcome of pregnancy was compared between two methods of frozen and fresh embryo transfer in infertile women with endometriosis who underwent assisted reproductive treatment in Shariati Hospital from 2013 to 2020.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: From 197 patients with endometriosis who received infertility treatment, 105 were assigned to fresh embryo transfer group and 92 were assigned to frozen embryo transfer group. Patient’s data was gathered using archive files. Patients in both groups were matched in terms of age, BMI (Body Mass Index), duration of primary infertility, base FSH (Follicle-Stimulating Hormone) serum levels and number of transferred embryos (P\u0026gt;0.05). The IVF (In Vitro Fertilization) pregnancy outcomes in two groups were compared in terms of live birth rate, clinical pregnancy rate, chemical pregnancy rate, miscarriage rate, ongoing pregnancy rate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eLive birth rate, clinical pregnancy rate, ongoing pregnancy rate and chemical pregnancy rate in frozen embryo transfer group was significantly higher than fresh embryo transfer group (P\u0026lt;0.049). miscarriage rate was not significantly different in both groups (P=0.546).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e According to the results and parameters in this study frozen embryo transfer is more successful in terms of pregnancy outcomes than fresh embryo transfer.\u003c/p\u003e","manuscriptTitle":"Comparison of pregnancy outcomes in two methods of frozen and fresh embryo transfer in infertile women with endometriosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-18 11:35:53","doi":"10.21203/rs.3.rs-3197418/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9792c2c9-5bba-4e6b-b9d1-b2d5bb3725ad","owner":[],"postedDate":"August 18th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T19:31:09+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-18 11:35:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3197418","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3197418","identity":"rs-3197418","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}