Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis

Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis | 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 Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis Muzi Li, Lihong Xu, Heng Zhao, Lei Yan, Yanbo Du This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-506178/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Gonadotropin-releasing hormone agonist(GnRH-a) is generally added to improve pregnancy outcomes of adenomyosis based hormone replacement therapy cycle. Our objective in this study is to investigate whether adding GnRH-a can obtain better pregnancy outcomes. In this retrospective analysis, a total of 341 patients with adenomyosis complicated in vitro fertilization-embryo transfer(IVF-ET) of the frozen embryo transfer (FET). The control group was only treated by hormone replacement therapy cycles to prepare emdometrium, and the study group was added GnRH-a before using hormone to adjust menstruation period. Based on the similar baseline values and embryological data, there was no significantly difference about their clinical pregnancy rates (40.63% vs 42.54%, P=0.72) and live birth rates (23.75% vs 23.75%, P=0.74) between the control group and the study group. Other secondary outcomes including clinical miscarriage rates, ectopic pregnancy rates, preterm pregnancy rates and term pregnancy rates did not show significant difference between the two groups. Compared with using hormone replacement therapy cycle alone, GnRH-a down-regulation based on hormone replacement therapy cycle may not increase the rates of clinical pregnancy and live birth rates in IVF-ET of FET for infertile patients with adenomyosis. Sexual & Reproductive Medicine adenomyosis cryopreserved embryo transfer Gonadotropin-releasing hormone agonist hormone replacement therapy cycle Introduction Adenomyosis is defined as endometrium-like epithelium and stroma outside the endometrium invading the myometrium. Some studies showed that patients with adenomyosis had lower implantation rates, clinical pregnancy rates and ongoing pregnancy rates but high level of miscarriage rates compared with non-adenomyosis patients[1-2]. At the same time, patients with adenomyosis benefits less from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)[3-4]. Considering adverse effect of adenomyosis, many methods have been tried in order to obtain better reproductive outcomes. It is still disputable whether GnRH-a downregulation can help patients with endometriosis obtain reproductive outcomes. A meta-analysis suggested that Gonadotropin-releasing hormone agonist (GnRH-a) can effectively elevate the clinical pregnancy rates for patients with endometriosis[5]. In assisted reproductive technology(ART), GnRH-a had been widely used in patients with endometriosis for frozen or fresh embryo transfer in order to improve the pregnancy outcomes[6-9]. Another study found only fertilization rates but not clinical pregnancy rates involving fresh and frozen embryo transfer(FET) benefited from GnRH-a for women with endometriosis[10]. There were also two studies which suggested GnRH-a down-regulation did not work well in patients of endometriosis undergoing IVF[11-12]. As for the application of GnRH-a in adenomyosis, this drug was used to carry out pituitary down-regulation in order to ameliorate the not positive reproductive situations in ART. Studies showed the potential efficacy of adding GnRH-a on pregnancy outcomes in women who undergo the IVF/ICSI and supported using GnRH-a down-regulation can improve the success rates of IVF/ICSI involving fresh embryo transfer or FET[13-15]. However, considering the controversial role of GnRH-a in patients with endometriosis, we analyzed the pregnancy outcomes aiming whether the GnRH-a down-regulation would be beneficial in the endometrial preparation protocols of adenomyosis with the FET based on hormone replacement therapy cycle. Materials And Methods We analyzed the data from the hospital electronic database for patients undergoing FET between 2013 and 2018. This retrospective cohort study was conducted at the Reproductive Hospital Affiliated to Shandong University. Inclusion criteria included patients were no more than 45 years old and were diagnosed as adenomyosis mainly by two-dimensional ultrasound, which were depicted that (1) subjective enlargement of uterine corpus, (2) asymmetrically thickened myometrium between anterior and posterior walls, (3) heterogeneity of myometrium/hypoechoic striations, (4) poor definition of endometrio-myometrial junction[16]. This article only analysed the first cycle of FET. The day of embryo transfer was respectively day 3, day 5 and day 6 and the number of transferring embryos was no more than two. Patients with donor oocytes were excluded. Other exclusion criteria were malformations of reproductive system without therapy, hydrosalpinx, polycystic ovary syndrome(PCOS), endometriosis, malignant diseases of reproductive system and chromosome abnormality or disease genes existing in one part of couples. The patients in group A were treated by the dual treatment of hormone replacement cycle and GnRH-a, and group B were treated by hormone replacement cycle. Procedures For the hormone replacement therapy cycle regimen, the endometrium prepared with oral estradiol valerateat a dose of 4mg daily was started on days 2–4 of the menstrual cycle for 5-6 days. and then 6 mg for the following 5-6 days. Endometrium thickness was monitored after 10–12 days of medication by transvaginal ultrasound along with the serum levels of FSH, LH, estradiol (E2) and progesterone (P). Thereafter the dose of estradiol valerate , which was 8mg/d maximally, was modulated according to the endometrium thickness and the E2 levels. Progesterone capsule 200 mg/day and oral dydrogesterone 40 mg/day as luteal phase support were added when the endometrial thickness reached to 7 mm or more and FET was carried out in 6 days. Estradiol valerate at the dose for endometrium preparation was continued until the day of the serum hCG test, 2 weeks after embryo transfer. If pregnancy was achieved, estradiol valerate stopped gradually at 7-8 weeks of gestation; progesterone capsule and oral dydrogesterone was continued until 12 weeks of gestation. In the study group, GnRH-a long-acting injection including triptorelin and leuprorelin was used at a dose of 3.75mg during menstration. After a follow-visit in 30 days, patients would start hormone replacement cycles. Some patients had a larger uterus due to adenomyosis and would receive multiple GnRH-a injections at the 3.75mg dose once every month. Outcome measures One primary outcomes of this study are clinical pregnancy rates and live birth rates. Secondary outcomes include clinical miscarriage rates, ectopic pregnancy rates, preterm pregnancy rates and term pregnancy rates. Clinical pregnancy is defined as a pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. Apart from intra-uterine pregnancy, it includes a clinically documented ectopic pregnancy. Live birth is defined as the complete expulsion or extraction from a woman of a product of fertilization, after 22 completed weeks of gestational age; which, after such separation, breathes or shows any other evidence of life, such as heart beat, umbilical cord pulsation or definite movement of voluntary muscles, irrespective of whether the umbilical cord has been cut or the placenta is attached. A birth weight of 500 grams or more can be used if gestational age is unknown. Live births refer to the individual newborn; for example, a twin delivery represents two live births. Secondary outcomes are defined according to our previous published paper[17]. Statistical analysis Relevant data was analyzed by SPSS 22.0.Values. P<0.05 was considered to indicate statistical significance. Mean ± standard deviation was used to show continuous variables of normal distribution by two-sample t-test. Variables were tested for normality. We expressed categorical variables as percentage, and make inter-group comparisons by the chi-square test or Fisher’s exact test. Binary logistic regression was used to analyze the relationship between the dichotomous dependent variable and independent variable. Ethics approval The study protocol was approved by the Ethics Committee of the Reproductive Hospital Affiliated to Shandong University and adhered to relevant ethical guidelines. Results Totally, 341 women were analyzed in this study. One hundred and sixty female in Group A were carried out with GnRH-a down-regulation treatment based on the hormone replacement therapy cycle, the other one hundred and eighty-one patients in Group B were only treated with hormone replacement therapy cycle. The baseline values of patients are presented in Table 1. There was no significant difference between two groups including age, height, weight and body mass index(BMI)(34.56±4.49 vs 35.25±4.95, P=0.18; 162.63±5.57cm vs 161.56±5.29cm, P=0.08; 64.99±11.04kg vs 63.76 ±9.42kg, P=0.27; 24.56±3.87 vs 24.43± 3.42, P=0.73). Types of infertility and baseline hormone values including FSH, LH, E2 and PRL all were comparable between the two groups(6.54±1.89IU/L vs 6.32± 2.04IU/L, P=0.31; 4.39±2.05IU/L vs 4.85±2.57IU/L, P=0.07; 42.38±33.86pg/ml vs 48.08 ±76.54pg/ml, P=0.39; 19.87±35.15ng/ml vs 16.76±19.48pg/ml, P=0.31). The percentage of primary and secondary infertility were also comparable between the two groups(40.62% vs 33.70%, 59.38% vs 66.30%, P=0.19). The endometrial thickness of patients in group B was slightly thinner than that in Group A(0.96±0.20mm vs 0.91±0.18mm，P=0.02), but mean values both were more than 8mm. Embryological data was shown in the Table 2. Time of embryo transfer was divided as three parts which are respectively cleavage stage embryos and blastocyst embryos. Cleavage stage embryo was defined embryos beginning with the 2-cell stage and up to, but not including, the morula stage. Blastocyst embryo was defined as the preimplantation embryo development that occured around day 5–6 after insemination or ICSI. The blastocyst contained a fluid filled central cavity (blastocoele), an outer layer of cells(trophectoderm) and an inner group of cells (inner cell mass). The number of transferring embryos was generally no more than two. Time of embryo transfer and the number of transferring embryos did not differ obviously between the two groups. The percentage of day 3, day 5 or day 6 and the percentage of one or two embryo did not show any significant difference between two groups(1.25% vs 2.76%, 72.5% vs 75.14%, 26.25% vs 22.10%, P=0.44; 89.83% vs 88.40%， 10.62% vs 11.60%，P=0.78) We respectively compared the pregnancy outcomes of infertility patients with adenomyosis between the two groups in Table 3. Compared with the direct hormone replacement group, the clinical pregnancy rates (40.63% vs 42.54%, P=0.72) and the live birth rates (23.75% vs 23.75%, P=0.74) do not differ from each other. The clinical miscarriage rates(41.5% vs 44.2%, P=0.754), biochemical pregnancy rates(13.75% vs 11.05%, P=0.45) and ectopic pregnancy rates (3.08% vs 3.90%, P=1) were also similar with each other. Binary logistic regression in Table 4 indicated that age, BMI, endometrial thickness on HCG trigger day, baseline hormone values of FSH, LH, PRL, and E2 and types of infertility were not related to clinical pregnancy rates. However, it was the day of embryo transfer that was the only independent variables associated with clinical pregnancy rates(OR 1.67, 95% CI 0.27 to 10.14 for women having a day 5 embryo transfer compared with women having a day 3 embryo transfer; OR 2.99, 95% CI 1.62 to 5.52 for women having a day 6 embryo transfer compared with women having a day 3 embryo transfer). For live birth rates, binary logistic regression in Table 5 showed that BMI, types of infertility, baseline hormone values of FSH, LH, PRL, and E2 and endometrial thickness on HCG trigger day were not associated with that. Age and the day of embryo transfer were the related independent variables to the live birth rates for patients with adenomyosis (OR 0.92, 95% CI 0.87 to 0.98 for live birth rates for age; OR 4.42 95% CI 0.60 to 32.81 for women having a day 5 embryo transfer compared with women having a day 3 embryo transfer; OR 3.64, 95% CI 1.60 to 8.27 for women having a day 6 embryo transfer compared with women having a day 3 embryo transfer). Time of GnRH-a down-regulation in study group was shown in Table 6. 73.75% and 15.625% of patients respectively underwent once and twice GnRH-a down-regulation and only 10.625% of patients underwent no less than three times GnRH-a down-regulation. Discussion This respective study did not find obvious effecy of GnRH-a in pregnancy outcomes for patient with adenomyosis. The result of comparable clinical pregnancy rates seemed conflicted with GnRH-a increasing the chance of pregnancy for female with adenomyosis[13-14]. Preterm rates and full-term rates happened almost in the same level between the two groups, which was different from the previous epidemiological studies[18]. Meta-analysis explored the association between the endometrium thickness and pregnancy outcomes, thinner endometrium(＜7mm) resulting in negative ongoing pregnancy rates and live birth rates[19-20]. In this study, the difference of endometrium thickness between two groups had statistical significance; however, mean values of both were more than 9mm. So it was debatable to detect whether the different endometrium thickness impaired pregnancy outcomes in this study. A randomized controlled trial indicated that embryo transfer conducted at day 5 was more likely to obtain higher ongoing or cumulative pregnancy rates compared with the result at day 3[21]. Another meta-analysis demonstrated that clinical pregnancy rates and live birth rates were significantly higher following day 5 compared to day 6 blastocyst transfers[22]. Both Group A and Group B covered the day 3, day 5 and day 6 of embryo transfer and the variation between two groups was no statistical significance even if the proportion of day 3 was relatively low. The embryos of day 5 covered the vast majority in both groups, which can improve the pregnancy rates in a way. The proportion of primary infertility in Group A was more than that of Group B, although the difference of the ratio of primary and secondary infertility between two groups did not have statistical significance. Studies demonstrated that pregnancy performance of the secondary infertility was significantly better than that of the primary infertility[23-24]. The higher percentage of primary infertility in group A may be a key factor to decreasing rates. As for the number of transferring embryos, a study indicated that two elective single embryo can obtain better reproductive outcomes than one double embryo transfer using blastocysts[25]. In our study, single embryo transfer protocol was also regarded as the major protocol to ensure the better pregnancy outcomes. In addition, it was easy to find the total clinical pregnancy rates and live birth rates of patients still stayed at low level regardless what measures had been taken. In this study, GnRH-a did not show obvious effect of improving pregnancy outcomes. We came up with several reasons to explain this phenomenon. Firstly, the current cycles of GnRH-a was not enough for patients with adenomyosis so that the effects of the drug did not work. We failed to get the information of the degree of adenomyosis between the two groups, maybe many patients did not suffer from severe adenomyosis, and it may be another reason leading to the negative result in GnRH-a improving pregnancy outcomes. Furthermore, we can consider whether patients was not sensitive to GnRH-a resulting in uterus not changing much, or GnRH-a did not work at all. One advantage of our study was that the number of women with adenomyosis was relatively large, including patients in a time span of six years. In addition, according to 2018 specialist consensus published in Journal of Reproductive Medicine, the number of embryo transfer was no more than two under 40 years and single embryo transfer was recommended. In our study, single embryo transfer constitutes the vast majority and the others were double embryo transfer, which was consistent with consensus. This two advantages made this study applicative for more population with adenomyosis. Apart from that, we also found that good reproductive outcomes still stayed at a low level although different measures had been taken, which meant many new explorations needed to be done to improve reproductive outcomes for women with adenomyosis. Two obvious defects existed in this study. Firstly, this study did not analysis the duration of GnRH-a for women with adenomyosis. If patients could get enough duration of GnRH-a down-regulation, the attachment of high quality follicles will be affected as most of our patients only underwent only once GnRH-a down-regulation. In addition, the severity of adenomyosis did not be discussed, which may be influence therapeutic effect in a way. These questions both needed to be studied in the future. Although many studies thought that administrating GnRH agonists was very beneficial for patients of adenomyosis in improving reproductive outcomes of IVF-ET, our study did not demonstrate advantages of adding GnRH agonists based on hormone replacement therapy cycle. Similiar negative conclusions were also shown in endometriosis[10-12]. In addition, Movahedi S et al. did a study that Endometrial preparation for FET using GnRH agonists appeared to be as effective as FET without administrating these agonists[26]. The other two articles also did not think that GnRH-a down-regulation showed any significant advantages of IVF-ET[27-28]. Those all provided some supportive evidence for our study result. In conclusion, patients with adenomysis carried out GnRH-a down regulation or not based on hormone replacement therapy cycle had similar reproductive outcomes. Adding GnRH-a based on hormone replacement therapy cycle may not increase the rates of clinical pregnancy and live birth. Declarations Acknowledgements Many people have offered me valuable help in my thesis writing, inclusing my tutor and my classmates. Particularly, I would like to give my sincere gratitude to Prof. Lei Yan, my tutor who give me great help by providing me with necessary materials, advice of great value and inspiration of new ideas. It is his suggestions that draw my attention to the number of deficiencies and make many things clearer. Without his strong support, this thesis could not been the present form. I also wish to sincerely thank Dr. Du and my classmates. They graciously make considerable comments and sound suggestions to the outline of this paper. Finally, I am grateful to Innovative Research Group Project of the National Natural Science Foundation of China (CN) for financial support. I would like to express my gratitude to all those who helped me during the writing of this thesis. Author Contribution Muzi Li took the responsibility of project development, data collection, data analysis,and manuscript writing. And Heng Zhao, Lihong Xu, Yanbo Du and Lei Yan also took part in the work project development. In addition, Lei Yan also finished part of manuscript writing and amending. Additional Information Funding: Innovative Research Group Project of the National Natural Science Foundation of China (CN) Conflicts of interest/Competing interests: The authors declare that they have no conflict of interest. Conflict of interest statement will be submitted separately in PDF format. Availability of data and material: Data and material were available. Code availability: Software application was available. Author Contribution: Muzi Li: project development, data collection, data analysis, manuscript writing; Heng Zhao: project development; Lihong Xu: project development; Lei Yan: project development, manuscript writing. Data availability statement The datasets generated during and/or analyzed during the current study are available by request. Ethics declarations The studies involving human participants were reviewed and approved by research ethics committee of Reproductive Hospital affiliate d to Shandong University. The patients/participants provided their written informed consent to participate in this study. References Soave, I., Wenger, J. M., Pluchino, N., & Marci, R. Treatment options and reproductive outcome for adenomyosis-associated infertility. Current medical research and opinion. 34(5) , 839–849. https://doi.org/10.1080/03007995.2017.1393404 (2018). 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Cycle regimens for frozen-thawed embryo transfer. The Cochrane database of systematic reviews. 7(7) , CD003414. https://doi.org/10.1002/14651858.CD003414.pub3 (2017). Fábregues, F. et al. Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program. Fertility and sterility. 70(1) , 46–51. https://doi.org/10.1016/s0015-0282(98)00123-x (1998). Tables Table 1 Comparison of baseline data between two groups GROUP A(n=160) [1] GROUP B(n=181) [2] Two-tailed P value Mean(SD) Mean(SD) Age(SD)(year) 34.56（4.49） 35.25（4.95） 0.18 Height（SD）(cm) 162.63(5.57) 161.56(5.29) 0.08 Weight（SD）(kg) 64.99(11.04) 63.76(9.42) 0.27 BMI(SD) 24.56(3.87) 24.43(3.42) 0.73 Laboratory Tests Mean(SD) Mean(SD) FSH(SD)（IU/L） 6.54(1.89) 6.32(2.04) 0.31 LH(SD)(IU/L) 4.39(2.05) 4.85(2.57) 0.07 E2(SD)(Pg/ml) 42.38(33.86) 48.08(76.54) 0.39 PRL(SD)(ng/ml) 19.87(35.15) 16.76(19.48) [3] 0.31 Infertility 0.19 Primary Infertility— no./total no. (%) 65/160(40.62) 61/181(33.70) Secondary Infertility— no./total no. (%) 95/160(59.38) 120/181(66.30) Endometrial thickness on hCG trigger day(mm)？ 0.96（0.20） [4] 0.91（0.18） 0.02 [1] the study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period. [2] The control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium. [3] One value was missing. [4] Five values were missing. Table 2 Comparison of embryological characteristics between two groups GROUP A(n=160) [1] GROUP B(n=181) [2] Two-tailed P value Time of embryo transfer — no./total no. (%) D3 2/160(1.25) 5/181(2.76) 0.44 D5 116/160(72.5) 136/181(75.14) D6 42/160(26.25) 40/181(22.10) No. of embryos transferred 0.78 One embryo — no./total no. (%) 143/160(89.38) 160/181(88.40) Two embryos — no./total no. (%) 17/160(10.62) 21/181(11.60) [1] the study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period. [2] The control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium. Table 3 Comparison of clinical pregnancy outcomes between two groups GROUP A(n=160) [1] GROUP B(n=181) [2] Two-tailed P value Clinical outcome(%) clinical pregancy 65/160(40.63) 77/181(42.54) 0.72 biochemical pregnancy rate 22/160(13.75) 20/181(11.05) 0.45 clinical miscarriage rate 27/65(41.54) 34/77(44.16) 0.75 ectopic pregnancy 2/65(3.08) 3/77(3.90) 1 [3] live birth rate 38/160(23.75) 43/181(23.75) 0.74 preterm pregnancy 5/160(3.12) 5/181(2.76) 0.84 full-term pregnancy 33/160(20.63) 38/181(20.99) 0.95 [1] the study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period. [2] The control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium. [3] This value was calculated by Fisher’s exact test. Table 4 Binary logistic regression of influence factors of pregnancy rates between two groups OR（95%CI） Two-tailed P value the day of embryo transfer DAY3 1 P=0.00 DAY5 1.67(0.27-10.14) DAY6 2.99(1.62-5.52) Table 5 Binary logistic regression of influence factors of live birth rates between two groups OR（95%CI） Two-tailed P value age(year) 0.92(0.87-0.98) P=0.01 the day of embryo transfer DAY3 1 P=0.01 DAY5 4.42(0.60-32.81) DAY6 3.64(1.60-8.27) Table 6 Time of GnRH-a down-regulation in Group A GROUP A(n=160) time of GnRH-a down-regulation(%) 1 118/160(73.75) 2 25/160(15.625) no less than 3 17/160(10.625) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 19 Jul, 2021 Reviews received at journal 16 Jul, 2021 Reviewers agreed at journal 08 Jul, 2021 Reviews received at journal 15 Jun, 2021 Reviewers agreed at journal 14 Jun, 2021 Reviewers invited by journal 14 Jun, 2021 Editor assigned by journal 14 Jun, 2021 Editor invited by journal 11 May, 2021 Submission checks completed at journal 11 May, 2021 First submitted to journal 08 May, 2021 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. 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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-506178","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":26346696,"identity":"f29cf302-330b-42b2-a22e-28d52c43aae5","order_by":0,"name":"Muzi Li","email":"","orcid":"","institution":"Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China","correspondingAuthor":false,"prefix":"","firstName":"Muzi","middleName":"","lastName":"Li","suffix":""},{"id":26346697,"identity":"4cf3883e-6bee-44cb-a3a6-f98b0d5e8150","order_by":1,"name":"Lihong Xu","email":"","orcid":"","institution":"center for reproductive medcine，Shandong Provincial Hospital Affiliated to Shandong First Medical university,Jinan,Shandong，250021,","correspondingAuthor":false,"prefix":"","firstName":"Lihong","middleName":"","lastName":"Xu","suffix":""},{"id":26346698,"identity":"91643bed-ddaf-4d32-ba3e-97e297b434e1","order_by":2,"name":"Heng Zhao","email":"","orcid":"","institution":"Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China","correspondingAuthor":false,"prefix":"","firstName":"Heng","middleName":"","lastName":"Zhao","suffix":""},{"id":26346699,"identity":"cd2855da-5801-4cc7-a2c0-8b5ab92f3ee9","order_by":3,"name":"Lei Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYHACxgMMBjYMDAeATB5i9QC1pJGsheEwCVoMjp89cOBDwXl7vhsJjA/etjHImxPUciYv4eAMg9uJM28kMBvObWMw3NlASMuBHIPDPAa3EwxuJLBJ87YxJBgcIKTl/BuDw38MztkDtbD/Jk7LDaAtQLsYNwBtYSZKi+SNNwYHewySE2eeedgsOeechOEGQlr4zucYPvjxx86e73jywQ9vymzkCdqigFDA2AAkJAioBwL5BsJqRsEoGAWjYKQDAMqsR7ycRZcRAAAAAElFTkSuQmCC","orcid":"","institution":"Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China","correspondingAuthor":true,"prefix":"","firstName":"Lei","middleName":"","lastName":"Yan","suffix":""},{"id":26346700,"identity":"ab0c2776-01fd-48ad-9424-d84d2fecee69","order_by":4,"name":"Yanbo Du","email":"","orcid":"","institution":"Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China","correspondingAuthor":false,"prefix":"","firstName":"Yanbo","middleName":"","lastName":"Du","suffix":""}],"badges":[],"createdAt":"2021-05-08 09:59:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-506178/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-506178/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13692652,"identity":"17cf6e84-fb47-4bd9-b503-66c1675c43c0","added_by":"auto","created_at":"2021-09-17 12:44:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":282015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-506178/v1/492d8141-af0f-46c0-95ec-74b995040d15.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdenomyosis is defined as endometrium-like epithelium and stroma outside the endometrium invading the myometrium. Some studies showed that patients with adenomyosis had lower implantation rates, clinical pregnancy rates and ongoing pregnancy rates but high level of miscarriage rates compared with non-adenomyosis patients[1-2]. At the same time, patients with adenomyosis benefits less from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)[3-4]. Considering adverse effect of adenomyosis, many methods have been tried in order to obtain better reproductive outcomes.\u003c/p\u003e\n\u003cp\u003eIt is still disputable whether GnRH-a downregulation can help patients with endometriosis obtain reproductive outcomes. A meta-analysis suggested that Gonadotropin-releasing hormone agonist (GnRH-a) can effectively elevate the clinical pregnancy rates for patients with endometriosis[5]. In assisted reproductive technology(ART), GnRH-a had been widely used in patients with endometriosis for frozen or fresh embryo transfer in order to improve the pregnancy outcomes[6-9]. Another study found only fertilization rates but not clinical pregnancy rates involving fresh and frozen embryo transfer(FET) benefited from GnRH-a for women with endometriosis[10]. There were also two studies which suggested GnRH-a down-regulation did not work well in patients of endometriosis undergoing IVF[11-12].\u003c/p\u003e\n\u003cp\u003eAs for the application of GnRH-a in adenomyosis, this drug was used to carry out pituitary down-regulation in order to ameliorate the not positive reproductive situations in ART. Studies showed the potential efficacy of adding GnRH-a on pregnancy outcomes in women who undergo the IVF/ICSI and supported using GnRH-a down-regulation can improve the success rates of IVF/ICSI involving fresh embryo transfer or FET[13-15].\u003c/p\u003e\n\u003cp\u003eHowever, considering the controversial role of GnRH-a in patients with endometriosis, we analyzed the pregnancy outcomes aiming whether the GnRH-a down-regulation would be beneficial in the endometrial preparation protocols of adenomyosis with the FET based on hormone replacement therapy cycle.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eWe analyzed the data from the hospital electronic database for patients undergoing FET between 2013 and 2018. This retrospective cohort study was conducted at the Reproductive Hospital Affiliated to Shandong University. Inclusion criteria included patients were no more than 45 years old and were diagnosed as adenomyosis mainly by two-dimensional ultrasound, which were depicted that (1) subjective enlargement of uterine corpus, (2) asymmetrically thickened myometrium between anterior and posterior walls, (3) heterogeneity of myometrium/hypoechoic striations, (4) poor definition of endometrio-myometrial junction[16]. This article only analysed the first cycle of FET. The day of embryo transfer was respectively day 3, day 5 and day 6 and the number of transferring embryos was no more than two. Patients with donor oocytes were excluded. Other exclusion criteria were malformations of reproductive system without therapy, hydrosalpinx, polycystic ovary syndrome(PCOS), endometriosis, malignant diseases of reproductive system and chromosome abnormality or disease genes existing in one part of couples. The patients in group A were treated by the dual treatment of hormone replacement cycle and GnRH-a, and group B were treated by hormone replacement cycle.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the hormone replacement therapy cycle regimen, the endometrium prepared with oral estradiol valerateat a dose of 4mg daily was started on days 2\u0026ndash;4 of the menstrual cycle for 5-6 days. and then 6 mg for the following 5-6 days. Endometrium thickness was monitored after 10\u0026ndash;12 days of medication by transvaginal ultrasound along with the serum levels of FSH, LH, estradiol (E2) and progesterone (P). Thereafter the dose of estradiol valerate , which was 8mg/d maximally, was modulated according to the endometrium thickness and the E2 levels. Progesterone capsule 200 mg/day and oral dydrogesterone 40 mg/day as luteal phase support were added when the endometrial thickness reached to 7 mm or more and FET was carried out in 6 days. Estradiol valerate at the dose for endometrium preparation was continued until the day of the serum hCG test, 2 weeks after embryo transfer. If pregnancy was achieved, estradiol valerate stopped gradually at 7-8 weeks of gestation; progesterone capsule and oral dydrogesterone was continued until 12 weeks of gestation.\u003c/p\u003e\n\u003cp\u003eIn the study group, GnRH-a long-acting injection including triptorelin and leuprorelin was used at a\u003c/p\u003e\n\u003cp\u003edose of 3.75mg during menstration. After a follow-visit in 30 days, patients would start hormone replacement cycles. Some patients had a larger uterus due to adenomyosis and would receive multiple GnRH-a injections at the 3.75mg dose once every month.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne primary outcomes of this study are clinical pregnancy rates and live birth rates. Secondary outcomes include clinical miscarriage rates, ectopic pregnancy rates, preterm pregnancy rates and term pregnancy rates. Clinical pregnancy is defined as a pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. Apart from intra-uterine pregnancy, it includes a clinically documented ectopic pregnancy. Live birth is defined as the complete expulsion or extraction from a woman of a product of fertilization, after 22 completed weeks of gestational age; which, after such separation, breathes or shows any other evidence of life, such as heart beat, umbilical cord pulsation or definite movement of voluntary muscles, irrespective of whether the umbilical cord has been cut or the placenta is attached. A birth weight of 500 grams or more can be used if gestational age is unknown. Live births refer to the individual newborn; for example, a twin delivery represents two live births. Secondary outcomes are defined according to our previous published paper[17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelevant data was analyzed by SPSS 22.0.Values. P\u0026lt;0.05 was considered to indicate statistical significance. Mean \u0026plusmn; standard deviation was used to show continuous variables of normal distribution by two-sample t-test. Variables were tested for normality. We expressed categorical variables as percentage, and make inter-group comparisons by the chi-square test or Fisher\u0026rsquo;s exact test. Binary logistic regression was used to analyze the relationship between the dichotomous dependent variable and independent variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of the Reproductive Hospital Affiliated to Shandong University and adhered to relevant ethical guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTotally, 341 women were analyzed in this study. One hundred and sixty female in Group A were carried out with GnRH-a down-regulation treatment based on the hormone replacement therapy cycle, the other one hundred and eighty-one patients in Group B were only treated with hormone replacement therapy cycle.\u003c/p\u003e\n\u003cp\u003eThe baseline values of patients are presented in Table 1. There was no significant difference between two groups including age, height, weight and body mass index(BMI)(34.56\u0026plusmn;4.49 vs 35.25\u0026plusmn;4.95, P=0.18; 162.63\u0026plusmn;5.57cm vs 161.56\u0026plusmn;5.29cm, P=0.08; 64.99\u0026plusmn;11.04kg vs 63.76 \u0026plusmn;9.42kg, P=0.27; 24.56\u0026plusmn;3.87 vs 24.43\u0026plusmn; 3.42, P=0.73). Types of infertility and baseline hormone values including FSH, LH, E2 and PRL all were comparable between the two groups(6.54\u0026plusmn;1.89IU/L vs 6.32\u0026plusmn; 2.04IU/L, P=0.31; 4.39\u0026plusmn;2.05IU/L vs 4.85\u0026plusmn;2.57IU/L, P=0.07; 42.38\u0026plusmn;33.86pg/ml vs 48.08 \u0026plusmn;76.54pg/ml, P=0.39; 19.87\u0026plusmn;35.15ng/ml vs 16.76\u0026plusmn;19.48pg/ml, P=0.31). The percentage of primary and secondary infertility were also comparable between the two groups(40.62% vs 33.70%, 59.38% vs 66.30%, P=0.19). The endometrial thickness of patients in group B was slightly thinner than that in Group A(0.96\u0026plusmn;0.20mm vs 0.91\u0026plusmn;0.18mm，P=0.02), but mean values both were more than 8mm.\u003c/p\u003e\n\u003cp\u003eEmbryological data was shown in the Table 2. Time of embryo transfer was divided as three parts which are respectively cleavage stage embryos and blastocyst embryos. Cleavage stage embryo was defined embryos beginning with the 2-cell stage and up to, but not including, the morula stage. Blastocyst embryo was defined as the preimplantation embryo development that occured around day 5\u0026ndash;6 after insemination or ICSI. The blastocyst contained a fluid filled central cavity (blastocoele), an outer layer of cells(trophectoderm) and an inner group of cells (inner cell mass). The number of transferring embryos was generally no more than two. Time of embryo transfer and the number of transferring embryos did not differ obviously between the two groups. The percentage of day 3, day 5 or day 6 and the percentage of one or two embryo did not show any significant difference between two groups(1.25% vs 2.76%, 72.5% vs 75.14%, 26.25% vs 22.10%, P=0.44; 89.83% vs 88.40%， 10.62% vs 11.60%，P=0.78)\u003c/p\u003e\n\u003cp\u003eWe respectively compared the pregnancy outcomes of infertility patients with adenomyosis between the two groups in Table 3. Compared with the direct hormone replacement group, the clinical pregnancy rates (40.63% vs 42.54%, P=0.72) and the live birth rates (23.75% vs 23.75%, P=0.74) do not differ from each other. The clinical miscarriage rates(41.5% vs 44.2%, P=0.754), biochemical pregnancy rates(13.75% vs 11.05%, P=0.45) and ectopic pregnancy rates (3.08% vs 3.90%, P=1) were also similar with each other.\u003c/p\u003e\n\u003cp\u003eBinary logistic regression in Table 4 indicated that age, BMI, endometrial thickness on HCG trigger day, baseline hormone values of FSH, LH, PRL, and E2 and types of infertility were not related to clinical pregnancy rates. However, it was the day of embryo transfer that was the only independent variables associated with clinical pregnancy rates(OR 1.67, 95% CI 0.27 to 10.14 for women having a day 5 embryo transfer compared with women having a day 3 embryo transfer; OR 2.99, 95% CI 1.62 to 5.52 for women having a day 6 embryo transfer compared with women having a day 3 embryo transfer). For live birth rates, binary logistic regression in Table 5 showed that BMI, types of infertility, baseline hormone values of FSH, LH, PRL, and E2 and endometrial thickness on HCG trigger day were not associated with that. Age and the day of embryo transfer were the related independent variables to the live birth rates for patients with adenomyosis (OR 0.92, 95% CI 0.87 to 0.98 for live birth rates for age; OR 4.42 95% CI 0.60 to 32.81 for women having a day 5 embryo transfer compared with women having a day 3 embryo transfer; OR 3.64, 95% CI 1.60 to 8.27 for women having a day 6 embryo transfer compared with women having a day 3 embryo transfer).\u003c/p\u003e\n\u003cp\u003eTime of GnRH-a down-regulation in study group was shown in Table 6. 73.75% and 15.625% of patients respectively underwent once and twice GnRH-a down-regulation and only 10.625% of patients underwent no less than three times GnRH-a down-regulation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis respective study did not find obvious effecy of GnRH-a in pregnancy outcomes for patient with adenomyosis. The result of comparable clinical pregnancy rates seemed conflicted with GnRH-a increasing the chance of pregnancy for female with adenomyosis[13-14]. Preterm rates and full-term rates happened almost in the same level between the two groups, which was different from the previous epidemiological studies[18].\u003c/p\u003e\n\u003cp\u003eMeta-analysis explored the association between the endometrium thickness and pregnancy outcomes, thinner endometrium(＜7mm) resulting in negative ongoing pregnancy rates and live birth rates[19-20]. In this study, the difference of endometrium thickness between two groups had statistical significance; however, mean values of both were more than 9mm. So it was debatable to detect whether the different endometrium thickness impaired pregnancy outcomes in this study.\u003c/p\u003e\n\u003cp\u003eA randomized controlled trial indicated that embryo transfer conducted at day 5 was more likely to obtain higher ongoing or cumulative pregnancy rates compared with the result at day 3[21]. Another meta-analysis demonstrated that clinical pregnancy rates and live birth rates were significantly higher following day 5 compared to day 6 blastocyst transfers[22]. Both Group A and Group B covered the day 3, day 5 and day 6 of embryo transfer and the variation between two groups was no statistical significance even if the proportion of day 3 was relatively low. The embryos of day 5 covered the vast majority in both groups, which can improve the pregnancy rates in a way.\u003c/p\u003e\n\u003cp\u003eThe proportion of primary infertility in Group A was more than that of Group B, although the difference of the ratio of primary and secondary infertility between two groups did not have statistical significance. Studies demonstrated that pregnancy performance of the secondary infertility was significantly better than that of the primary infertility[23-24]. The higher percentage of primary infertility in group A may be a key factor to decreasing rates.\u003c/p\u003e\n\u003cp\u003eAs for the number of transferring embryos, a study indicated that two elective single embryo can obtain better reproductive outcomes than one double embryo transfer using blastocysts[25]. In our study, single embryo transfer protocol was also regarded as the major protocol to ensure the better pregnancy outcomes. In addition, it was easy to find the total clinical pregnancy rates and live birth rates of patients still stayed at low level regardless what measures had been taken.\u003c/p\u003e\n\u003cp\u003eIn this study, GnRH-a did not show obvious effect of improving pregnancy outcomes. We came up with several reasons to explain this phenomenon. Firstly, the current cycles of GnRH-a was not enough for patients with adenomyosis so that the effects of the drug did not work. We failed to get the information of the degree of adenomyosis between the two groups, maybe many patients did not suffer from severe adenomyosis, and it may be another reason leading to the negative result in GnRH-a improving pregnancy outcomes. Furthermore, we can consider whether patients was not sensitive to GnRH-a resulting in uterus not changing much, or GnRH-a did not work at all.\u003c/p\u003e\n\u003cp\u003eOne advantage of our study was that the number of women with adenomyosis was relatively large, including patients in a time span of six years. In addition, according to 2018 specialist consensus published in Journal of Reproductive Medicine, the number of embryo transfer was no more than two under 40 years and single embryo transfer was recommended. In our study, single embryo transfer constitutes the vast majority and the others were double embryo transfer, which was consistent with consensus. This two advantages made this study applicative for more population with adenomyosis. Apart from that, we also found that good reproductive outcomes still stayed at a low level although different measures had been taken, which meant many new explorations needed to be done to improve reproductive outcomes for women with adenomyosis.\u003c/p\u003e\n\u003cp\u003eTwo obvious defects existed in this study. Firstly, this study did not analysis the duration of GnRH-a for women with adenomyosis. If patients could get enough duration of GnRH-a down-regulation, the attachment of high quality follicles will be affected as most of our patients only underwent only once GnRH-a down-regulation. In addition, the severity of adenomyosis did not be discussed, which may be influence therapeutic effect in a way. These questions both needed to be studied in the future.\u003c/p\u003e\n\u003cp\u003eAlthough many studies thought that administrating GnRH agonists was very beneficial for patients of adenomyosis in improving reproductive outcomes of IVF-ET, our study did not demonstrate advantages of adding GnRH agonists based on hormone replacement therapy cycle. Similiar negative conclusions were also shown in endometriosis[10-12]. In addition, Movahedi S et al. did a study that Endometrial preparation for FET using GnRH agonists appeared to be as effective as FET without administrating these agonists[26]. The other two articles also did not think that GnRH-a down-regulation showed any significant advantages of IVF-ET[27-28]. Those all provided some supportive evidence for our study result.\u003c/p\u003e\n\u003cp\u003eIn conclusion, patients with adenomysis carried out GnRH-a down regulation or not based on hormone replacement therapy cycle had similar reproductive outcomes. Adding GnRH-a based on hormone replacement therapy cycle may not increase the rates of clinical pregnancy and live birth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany people have offered me valuable help in my thesis writing, inclusing my tutor and my classmates.\u003c/p\u003e\n\u003cp\u003eParticularly, I would like to give my sincere gratitude to Prof. Lei Yan, my tutor who give me great help by providing me with necessary materials, advice of great value and inspiration of new ideas. It is his suggestions that draw my attention to the number of deficiencies and make many things clearer. Without his strong support, this thesis could not been the present form. I also wish to sincerely thank Dr. Du and my classmates. They graciously make considerable comments and sound suggestions to the outline of this paper. Finally, I am grateful to Innovative Research Group Project of the National Natural Science Foundation of China (CN) for financial support.\u003c/p\u003e\n\u003cp\u003eI would like to express my gratitude to all those who helped me during the writing of this thesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMuzi Li took the responsibility of project development, data collection, data analysis,and manuscript writing. And Heng Zhao, Lihong Xu, Yanbo Du and Lei Yan also took part in the work project development. In addition, Lei Yan also finished part of manuscript writing and amending.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding: Innovative Research Group Project of the National Natural Science Foundation of China (CN)\u003c/p\u003e\n\u003cp\u003eConflicts of interest/Competing interests: The authors declare that they have no conflict of interest. Conflict of interest statement will be submitted separately in PDF format.\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: Data and material were available.\u003c/p\u003e\n\u003cp\u003eCode availability: Software application was available.\u003c/p\u003e\n\u003cp\u003eAuthor Contribution: Muzi Li: project development, data collection, data analysis, manuscript writing; Heng Zhao: project development; Lihong Xu: project development; Lei Yan: project development, manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available by request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by research ethics committee of Reproductive Hospital affiliate d to Shandong University. The patients/participants provided their written informed consent to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSoave, I., Wenger, J. M., Pluchino, N., \u0026amp; Marci, R. Treatment options and reproductive outcome for adenomyosis-associated infertility.\u0026nbsp;\u003cem\u003eCurrent medical research and opinion.\u003c/em\u003e\u003cstrong\u003e34(5)\u003c/strong\u003e, 839\u0026ndash;849. \u003ca href=\"https://doi.org/10.1080/03007995.2017.1393404\"\u003ehttps://doi.org/10.1080/03007995.2017.1393404\u003c/a\u003e (2018).\u0026nbsp;\u003c/li\u003e\n\u003cli\u003eBuggio, L., Monti, E., Gattei, U., Dridi, D., \u0026amp; Vercellini, P. Adenomyosis: fertility and obstetric outcome. A comprehensive literature review. \u003cem\u003eMinerva ginecologica.\u003c/em\u003e \u003cstrong\u003e70(3)\u003c/strong\u003e, 295\u0026ndash;302. \u003ca href=\"https://doi.org/10.23736/S0026-4784.17.04163-6\"\u003ehttps://doi.org/10.23736/S0026-4784.17.04163-6\u003c/a\u003e (2018).\u003c/li\u003e\n\u003cli\u003eDueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in\u0026nbsp;vitro fertilization and surgery.\u0026nbsp;\u003cem\u003eActa obstetricia et gynecologica Scandinavica.\u003c/em\u003e\u003cstrong\u003e96(6)\u003c/strong\u003e, 715\u0026ndash;726. \u003ca href=\"https://doi.org/10.1111/aogs.13158\"\u003ehttps://doi.org/10.1111/aogs.13158\u003c/a\u003e (2017).\u003c/li\u003e\n\u003cli\u003eHuang, Y. et al. 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X. et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. \u003cem\u003eThe Cochrane database of systematic reviews.\u003c/em\u003e \u003cstrong\u003e2019(11)\u003c/strong\u003e, CD013240. \u003ca href=\"https://doi.org/10.1002/14651858.CD013240.pub2\"\u003ehttps://doi.org/10.1002/14651858.CD013240.pub2\u003c/a\u003e (2019).\u003c/li\u003e\n\u003cli\u003eTao, T. et al. [Effects of uterine adenomyosis on clinical outcomes of infertility patients treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET)]. \u003cem\u003eNan Fang Yi Ke Da Xue Xue Bao.\u003c/em\u003e \u003cstrong\u003e35(2)\u003c/strong\u003e, 248-51. Chinese. PMID: 25736122 2015 Feb.\u003c/li\u003e\n\u003cli\u003eMa, X., Du, W., Hu, J., Yang, Y., \u0026amp; Zhang, X. Effect of Gonadotrophin-Releasing Hormone Agonist Addition for Luteal Support on Pregnancy Outcome in vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Meta-Analysis Based on Randomized Controlled Trials\u003cem\u003e.\u003c/em\u003e \u003cem\u003eGynecologic and obstetric investigation\u003c/em\u003e. \u003cstrong\u003e85(1)\u003c/strong\u003e, 13\u0026ndash;25. \u003ca href=\"https://doi.org/10.1159/000501204\"\u003ehttps://doi.org/10.1159/000501204\u003c/a\u003e (2020).\u003c/li\u003e\n\u003cli\u003eNiu, Z., Chen, Q., Sun, Y., \u0026amp; Feng, Y. 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Effects of bicornuate uterus on pregnancy and obstetric outcomes of in vitro fertilization / intracytoplasmic sperm injection. \u003cem\u003eEuropean journal of obstetrics, gynecology, and reproductive biology.\u003c/em\u003e\u003cstrong\u003e 258\u003c/strong\u003e, 132\u0026ndash;138. \u003ca href=\"https://doi.org/10.1016/j.ejogrb.2020.12.046\"\u003ehttps://doi.org/10.1016/j.ejogrb.2020.12.046\u003c/a\u003e (2021).\u003c/li\u003e\n\u003cli\u003eYounes, G., \u0026amp; Tulandi, T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. \u003cem\u003eFertility and sterility.\u003c/em\u003e \u003cstrong\u003e108(3)\u003c/strong\u003e, 483\u0026ndash;490.e3. \u003ca href=\"https://doi.org/10.1016/j.fertnstert.2017.06.025\"\u003ehttps://doi.org/10.1016/j.fertnstert.2017.06.025\u003c/a\u003e (2017).\u003c/li\u003e\n\u003cli\u003eGao, G. et al. Endometrial thickness and IVF cycle outcomes: a meta-analysis. \u003cem\u003eReproductive biomedicine online.\u003c/em\u003e \u003cstrong\u003e40(1)\u003c/strong\u003e, 124\u0026ndash;133. \u003ca href=\"https://doi.org/10.1016/j.rbmo.2019.09.005\"\u003ehttps://doi.org/10.1016/j.rbmo.2019.09.005\u003c/a\u003e (2020).\u003c/li\u003e\n\u003cli\u003eKasius, A. et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. \u003cem\u003eHuman reproduction update.\u003c/em\u003e \u003cstrong\u003e20(4)\u003c/strong\u003e, 530\u0026ndash;541. \u003ca href=\"https://doi.org/10.1093/humupd/dmu011\"\u003ehttps://doi.org/10.1093/humupd/dmu011\u003c/a\u003e (2014).\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-Shaw, S., Cercas, R., Bra\u0026ntilde;a, C., Villas, C., \u0026amp; Pons, I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. \u003cem\u003eJournal of assisted reproduction and genetics.\u003c/em\u003e \u003cstrong\u003e32(2)\u003c/strong\u003e, 177\u0026ndash;184. \u003ca href=\"https://doi.org/10.1007/s10815-014-0387-9\"\u003ehttps://doi.org/10.1007/s10815-014-0387-9\u003c/a\u003e (2015).\u003c/li\u003e\n\u003cli\u003eBourdon, M. et al. Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes. \u003cem\u003eHuman reproduction (Oxford, England).\u003c/em\u003e \u003cstrong\u003e34(10)\u003c/strong\u003e, 1948\u0026ndash;1964. \u003ca href=\"https://doi.org/10.1093/humrep/dez163\"\u003ehttps://doi.org/10.1093/humrep/dez163\u003c/a\u003e (2019).\u003c/li\u003e\n\u003cli\u003eXia, Q. et al. Identification of factors related to fertilization failure in in vitro fertilization-embryo transfer. Zhong nan da xue xue bao. \u003cem\u003eYi xue ban = Journal of Central South University.\u003c/em\u003e \u003cem\u003eMedical sciences.\u003c/em\u003e \u003cstrong\u003e45(8)\u003c/strong\u003e, 960\u0026ndash;965. \u003ca href=\"https://doi.org/10.11817/j.issn.1672-7347.2020.200076\"\u003ehttps://doi.org/10.11817/j.issn.1672-7347.2020.200076\u003c/a\u003e (2020).\u003c/li\u003e\n\u003cli\u003eLessing, J. B. et al. The performance of primary and secondary unexplained infertility in an in vitro fertilization-embryo transfer program. \u003cem\u003eFertility and sterility.\u003c/em\u003e \u003cstrong\u003e50(6)\u003c/strong\u003e, 903\u0026ndash;905. \u003ca href=\"https://doi.org/10.1016/s0015-0282(16)60369-2\"\u003ehttps://doi.org/10.1016/s0015-0282(16)60369-2\u003c/a\u003e (1988).\u003c/li\u003e\n\u003cli\u003eMehta, V. P., Patel, J. A., Gupta, R. H., Shah, S. I., \u0026amp; Banker, M. R. One Plus One Is Better Than Two: Cumulative Reproductive Outcomes Are Better after Two Elective Single Blastocyst Embryo Transfers Compared to One Double Blastocyst Embryo Transfer. \u003cem\u003eJournal of human reproductive sciences.\u003c/em\u003e \u003cstrong\u003e11(2)\u003c/strong\u003e, 161\u0026ndash;168. \u003ca href=\"https://doi.org/10.4103/jhrs.JHRS_117_17\"\u003ehttps://doi.org/10.4103/jhrs.JHRS_117_17\u003c/a\u003e (2018).\u003c/li\u003e\n\u003cli\u003eMovahedi, S. et al. Endometrial Preparation for Women Undergoing Embryo Transfer Frozen-Thawed Embryo Transfer With and Without Pretreatment With Gonadotropin Releasing Hormone Agonists. \u003cem\u003eJournal of family \u0026amp; reproductive health.\u003c/em\u003e \u003cstrong\u003e12(4)\u003c/strong\u003e, 191\u0026ndash;196 (2018).\u003c/li\u003e\n\u003cli\u003eGhobara, T., Gelbaya, T. A., \u0026amp; Ayeleke, R. O. Cycle regimens for frozen-thawed embryo transfer. \u003cem\u003eThe Cochrane database of systematic reviews.\u003c/em\u003e \u003cstrong\u003e7(7)\u003c/strong\u003e, CD003414. \u003ca href=\"https://doi.org/10.1002/14651858.CD003414.pub3\"\u003ehttps://doi.org/10.1002/14651858.CD003414.pub3\u003c/a\u003e (2017).\u003c/li\u003e\n\u003cli\u003eF\u0026aacute;bregues, F. et al. Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program. \u003cem\u003eFertility and sterility.\u003c/em\u003e \u003cstrong\u003e70(1)\u003c/strong\u003e, 46\u0026ndash;51. \u003ca href=\"https://doi.org/10.1016/s0015-0282(98)00123-x\"\u003ehttps://doi.org/10.1016/s0015-0282(98)00123-x\u003c/a\u003e (1998).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTable 1 Comparison of baseline data between two groups\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:454.1pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP A(n=160)\u003csup\u003e[1]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP B(n=181)\u003csup\u003e[2]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo-tailed P value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border:none;background:white;padding:.5pt .5pt 0in .5pt;height: 14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;border:none;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eMean(SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;border:none;background:white;padding:.5pt .5pt 0in .5pt;height: 14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eMean(SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eAge(SD)(year)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e34.56（4.49）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e35.25（4.95）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eHeight（SD）(cm)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e162.63(5.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e161.56(5.29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eWeight（SD）(kg)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e64.99(11.04)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e63.76(9.42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eBMI(SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e24.56(3.87)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e24.43(3.42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eLaboratory Tests\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eMean(SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eMean(SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eFSH(SD)（IU/L）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e6.54(1.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e6.32(2.04)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eLH(SD)(IU/L)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e4.39(2.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e4.85(2.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eE2(SD)(Pg/ml)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e42.38(33.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e48.08(76.54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003ePRL(SD)(ng/ml)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e19.87(35.15)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e16.76(19.48)\u003csup\u003e[3]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eInfertility\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:34.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003ePrimary Infertility\u0026mdash; no./total no. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:34.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e65/160(40.62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:34.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e61/181(33.70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:34.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:48.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eSecondary Infertility\u0026mdash; no./total no. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;background:white;padding:.5pt .5pt 0in .5pt;height:48.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e95/160(59.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:48.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e120/181(66.30)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:48.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:42.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eEndometrial thickness on hCG trigger day(mm)？\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:86.5pt;border:none;border-bottom:solid windowtext 1.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:42.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.96（0.20）\u003csup\u003e[4]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:115.0pt;border:none;border-bottom:solid windowtext 1.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:42.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.91（0.18）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border:none;border-bottom:solid windowtext 1.0pt;background:white;padding:.5pt .5pt 0in .5pt;height:42.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.02\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[1]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003ethe study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[2]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eThe control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[3]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eOne value was missing.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[4]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eFive values were missing.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003eTable 2 Comparison of embryological characteristics between two groups\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border: none;margin-left:.5pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:35.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:35.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP A(n=160)\u003csup\u003e[1]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:35.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP B(n=181)\u003csup\u003e[2]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:35.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo-tailed P value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;border:none;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTime of embryo transfer \u0026mdash; no./total no. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;border:none;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border:none;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eD3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e2/160(1.25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e5/181(2.76)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:127.55pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eD5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e116/160(72.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e136/181(75.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eD6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e42/160(26.25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e40/181(22.10)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eNo. of embryos transferred\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:.5pt .5pt 0in .5pt;height:28.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eOne embryo \u0026mdash; no./total no. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e143/160(89.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e160/181(88.40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:148.85pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo embryos \u0026mdash; no./total no. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:92.15pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e17/160(10.62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e21/181(11.60)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[1]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003ethe study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[2]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eThe control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003eTable 3 Comparison of clinical pregnancy outcomes between two groups\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border: none;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP A(n=160)\u003csup\u003e[1]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP B(n=181)\u003csup\u003e[2]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo-tailed P value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eClinical outcome(%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;border:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;border:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eclinical pregancy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e65/160(40.63)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e77/181(42.54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.72\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003ebiochemical pregnancy rate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e22/160(13.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e20/181(11.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.45\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eclinical miscarriage rate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e27/65(41.54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e34/77(44.16)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.75\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eectopic pregnancy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e2/65(3.08)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e3/77(3.90)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e1\u003csup\u003e[3]\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003elive birth rate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e38/160(23.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e43/181(23.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.74\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003epreterm pregnancy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e5/160(3.12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e5/181(2.76)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:146.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003efull-term pregnancy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:95.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e33/160(20.63)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:105.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e38/181(20.99)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.1pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.95\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[1]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003ethe study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[2]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eThe control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003csup\u003e\u003cspan style=\"font-family:SimSun;\"\u003e[3]\u003c/span\u003e\u003c/sup\u003e\u003cspan style=\"font-family:SimSun;\"\u003eThis value was calculated by Fisher\u0026rsquo;s exact test.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003eTable 4 Binary logistic regression of influence factors of pregnancy rates between two groups\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border: none;margin-left:.5pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:137.0pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:126.1pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eOR（95%CI）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:190.5pt;border-top:solid black 1.0pt;border-left: none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo-tailed P value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:137.0pt;padding:.5pt .5pt 0in .5pt;height:38.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-family: SimSun;color:black;\"\u003ethe day of embryo transfer\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:126.1pt;padding:.5pt .5pt 0in .5pt;height:38.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:190.5pt;padding:.5pt .5pt 0in .5pt;height:38.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:137.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:126.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:190.5pt;border:none;border-bottom: solid black 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eP=0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:137.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:126.1pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e1.67(0.27-10.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:137.0pt;border:none;border-bottom:solid black 1.0pt;padding:.5pt .5pt 0in .5pt;height: 14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:126.1pt;border:none;border-bottom:solid black 1.0pt;padding:.5pt .5pt 0in .5pt;height: 14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e2.99(1.62-5.52)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003eTable 5 Binary logistic regression of influence factors of live birth rates between two groups\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border: none;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:137.5pt;border-top:solid black 1.0pt;border-left:none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:126.55pt;border-top:solid black 1.0pt;border-left:none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eOR（95%CI）\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:190.05pt;border-top:solid black 1.0pt;border-left:none;border-bottom:solid black 1.0pt;border-right:none;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTwo-tailed P value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:137.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eage(year)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:126.55pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e0.92(0.87-0.98)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:190.05pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eP=0.01\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width:454.1pt;padding:.5pt .5pt 0in .5pt;height:27.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;color:black;\"\u003ethe day of embryo transfer\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:137.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:126.55pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" style=\"width:190.05pt;border:none;border-bottom:solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eP=0.01\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:137.5pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:126.55pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e4.42(0.60-32.81)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:137.5pt;border:none;border-bottom: solid black 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eDAY6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:126.55pt;border:none;border-bottom: solid windowtext 1.0pt;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;vertical-align:middle;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e3.64(1.60-8.27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width:6.3in;padding:.5pt .5pt 0in .5pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:22.0pt;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:22.0pt;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eTable 6 Time of GnRH-a down-regulation in Group A\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width:269.35pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:184.25pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eGROUP A(n=160)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:208.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003etime of GnRH-a down-regulation(%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:245.6pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:208.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:245.6pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e118/160(73.75)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:208.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:245.6pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e25/160(15.625)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:208.0pt;border:none;border-bottom: solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003eno less than 3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:245.6pt;border:none;border-bottom: solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:14.0pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e17/160(10.625)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-family:SimSun;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adenomyosis, cryopreserved embryo transfer, Gonadotropin-releasing hormone agonist, hormone replacement therapy cycle ","lastPublishedDoi":"10.21203/rs.3.rs-506178/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-506178/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Gonadotropin-releasing hormone agonist(GnRH-a) is generally added to improve pregnancy outcomes of adenomyosis based hormone replacement therapy cycle. Our objective in this study is to investigate whether adding GnRH-a can obtain better pregnancy outcomes. In this retrospective analysis, a total of 341 patients with adenomyosis complicated in vitro fertilization-embryo transfer(IVF-ET) of the frozen embryo transfer (FET). The control group was only treated by hormone replacement therapy cycles to prepare emdometrium, and the study group was added GnRH-a before using hormone to adjust menstruation period. Based on the similar baseline values and embryological data, there was no significantly difference about their clinical pregnancy rates (40.63% vs 42.54%, P=0.72) and live birth rates (23.75% vs 23.75%, P=0.74) between the control group and the study group. Other secondary outcomes including clinical miscarriage rates, ectopic pregnancy rates, preterm pregnancy rates and term pregnancy rates did not show significant difference between the two groups. Compared with using hormone replacement therapy cycle alone, GnRH-a down-regulation based on hormone replacement therapy cycle may not increase the rates of clinical pregnancy and live birth rates in IVF-ET of FET for infertile patients with adenomyosis.","manuscriptTitle":"Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-05-13 00:26:04","doi":"10.21203/rs.3.rs-506178/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-07-19T15:30:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-07-16T23:03:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77733a59-d74d-449b-b2d4-c2d3fc44e5db","date":"2021-07-08T09:30:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-06-15T07:13:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9374addb-76aa-4a0d-b208-5e8add722984","date":"2021-06-14T13:16:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-06-14T13:03:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-06-14T12:59:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-05-11T11:10:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-05-11T10:58:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2021-05-08T09:55:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03cbea61-554d-4beb-b977-e74c9f23894c","owner":[],"postedDate":"May 13th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":4271507,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2021-09-14T11:44:01+00:00","versionOfRecord":[],"versionCreatedAt":"2021-05-13 00:26:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-506178","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-506178","identity":"rs-506178","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}