Protocols for Endometrial Preparation and Endometrial Pattern Before Embryo Transfer in Patients with Asherman Syndrome

Wenqian Xiong, Yi Liu, Ling Zhang, Chun Yang Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of ChinaCorrespondence: Chun Yang, Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China, Email [email protected]: Endometrial thickness measurement (EMT) is not a reliable predictor of clinical pregnancy in Asherman syndrome (AS) patients. The aim of this study is to investigate the impact of endometrial patterns on reproductive outcomes in patients with AS for both fresh and frozen embryo transfers. Additionally, it is essential to determine the preferred endometrial preparation protocol for women in this population who are planning frozen embryo transfer (FET).Methods: Seventy-six patients diagnosed with Asherman syndrome underwent hysteroscopic adhesiolysis followed by in vitro fertilization-embryo transfer (IVF-ET) at Union Hospital of Huazhong University of Science and Technology between February 2019 and July 2021. This study reviewed the endometrial patterns of 134 embryo transfers and the endometrial preparation protocols of 127 frozen embryo transfer (FET) cycles within this cohort of patients.Results: The triple-line endometrial pattern before embryo transfer (ET) was found to be a significant predictor of a positive clinical pregnancy outcome (odds ratio 0.315, P = 0.007) and a successful live birth (odds ratio 0.306, P = 0.009). Moreover, the gonadotropin-releasing hormone agonist (GnRHa) downregulation in conjunction with hormone replacement therapy (HRT) protocol showed improvements in both the clinical pregnancy rate (odds ratio 0.218, P = 0.005) and live birth rate (odds ratio 0.362, P = 0.049) compared to the HRT protocol in FET cycles.Conclusion: A triple-line endometrial pattern before embryo transfer is associated with successful clinical pregnancy and live birth in AS patients undergoing IVF. Additionally, the GnRHa+HRT protocol may increase the clinical pregnancy and live birth rates in AS women undergoing FET cycles.Keywords: asherman syndrome, FET, IVF, endometrial pattern, endometrial preparation protocol