Reassessing Endometrial and Procedural Predictors of Clinical Pregnancy in Ghanaian Assisted Reproductive Technology Cycles: A Null-finding Retrospective Cohort Study

Abstract Background: Assisted reproductive technology (ART) has improved globally, yet pregnancy outcomes per cycle remain suboptimal, with limited evidence from Sub-Saharan Africa (SSA). Endometrial characteristics, embryo placement depth, and transfer timing are commonly used as predictors of success, but their combined value in African populations is unclear. Methods: A retrospective cohort study was conducted at Oak Specialist Hospital, Kumasi, Ghana. Women who underwent fresh or frozen-thawed embryo transfer between October 2024 and February 2025 were included. Data on sociodemographic factors, body mass index (BMI), surgical history, uterine myomata, endometrial thickness (EMT) and pattern, embryo placement depth, and transfer duration were extracted. Results: A total of 199 women were analyzed (mean age: 37.93 ± 7.15 years; 52.26% aged >38 years; 77.78% overweight or obese). Clinical pregnancy rates showed no significant differences across age groups, BMI categories, surgical history, EMT or pattern, embryo placement depth, or transfer duration ( P > 0.05). A nonsignificant trend suggested higher pregnancy rates among obese women compared with those of normal weight (65.06% vs. 50.00%), likely reflecting selection bias and confounding. Conclusion: Common clinical and procedural parameters were not significantly associated with clinical pregnancy in this Ghanaian ART cohort. These findings provide context-specific evidence from SSA and suggest that, under standardized ultrasound-guided embryo transfer protocols, isolated endometrial and procedural measures have limited predictive value. The results discourage unnecessary cycle cancellation based on marginal findings and emphasize the need for larger multicenter studies and regional ART registries to improve predictive models and optimize outcomes in African ART practice.