Anxiety and depression in recurrent implantation failure after frozen-thawed embryo transfer and efficacy of endometrial receptivity testing

Table 1 Comparative analysis of Self-Rating Anxiety Scale and Self-Rating Depression Scale scores among study participants

Total (n = 371)		Group	Score
SAS score	50.89 ± 9.34	Anxiety (n = 204)	57.91 ± 4.67
		Non-anxiety (n = 167)	42.31 ± 5.73
SDS score	55.55 ± 9.48	Depression (n = 227)	62.00 ± 4.92
		Non-depression (n = 144)	45.38 ± 4.92

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 2 Univariate analysis of factors associated with anxiety and depression in patients with recurrent implantation failure

Characteristics	Anxiety group (n = 204)	Non-anxiety group (n = 167)	χ2/t	P value	Depression group (n = 227)	Non-depression group (n = 144)	χ2/t	P value
Age (years)	-	-	9.655	0.002	-	-	13.001	0.000
≤ 35	83	95	-	-	92	86	-	-
> 35	121	72	-	-	135	58	-	-
BMI (kg/m2)	22.08 ± 2.09	21.82 ± 2.28	1.149	0.251	21.91 ± 2.04	22.04 ± 2.38	0.581	0.562
Marital status	-	-	5.171	0.023	-	-	0.253	0.615
First marriage	103	104	-	-	129	78	-	-
Remarriage	101	63	-	-	98	66	-	-
Educational attainment	-	-	0.402	0.526	-	-	2.160	0.023
Senior high school/technical secondary school or below	91	80	-	-	94	77	-	-
College/bachelor's degree or above	113	87	-	-	133	67	-	-
Annual household income (in ten thousand yuan)	-	-	9.931	0.007	-	-	21.832	< 0.0001
< 5	49	19	-	-	53	15	-	-
5-10	88	87	-	-	115	60	-	-
> 10	67	61	-	-	59	69	-	-
Occupation	-	-	1.117	0.773	-	-	5.219	0.157
Work unit	51	38	-	-	48	41	-	-
Self-employed	46	42	-	-	62	26	-	-
Farmer	54	49	-	-	62	41	-	-
Unemployed	53	38	-	-	55	36	-	-
Residential area	-	-	1.922	0.166	-	-	7.038	0.008
Urban	115	106	-	-	123	98	-	-
Rural	89	61	-	-	104	46	-	-
Type of infertility	-	-	0.703	0.402	-	-	0.167	0.683
Primary	84	76	-	-	96	64	-	-
Secondary	120	91	-	-	131	80	-	-
Infertility duration (years)	-	-	13.012	0.002	-	-	9.426	0.009
< 3	51	58	-	-	50	60	-	-
3-5	81	59	-	-	86	54	-	-
> 5	72	50	-	-	91	30	-	-
Cause of infertility	-	-	9.871	0.020	-	-	9.896	0.019
Male-factor	51	57	-	-	70	38	-	-
Female-factor	86	45	-	-	76	55	-	-
Combined male-female-factor	31	33	-	-	31	33	-	-
Unexplained	36	32	-	-	50	18	-	-
Female party’s only-child status	-	-	1.100	0.294	-	-	0.056	0.813
Yes	83	77	-	-	99	61	-	-
No	121	90	-	-	128	83	-	-
Spouse’s only-child status	-	-	5.602	0.018	-	-	2.036	0.154
Yes	124	71	-	-	126	69	-	-
No	80	96	-	-	101	75	-	-
Infertility treatment duration (years)	-	-	17.033	0.001	-	-	7.202	0.066
< 1	68	57	-	-	78	47	-	-
1-3	40	60	-	-	62	38	-	-
3-5	37	24	-	-	44	17	-	-
> 5	59	26	-	-	43	42	-	-
Number of failed implantation attempts	-	-	12.301	0.001	-	-	18.081	< 0.0001
2	91	105	-	-	100	96	-	-
≥ 3	113	62	-	-	127	48	-	-

BMI: Body mass index.

Table 3 Multivariate logistic regression analysis of anxiety-related risk factors in patients with recurrent implantation failure

Variable	β	SE	Wald	P value	HR	95%CI
Constant	-0.340	0.539	0.398	0.528	0.712	-
Age (0: ≤ 35, 1: > 35)	0.753	0.240	9.876	0.002	2.124	1.328-3.397
Marital status (0: First marriage, 1: Remarriage)	0.366	0.236	2.395	0.122	1.442	0.907-2.291
Annual household income (0: < 5 thousand yuan)	-	-	9.608	0.008	-	-
1: 5-10 thousand yuan	-1.091	0.358	9.263	0.002	0.336	0.166-0.678
2: > 10 thousand yuan	-0.997	0.373	7.145	0.008	0.369	0.177-0.766
Infertility duration (0: < 3 years)	-	-	2.981	0.225	-	-
1: 3-5 years	0.150	0.331	0.206	0.650	1.162	0.607-2.225
2: > 5 years	-0.439	0.349	1.583	0.208	0.645	0.325-1.278
Cause of infertility (0: Unexplained)	-	-	5.398	0.145	-	-
1: Male-factor	-0.036	0.343	0.011	0.916	0.965	0.492-1.891
2: Female-factor	0.440	0.337	1.712	0.191	1.553	0.803-3.300
3: Combined male-female-factor	-0.305	0.400	0.582	0.446	0.737	0.336-1.614
Spouse’s only-child status (0: No, 1: Yes)	0.732	0.236	9.614	0.002	2.078	1.309-3.300
Infertility treatment duration (0: < 1 year)	-	-	19.282	0.000	-	-
1: 1-3 years	-0.623	0.329	3.594	0.058	0.536	0.282-1.021
2: 3-5 years	0.206	0.363	0.321	0.571	1.229	0.603-2.504
3: > 5 years	1.128	0.393	8.226	0.004	3.089	1.429-6.676
Number of failed implantation attempts (0: 2, 1: ≥ 3)	0.785	0.252	9.726	0.002	2.192	1.339-3.591

HR: Hazard ratio; CI: Confidence intervals.

Table 4 Multivariable logistic regression analysis of depression-associated risk factors in patients with recurrent implantation failure

Variable	β	SE	Wald	P value	HR	95%CI
Constant	-0.787	0.513	2.349	0.125	2.196	-
Age (0: ≤ 35, 1: > 35)	0.697	0.244	8.178	0.004	2.008	1.245-3.239
Educational attainment (0: Senior high school/technical secondary school or below, 1: College/bachelor’s degree or above)	0.533	0.245	4.732	0.030	1.705	1.054-2.757
Annual household income (0: < 5 thousand yuan)	-	-	13.930	0.001	-	-
1: 5-10 thousand yuan	-0.545	0.379	2.069	0.150	0.580	0.276-1.219
2: > 10 thousand yuan	-1.281	0.384	11.148	0.001	0.278	0.131-0.589
Residential area (0: Rural, 1: Urban)	-0.799	0.260	9.436	0.002	0.450	0.270-0.749
Infertility duration (0: < 3 years)	-	-	12.723	0.002	-	-
1: 3-5 years	0.642	0.304	4.475	0.034	1.901	1.048-3.446
2: > 5 years	1.141	0.321	12.643	0.000	3.129	1.669-5.868
Cause of infertility (0: Unexplained infertility)	-	-	11.126	0.011	-	-
1: Male-factor	-0.531	0.376	2.000	0.157	0.588	0.281-1.228
2: Female-factor	-0.824	0.362	5.201	0.023	0.438	0.216-0.891
3: Combined male-female-factor	-1.344	0.421	10.211	0.001	0.261	0.114-0.595
Number of failed implantation attempts (0: 2, 1: ≥ 3)	0.794	0.256	9.610	0.002	2.211	1.339-3.652

HR: Hazard ratio; CI: Confidence intervals.

Table 5 Pregnancy outcome comparison: Endometrial receptivity testing vs non-endometrial receptivity testing groups, n (%)

Variable	Clinical pregnancy rate	Endometrial thickness on the day of transfer (mm)	Number of embryos transferred	Miscarriage rate
ERT group (n = 226)	115 (50.9)	9.67 ± 0.73	1.26 ± 0.21	14
Non-ERT group (n = 145)	45 (31.0)	9.38 ± 0.70	1.39 ± 0.20	18
χ2/t	14.191	3.760	2.896	4.335
P value	0.0002	0.0002	0.004	0.037

ERT: Endometrial receptivity testing.

Table 6 Univariate analysis of clinical pregnancy determinants

Variable	Clinical pregnancy group (n = 160)	Non-clinical pregnancy group (n = 211)	χ2/t	P value
Age (years)			40.251	< 0.0001
≤ 35	107	71
> 35	53	140
BMI (kg/m2)	22.05 ± 2.30	21.87 ± 2.07	0.925	0.355
Type of infertility			3.789	0.052
Primary	60	100
Secondary	100	110
Infertility duration (years)			1.042	0.594
< 3	43	67
3-5	63	77
> 5	54	67
Embryo type transferred			26.251	< 0.0001
Blastocyst-stage embryo	95	69
Cleavage-stage embryo	65	142
Number of embryos transferred (n)	1.33 ± 0.47	1.16 ± 0.37	3.898	0.0001
Total treatment cycles	1.53 ± 0.50	1.85 ± 0.41	6.839	< 0.0001
Endometrial thickness (mm)	10.08 ± 0.61	9.17 ± 0.55	14.980	< 0.0001
Anxiety			6.416	0.011
Yes	100	104
No	60	107
Depression			4.723	0.030
Yes	108	119
No	52	92

BMI: Body mass index.

Table 7 Multivariate analysis of clinical pregnancy failure in recurrent implantation failure patients

Variable	β	SE	Wald	P value	HR	95%CI
Constant	14.865	2.210	45.244	0.000	2855143.310	-
Anxiety (0: No, 1: Yes)	0.341	0.279	1.501	0.220	1.407	0.815-2.430
Depression (0: No, 1: Yes)	0.322	0.286	1.268	0.260	1.379	0.788-2.414
Age (0: ≤ 35, 1: > 35)	1.480	0.289	26.309	0.000	4.394	2.496-7.735
Embryo type transferred (0: Cleavage-stage embryo, 1: Blastocyst-stage embryo)	-1.107	0.280	15.638	0.000	0.330	0.191-0.572
Number of transferred embryos (continuous variable)	-0.786	0.314	6.279	0.012	0.456	0.246-0.843
Total treatment cycles (continuous variable)	0.497	0.282	3.116	0.078	1.644	0.947-2.856
Endometrial thickness (continuous variable)	-1.565	0.220	50.461	0.000	0.209	0.136-0.322

HR: Hazard ratio; CI: Confidence intervals.