Association Between D-Dimer/Fibrinogen Ratio and Pregnancy Outcomes in Normocoagulable Women Undergoing Frozen-Thawed Embryo Transfer Cycles: A Retrospective Cohort Study.

AIM: To explore the association between D-dimer/fibrinogen ratio (DFR) and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in normocoagulable women.

METHODS

This retrospective cohort study included 869 women undergoing their first single blastocyst frozen-thawed embryo transfer (FET) cycles at Beijing Chao-Yang Hospital. Data were collected from the medical records of FET cycles performed at the reproductive medicine center between January 2016 and November 2022. Eligible participants were normocoagulable women aged 22-38 years with a body mass index (BMI) < 30 kg/m2, those with metabolic or uterine disorders or incomplete records were excluded. The primary outcomes were live birth and miscarriage. Participants were stratified by live birth status to assess the association between DFR and pregnancy outcomes.

RESULTS

Participants were categorized into live birth group (n = 357) and non-live birth group (n = 512). Compared to the non-live birth group, the live birth group had lower D-dimer (0.19 vs. 0.23 mg/L, p = 0.010) and DFR (0.07 vs. 0.08, p = 0.003). Logistic regression revealed that elevated DFR increased pregnancy failure risk. Receiver operating characteristic (ROC) analysis indicated that DFR predicted live birth with a cut-off value of 0.085. Stratified by this cut-off value, the DFR > 0.085 group had a higher miscarriage rate (26.40% vs. 15.04%), a lower clinical rate (46.98% vs. 54.51%), and a lower live birth rate (34.38% vs. 46.31%).

CONCLUSIONS

A higher pre-pregnancy DFR is associated with adverse pregnancy outcomes in normocoagulable women and may serve as a predictor for IVF/ICSI.