Reproductive Sciences

https://doi.org/10.1007/s43032-019-00088-3

ORIGINAL ARTICLE

Atosiban and Pregnancy Outcomes Following In Vitro

Fertilization Treatment for Infertile Women Requiring One, Two,
or More Embryo Transfer Cycles: A Longitudinal Cohort Study
Meng-Hsing Wu 1,2 & Chih-Wei Lin 1 & Pei-Fang Su 3 & Edward Chai-Cheng Lai 4,5,6 & Fei-Ci Sie 3 & Yu-Lin Mau 3 &
New Geok Huey 1 & Huang-Tz Ou 4,5,6

Received: 29 April 2019 / Accepted: 1 August 2019

# Society for Reproductive Investigation 2020

Abstract
We assessed the effect of atosiban on pregnancy outcomes following in vitro fertilization (IVF) treatment among infertile women
requiring different numbers of embryo transfer (ET) cycles (i.e., one, two, and more than two ET cycles). A longitudinal cohort
study was conducted by utilizing the data from the Assisted Reproductive Technology Center in a university tertiary hospital
during 2007–2017. Patients receiving IVF treatment with at least one ET cycle were included. Pregnancy outcomes following
IVF treatment, including biochemical, clinical, and ongoing pregnancies, were investigated. The association between atosiban
and IVF pregnancy was assessed using logistic generalized estimating equation models, with adjustment for time-varying clinical
characteristics (e.g., maternal age) across multiple ET cycles for an individual. 403 women with 838 ET cycles were included,
where 165 patients required one ET cycle, 133 patients required two ET cycles (a total of 266 ET cycles), and 105 patients
required more than two ET cycles (a total of 407 ET cycles). Atosiban use was not significantly associated with pregnancy
outcomes among all study infertile women undergoing IVF treatment. However, the results for women requiring more than two
ET cycles showed significantly increased pregnancy rates associated with atosiban use (i.e., odds ratios [95% confidence interval]
of 4.40 [1.52, 12.73] and 2.85 [1.45, 5.60] for clinical and ongoing pregnancies, respectively). This association was not observed
for the women requiring only one or two ET cycles. Atosiban is a potential treatment for enhancing IVF pregnancy, especially
among infertile women requiring more than two ET cycles.

Keywords In vitro fertilization . Atosiban . Pregnancy . Embryo transfer cycle

Meng-Hsing Wu and Chih-Wei Lin are co-first/equal authorship; these

two authors provided equal contribution to this work.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s43032-019-00088-3) contains supplementary
material, which is available to authorized users.

* Huang-Tz Ou 3
Department of Statistics, National Cheng Kung University,
huangtz@mail.ncku.edu.tw Tainan, Taiwan
4
1
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College
Department of Obstetrics and Gynecology, National Cheng Kung of Medicine, National Cheng Kung University, Tainan, Taiwan
University Hospital, College of Medicine, National Cheng Kung
5
University, Tainan, Taiwan School of Pharmacy, College of Medicine, National Cheng Kung
2 University, Tainan, Taiwan
Department of Obstetrics and Gynecology and Department of
6
Physiology, College of Medicine, National Cheng Kung University, Department of Pharmacy, National Cheng Kung University Hospital,
Tainan, Taiwan Tainan, Taiwan

Introduction
Although in vitro fertilization (IVF) is widely used for
treating infertility, published success rates of IVF remain
suboptimal. In the early 1980s, the IVF pregnancy rate
was between 13% and 25% per oocyte retrieval cycle
[1–4]; in the 2000s, the estimated IVF pregnancy rates
were 29% and 39% in Europe [5] and the United States
[6], respectively. Embryo transfer (ET) is a critical step in
IVF treatment, where oocytes extracted from infertile
women and fertilized in vitro are transferred into the uter-
ine cavity. However, about 30% of patients undergoing
ET experience frequent uterine contractions (> 5 per min-
ute), which lead to worse pregnancy outcomes [7]. Less
than 50% of transferred embryos remain in the uterus
1 hour after the transfer [8], and approximately 15% of
embryos are present in the vagina following ET [9].
Hence, the absence of excessive uterine contractions is
important to ensure ideal endometrial receptivity and a
stable uterine environment for successful embryo implan-
tation [10]. However, high frequency of uterine contrac-
tions is usually found with increasing number of ET cy-
cles [11]. In addition, when women have more uterine
contractions, they typically have higher circulating oxyto-
cin or vasopressin levels and poor pregnancy outcomes
following IVF treatment [12].
Atosiban, a mixed oxytocin/vasopressin V1A receptor
antagonist, has been suggested to be administered during
embryo implantation to enhance the success of IVF preg-
nancy by reducing uterine contractions, inhibiting the re-
lease of oxytocin/PGF2α, and increasing endometrial per-
fusion [13]. Evidence suggests that atosiban may be use-
ful for women who are at risk of high frequency of uterine
contractions (e.g., patients undergoing three or more ET
cycles [11, 14], those with repeated implantation failures
[RIFs] [10, 14–19]), while playing a limited role in the
IVF success among all infertile women [20]. Specifically,
previous studies showed that the use of atosiban was not
significantly associated with successful IVF pregnancy
among all infertile women [20], while it improved im-
plantation and clinical pregnancy rates for IVF women
undergoing their third or subsequent ET cycles [11, 14].
However, one of these studies that assessed clinical ef-
fects of atosiban during different numbers of ET cycles
[11] had a limited sample size (i.e., 69, 76, 54, and 43
patients at the first, second, third, and subsequent 3 ET
cycles, respectively).
Against this background, we utilized longitudinal cohort
data with a large sample size and long follow-up to evaluate
the clinical effects of atosiban on IVF pregnancy (i.e., bio-
chemical, clinical, and ongoing pregnancies), especially for
infertile women requiring different numbers of ET cycles
(i.e., one, two, and more than two ET cycles).
Reprod. Sci.
Materials and Methods
Data Source
We used data from the Assisted Reproductive Technology
Center at National Cheng Kung University Hospital for the
period 2007–2017. Patients’ data were extracted from medical
charts and electronic medical records. The information for
each patient was collected on the basis of individual ET cycle
for the corresponding demographic characteristics and associ-
ated laboratory measurements, including the maternal age,
body mass index (BMI), gravidity, parity, history of pregnan-
cy loss, history of ET failure, infertility factors (i.e., from
male, female, both, or unknown), infertility duration, anti-
Müllerian hormone (AMH), fresh or frozen embryos trans-
ferred, and number (e.g., first, second, etc.) and date of ET.
IVF treatment procedures (including atosiban administration)
and pregnancy outcomes were also recorded for each ET.
Permission for this study was obtained from the Institutional
Review Board of National Cheng Kung University Hospital,
Tainan, Taiwan (B-ER-105-114). This study included patients
undergoing IVF and having at least one ET cycle. We excluded
those with poor quality of embryos, canceled IVF cycles, diffi-
cult ETs, or lost to follow-up from analysis. Poor quality of
embryos is defined as severe fragmentation (> 25%), not
stage-specific cell size, presence of multi-nucleation in
cleavage-stage embryos, not distinguishable inner cell mass with
few cells, and poor or uneven appearance of trophectoderm with
very few cells in blastocysts. And, the difficulty of ETs means
that the catheter was hard to insert into the uterine cavity for
smooth embryo release. As a result, the ET procedure was can-
celed and the embryos were refrozen for further cervical dilation.
In particular, we used the same standard catheter (i.e., Cook®
Sydney IVF Embryo Transfer Catheter Set (Cook Medical,
USA)) for all ETs, which was comprised of an outer firm guide
catheter and a soft inner transfer catheter. And, the post-loading
technique was adopted. That is, the inner transfer catheter loaded
with embryos was introduced through the guided catheter,
which had been placed beyond the cervix, to release the embry-
os into the uterine cavity. Moreover, all ETs were performed
under transabdominal ultrasound guidance, with an assistant
holding the transducer. The bladder was well-distended, which
helps visualize the cervical canal clearly under the guidance of
transabdominal ultrasound during the procedure of embryo
transfer. We could rotate the tip of the catheter based on the
utero-cervical angle and then release the embryo into the appro-
priate position of uterine cavity where hyperechogenic point can
be visualized from the loading of the embryo-associated bubble.
For all IVF cycles, controlled ovulation hyperstimulation, either
via a gonadotropin-releasing hormone (GnRH) agonist or a
GnRH antagonist protocol, was used. When the leading follicles
reached 18–20 mm, recombinant human chorionic gonadotro-
pin (hCG) was administered, followed by transvaginal oocyte
Reprod. Sci.
retrieval 34–36 h later. In vitro embryo culture with or without
intracytoplasmic sperm injection was then conducted. ET was
performed on Day 2–5 with good-quality embryos based on a
morphological study. For frozen ET cycles, previously cryopre-
served good-quality embryos were thawed for transfer per stan-
dard protocol.
For cycles with infusion of atosiban (Tractocile; Ferring
Pharmaceuticals), a single bolus dose (6.75 mg, 0.9 mL) was
administered intravenously before ET, followed by continu-
ous infusion of the remaining dose (30.75 mg, 4.1 mL) in
500 mL of normal saline for 1.5 h. We classified all ET cycles
on the basis of treatment of atosiban exposure (i.e., atosiban-
treated ET or non-atosiban-treated ET).
Pregnancy Outcomes
The primary outcomes of this study included biochemical,
clinical, and ongoing pregnancies. We confirmed biochemical
pregnancy by a blood sample β-HCG level of above 30 IU/L,
which is typically found in the blood of pregnant women as
early as 10 days after conception. A test for β-human chori-
onic gonadotropin hormone (β-HCG) was given 14 days after
ET. Clinical pregnancy was confirmed by the presence of
gestational sacs with a heartbeat at the 10th week of gestation-
al age. Ongoing pregnancy was confirmed on the basis of the
documentation of a live fetus (or fetuses) at the 24th week.
Statistical Analysis
We tabulated descriptive statistics, means with standard devi-
ations and frequencies with percentages for continuous and
categorical variables, respectively. We calculated the rates of
pregnancy outcomes and compared the effectiveness of ET
cycles with and without exposure to atosiban. Because the
pregnancy outcomes of multiple ET cycles from a given per-
son were likely to be correlated, we applied the logistic gen-
eralized estimating equation (GEE) model to assess the asso-
ciation between atosiban use and IVF pregnancy outcomes.
The logistic GEE is a specific statistic that accounts for the
correlation of repeated measures (i.e., pregnancy outcomes)
across multiple ET cycles within a person to adjust for con-
founding by time-invariant factors from unmeasured underly-
ing characteristics of individuals [21]. Specifically, we first
conducted univariate logistic GEE analyses where associa-
tions between each individual clinical characteristic (i.e.,
listed in Table 1) and pregnancy outcomes were tested sepa-
rately to identify significant characteristics. Second, multivar-
iate logistic GEE analysis was performed to assess the effect
of atosiban on pregnancy outcomes, with adjustment for sig-
nificant characteristics associated with pregnancy outcomes
from univariate analyses. In particular, we treated patients’
clinical characteristics measured from individual ET cycles
over the observation period as time-varying covariates in the
multivariate analysis. We did this because we considered pa-
tients’ clinical characteristics (e.g., maternal age), which could
vary over time across multiple ET cycles for a given person
and thus might confound the analyses. In addition, logistic
GEE with an exchangeable working correlation matrix spec-
ified was used for dichotomous data of pregnancy outcomes.
The odds ratios (ORs) and 95% confidence intervals (CIs) are
presented. Of note, we did not further impute missing values
for variables of interest, and patients with missing values for
the variables of interest were excluded from the analyses.
We further stratified study patients by the number of ET
cycles required (i.e., one, two, and more than two ET cycles)
to evaluate the clinical effects of atosiban among infertile
women having different numbers of ET cycles. All statistics
and figures were prepared with R software (version 3.4.0). All
statistical tests were 2-sided, with a p value of less than 0.05
considered to indicate statistical significance.
Results
A total of 403 women with 838 ET cycles were included in this
study, in which 165 patients required one ET, 133 patients re-
quired two ET cycles, and 105 patients required more than two
ET cycles (a total of 407 ET cycles). Table 1 shows the charac-
teristics for all study patients and stratified by the number of ET
cycles. Overall, the average maternal age (standard deviation) at
ET was 35.88 (4.66) years, infertility duration was 4.81 (3.33)
years, female infertility was a factor for about 40.1% of study
patients, and most transferred embryos were fresh (56.5%).
Table 2 summarizes the results of the association between
the use of atosiban and pregnancy outcomes based on our
overall study population (n = 403). Univariate and multivari-
ate GEE analyses indicate nonsignificantly increased chances
of pregnancy (i.e., biochemical, clinical, and ongoing preg-
nancies) with atosiban use among all infertile women under-
going IVF treatment.
Figure 1 summarizes the results of the association of
atosiban with IVF pregnancy outcomes in the overall study
population and in subgroups stratified by the number of ET
cycles (i.e., one, two, and more than two ET cycles).
Supplementary Tables 1–3 show the detailed results for the
association of atosiban use and pregnancy outcomes stratified
by the number of ET cycles. We found that the women who
required more than two ET cycles had significantly increased
chances of clinical and ongoing pregnancies associated with
atosiban use (i.e., ORs [95% CI] of 4.40 [1.52, 12.73] and
2.85 [1.45, 5.60], respectively; Supplementary Table 3), while
atosiban use among those having one or two ET cycles was
not significantly associated with IVF pregnancy outcomes
(Supplementary Tables 1 and 2).
 Reprod. Sci.

Table 1 Clinical characteristics for all study patients and subgroups stratified by number of embryo transfer (ET) cycles

Overall Subgroups by time of ET cycle

(403 patients
with 838 ET cycles) Only 1 ET Only 2 ET cycles ≥ 3 ET cycles
(165 patients (133 patients (105 patients
with 165 ET cycles) with 266 ET cycles) with 407 ET cycles)

Characteristics # of ET cycles Mean (sd) # of ET cycles Mean (sd) # of ET cycles Mean (sd) # of ET cycles Mean (sd)
or % or % or % or %

Age (years) 804 35.88 159 35.73 259 36.81 386 35.33
(4.66) (3.98) (4.36) (5.02)
BMI 832 22.45 164 22.61 265 22.21 403 22.54
(3.54) (3.90) (3.58) (3.37)
AMH (ng/mL) 380 3.24 (2.92) 136 3.56 (3.40) 109 3.07 (2.93) 135 3.07 (2.33)
Gravida 834 0.61 (0.96) 165 0.55 (0.81) 265 0.53 (1.00) 404 0.68 (0.99)
Parity 834 0.18 (0.44) 165 0.21 (0.51) 265 0.16 (0.46) 404 0.19 (0.40)
Infertility duration (years) 836 4.81 (3.33) 164 4.20 (3.03) 265 5.04 (3.46) 407 4.90 (3.34)
Number of oocytes retrieved 411 9.14 (6.1) 79 9.70 (5.24) 129 8.27 (5.66) 203 9.47 (6.63)
Number of embryos 805 2.58 (0.96) 164 2.49 (0.89) 258 2.53 (0.94) 383 2.65 (1.01)
transferred
Day of ET 414 3.56 (1.24) 154 3.61 (1.24) 111 3.66 (1.22) 149 3.43 (1.24)
Day 1–3 238 57.49% 81 52.60% 62 55.86% 95 63.76%
Day 4–5 176 42.51% 73 47.40% 49 44.14% 54 36.24%
HRV before ET 351 1.91 (1.94) 147 1.72 (1.83) 102 2.01 (1.94) 102 2.09 (2.07)
HRV after ET 324 1.43 (1.52) 134 1.46 (1.62) 94 1.52 (1.66) 96 1.29 (1.19)
Number of previous ET cycles 432 1.94 (1.83) 154 1.48 (1.09) 116 1.77 (1.26) 162 2.51 (2.48)
ET failure history
None 238 43.83% 112 70.00% 66 39.76% 60 27.65%
At least one 305 56.17% 48 30.00% 100 60.24% 157 72.35%
Pregnancy loss history
None 306 70.51% 112 72.26% 89 76.72% 105 64.42%
At least one 128 29.49% 43 27.74% 27 23.28% 58 35.58%
Infertility factor
Male 323 38.68% 59 35.76% 98 36.98% 166 40.99%
Female 335 40.12% 64 38.79% 102 38.49% 169 41.73%
Both 74 8.86% 18 10.91% 17 6.42% 39 9.63%
Unknown 103 12.34% 24 14.55% 48 18.11% 31 7.65%
Type of embryo transferred
Fresh 463 56.53% 89 53.94% 145 56.20% 229 57.83%
Frozen-thawed 356 43.47% 76 46.06% 113 43.80% 167 42.17%
Atosiban administration
Yes 311 37.88% 25 15.92% 108 41.54% 178 44.06%
No 510 62.12% 132 84.08% 152 58.46% 226 55.94%

Abbreviations: sd standard deviation, BMI body mass index, AMH anti-Müllerian hormone, ET embryo transfer, HRV heart rate variability

Discussion women requiring only one or two ET cycles. These results

This longitudinal cohort study of infertile women undergoing
IVF treatment found that the use of atosiban among women
requiring more than two ET cycles was significantly associated
with successful pregnancy (i.e., clinical and ongoing pregnan-
cies), while it might not be beneficial for IVF pregnancy among
support the rational use of atosiban based on the number of
ET cycles to improve the pregnancy rates of IVF patients.
Emerging evidence suggests that atosiban might be an ef-
fective treatment for IVF women to avoid excessive uterine
contractions following multiple ET cycles [11, 14]. Atosiban
can directly inhibit uterine contractions and decrease the
Reprod. Sci.

Note: the covariates selected in the multivariate analyses (e.g., maternal age) were significantly associated with IVF pregnancy in univariate analyses. Other patients’ characteristics (listed in Table 1) were
release of PGF2α in human uterine smooth muscle cells [22].

p value

< 0.001
0.4379
The blockage of oxytocin receptors and subsequent uterine

0.497

0.003
PGF2α production, which have been linked to increased em-
Ongoing pregnancy

bryonic survival, are important to ensure the success of IVF

Biochemical pregnancy was confirmed by blood sample β-HCG level of above 30 IU/L, which is typically found in the blood of pregnant women as early as 10 days after conception
388 patients with 1.12 (0.81, 1.57)

383 patients with 1.15 (0.81, 1.63)

1.65 (1.18, 2.31)

0.92 (0.88, 0.95)
pregnancy [23]. Atosiban was also found to relax uterine ar-
OR (95% CI)
(> 24 weeks)

teries in rats in near-term pregnancies [22], which decreased

the contractility of the myometrium and increased endometrial
Results of association of atosiban with IVF pregnancy outcomes in all study population (univariate and multivariate analyses using generalized estimating equations)

perfusion to reduce the expulsion rate of the embryo and thus

support embryo implantation [10]. He et al. recently analyzed
780 ET cycles

768 ET cycles
# of patients, #

several subgroups of infertile women undergoing different

of ET cycles

numbers of ET cycles and found that the use of atosiban sig-

nificantly increased clinical and implantation rates among IVF
patients undergoing third or subsequent ET cycles, but no
statistical significance was observed for the efficacy of
atosiban in the first- and second-ET patient groups. The pres-
p value

< 0.001
0.4298

0.001
0.299

ent study, which used larger numbers of ET cycles (i.e., our

study vs. He et al.’s study [11]: 165 vs. 69 in the first ET
Clinical pregnancy

group, 266 vs. 76 in the second ET group, and 407 vs. 97 in

256 patients with 1.20 (0.76, 1.88)
391 patients with 1.19 (0.86, 1.66)

0.89 (0.84, 0.94)

1.43 (1.15,1.77)

also tested in univariate analyses for IVF pregnancy, but they were not significant and thus not included in the multivariate analyses
OR (95% CI)
(> 10 weeks)

the third or subsequent ET group) showed that atosiban use

was not only associated with positive biochemical and clinical
pregnancy outcomes but also significantly improved the rate
of ongoing pregnancy. We also found that atosiban was not
792 ET cycles

381 ET cycles

effective for women who required only one or two ET cycles,

p value # of patients, #
of ET cycles

which is consistent with the results of He et al.’ study [11]. He

et al. [11] have found that low levels of serum oxytocin and
PGF2α among patients undergoing the first or second ET cycle
were associated with low uterine contractions, which implies
Abbreviations: ref. reference; OR odds ratio, 95%, CI 95% confidence interval; ET embryo transfer
Biochemical pregnancy a

1.42 (1.17, 1.73) < 0.001

0.90 (0.85, 0.95) < 0.001

a stable uterine environment and explains the lack of response

1.14 (0.85, 1.53) 0.400

0.94 (0.59, 1.51) 0.799

to atosiban observed among these patients.

Our findings also support that atosiban might improve IVF
OR (95% CI)

pregnancy for patients who are likely to have RIFs, which are
typically defined as good-quality embryos failing to implant
following multiple transfer cycles (e.g., commonly at least
three consecutive ET attempts). RIFs have been linked to ex-
391 patients with

256 patients with

792 ET cycles

384 ET cycles

cessive uterine contractions, which suggest a significantly un-

# of patients, #
of ET cycles

stable uterine environment, and thus lead to ET failure [10,

15]. However, the contractions of the uterus are not typically
included in diagnostic measures for infertile women undergo-
ing IVF treatment and are thus likely to be ignored. Excessive
(frozen-thawed vs. fresh = ref.)

contractions may thus persist among multiple ET attempts and

may lead to RIFs. The endometrial epithelium hyperactivated
Type of embryo transferred

autocrine/paracrine oxytocin/oxytocin receptor system has

(Yes vs. No = ref.)

(Yes vs. No = ref.)

been proposed for patients having previous failure cycles

[11], which may explain poor pregnancy outcomes in these
Maternal age

patients. Therefore, the use of atosiban during ET could be

Day of ET
Multivariate analysis Atosiban
Atosiban
Variable

beneficial for IVF patients who are inclined to high frequency

of uterine contractions such as those undergoing more than
two ET cycles or those who are likely to have RIFs.
Univariate analysis

Several observational studies had assessed the efficacy of

atosiban on IVF pregnancy with limited numbers of different
clinical characteristics between groups (i.e., atosiban-treated
Table 2

and non-treated patients) adjusted in the analyses [15–17],

which may have led to confounding bias, made comparisons
a

Figure 1 Summary of results of association of atosiban with IVF pregnancy outcomes in all study population and subgroups of patients stratified by
number of embryo transfer (ET) cycles (univariate and multivariate analyses using generalized estimating equations)
at an aggregated level (e.g., crude pregnancy rates in treatment
group vs. that in non-treatment group) [16, 19, 24], or had
limited numbers of study patients (e.g., n = 52 [16]). Some
evidence was based only on case reports [10, 19]. In contrast,
the present study has several methodological strengths to en-
sure the validity of our results. First, when women had multi-
ple ET cycles, pregnancy outcomes (e.g., pregnant or not at
different ET cycles) for a given patient are likely to be corre-
lated. For example, if women did not achieve a successful
pregnancy at the first ET cycle, she may request further ET
cycles and might be prone to have poor pregnancy outcomes
in the later ET cycles. She is also likely to use atosiban in the
later cycles to enhance pregnancy rates. This implies that the
pregnancy outcomes in different ET cycles for a given person
are not independent. Considering this, we applied GEE anal-
ysis [21], rather than traditional logistic regression analysis
where outcome data from subjects are assumed to be indepen-
dent. GEE analysis is recognized as the most appropriate an-
alytic procedure for IVF data collected from multiple cycles
[25]. Second, by using GEE analysis in which comparisons
were made within individuals, all time-invariant confounding
(e.g., infertility factor) from individuals was eliminated. Third,
considering that patients’ and clinical characteristics (e.g., ma-
ternal age, type of embryo transferred [i.e., fresh or frozen],
number of embryos transferred) varied over time in different
ET cycles and that these clinical characteristics could possibly
influence the success of IVF pregnancy, we adjusted these
time-varying clinical characteristics from multiple ET cycles
in the GEE analysis. Therefore, we believe that our analyses
lay a solid foundation for future prospective studies to fully
elucidate the mechanisms of the action and clinical value of
atosiban among infertile women undergoing IVF treatment.
However, several limitations of this study need to be ac-
knowledged. First, all participants were from one medical cen-
ter in southern Taiwan. Therefore, selection bias could not be
eliminated. Our findings may be applicable to only a subset of
Reprod. Sci.
ethnically Chinese women. Ethnically Chinese people are dis-
tributed over a large geographic area and are likely to have
differences in dietary habits, physical activity, and even treat-
ment approaches. Second, we did not measure uterine contrac-
tions after atosiban administration and did not track congenital
abnormalities in newborns. Third, this observational study in-
cluded all patients who attend study medical center during
study period so no formal sample size calculations were con-
ducted. Fourth, the present study only assessed biochemical
pregnancy, clinical pregnancy, and ongoing pregnancy, and
thus, future research is needed to corroborate our findings on
live birth outcome. Lastly, this was a retrospective study, and
thus the associated limitations could not be avoided (e.g., selec-
tion bias). Nevertheless, prospective studies are needed to fully
elucidate the mechanisms of the action and clinical efficacy of
atosiban among women undergoing IVF treatment. In addition,
optimal dosage and treatment duration of atosiban administra-
tion during embryo implantation for achieving successful IVF
pregnancy should be investigated in future studies.
In conclusion, the use of atosiban, especially among wom-
en who required more than two ET cycles, was positively
associated with successful IVF pregnancy. These women are
likely to have high levels of serum oxytocin/ PGF2α and thus
are inclined to high frequency of uterine contractions, leading
to poor pregnancy outcomes following IVF treatment. In this
regard, atosiban is a potential treatment for these women.
Acknowledgments We gratefully acknowledge the support from
National Cheng Kung University Hospital.
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