{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:06:31Z","timestamp":1789499191356,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objective: Non-cavity-distorting intramural fibroids have been linked to poorer reproductive outcomes in assisted reproduction, yet strategies to counteract this effect remain underexplored. This study examined whether a hyaluronan-enriched transfer medium (EmbryoGlue\u00ae) is associated with clinical pregnancy and live birth in women with such fibroids undergoing frozen-thawed single blastocyst transfer, and whether any such association depends on fibroid size. Methods: We conducted a single-center retrospective cohort analysis of 515 women, aged 20\u201337 years, carrying the International Federation of Gynecology and Obstetrics (FIGO) type 3\u20135 non-cavity-distorting intramural fibroids, who underwent frozen-thawed single blastocyst transfer between January 2021 and December 2025. Of these, 232 received a hyaluronan-enriched transfer medium and 283 received a standard medium. Clinical pregnancy served as the primary endpoint; positive pregnancy test, live birth, and early pregnancy loss were secondary endpoints. Multivariable logistic regression was used to identify independent predictors of clinical pregnancy and live birth and to test for an interaction between EmbryoGlue use and fibroid size. Results: Women who received EmbryoGlue had higher rates of positive pregnancy test (50.0% vs. 32.9%; p &lt; 0.001), clinical pregnancy (40.5% vs. 26.9%; p = 0.001), and live birth (30.2% vs. 19.1%; p = 0.003) than those in the control group. After adjustment, and taking a fibroid size of 3 cm as the reference point, EmbryoGlue use remained associated with greater odds of clinical pregnancy (adjusted odds ratio [aOR] 2.05, 95% CI 1.20\u20133.50; p = 0.008). A significant interaction between EmbryoGlue use and fibroid size emerged for both clinical pregnancy (aOR 1.74, 95% CI 1.13\u20132.68; p = 0.011) and live birth (aOR 1.68, 95% CI 1.06\u20132.67; p = 0.028): the association between EmbryoGlue and reproductive outcomes was not uniform but depended on fibroid size, with the widest gap between groups seen among women with fibroids exceeding 4 cm. Conclusions: Among women with non-cavity-distorting intramural fibroids undergoing frozen-thawed single blastocyst transfer, EmbryoGlue use was linked to more favorable reproductive outcomes overall, an association that varied by fibroid size and was most pronounced above 4 cm. These findings warrant confirmation through prospective randomized trials before influencing clinical practice.<\/jats:p>","DOI":"10.3390\/jcm15187176","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:23:53Z","timestamp":1789496633000},"page":"7176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Fibroid Size and Hyaluronan-Enriched Transfer Medium on Clinical Pregnancy and Live Birth: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7128-7550","authenticated-orcid":false,"given":"Zercan","family":"Kal\u0131","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Private G\u00f6zde Hospital, 44100 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6578-3371","authenticated-orcid":false,"given":"Emrah","family":"Zayman","sequence":"additional","affiliation":[{"name":"Department of Histology and Embryology, Faculty of Medicine, Malatya Turgut \u00d6zal University, 44210 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0622-8415","authenticated-orcid":false,"given":"Nihal","family":"Mavral","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Malatya Turgut \u00d6zal University, 44210 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1089\/jwh.2019.7813","article-title":"The impact of noncavity-distorting intramural fibroids on live birth rate in in vitro fertilization cycles: A systematic review and meta-analysis","volume":"29","author":"Rikhraj","year":"2020","journal-title":"J. Womens Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/humrep\/dep396","article-title":"The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: A systematic review and meta-analysis","volume":"25","author":"Sunkara","year":"2010","journal-title":"Hum. Reprod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.fertnstert.2023.02.018","article-title":"The effect of \u22646 cm sized noncavity-distorting intramural fibroids on in vitro fertilization outcomes: A systematic review and meta-analysis","volume":"119","author":"Erden","year":"2023","journal-title":"Fertil. Steril."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5152\/jtgga.2011.25","article-title":"Embryo culture media for human IVF: Which possibilities exist?","volume":"12","author":"Gruber","year":"2011","journal-title":"J. Turk. Ger. Gynecol. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1093\/humrep\/deac097","article-title":"The effect of hyaluronic acid in embryo transfer media in donor oocyte cycles and autologous oocyte cycles: A systematic review and meta-analysis","volume":"37","author":"Heymann","year":"2022","journal-title":"Human. Reprod."},{"key":"ref_6","first-page":"CD013063","article-title":"Endometrial injection of embryo culture supernatant for subfertile women in assisted reproduction","volume":"8","author":"Siristatidis","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","first-page":"CD007421","article-title":"Adherence compounds in embryo transfer media for assisted reproductive technologies","volume":"7","author":"Bontekoe","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.fertnstert.2013.11.004","article-title":"The nature of aneuploidy with increasing age of the female partner: A review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening","volume":"101","author":"Franasiak","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_9","first-page":"177","article-title":"Does EmbryoGlue transfer medium affect embryo transfer success rate?","volume":"83","author":"Tkadlec","year":"2018","journal-title":"Ceska Gynekol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bhoi, N.R., Murdia, N., Murdia, K., Chandra, V., Suwalka, I., Mistari, W., Aggrawal, R., Shah, N., and Kumar, D. (2024). Effect of hyaluronic acid-containing transfer media (EmbryoGlue\u00ae) on the live birth rate in frozen thawed embryo transfer cycles. Cureus, 16.","DOI":"10.7759\/cureus.52713"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1080\/03009734.2020.1751751","article-title":"Adjuvants in IVF-evidence for what works and what does not work","volume":"125","author":"Nardo","year":"2020","journal-title":"Ups. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1007\/s10815-021-02288-w","article-title":"Interventions \u201cadd-ons\u201d in clinical ART practice: Ethical, moral and commercial considerations","volume":"38","author":"Chimote","year":"2021","journal-title":"J. Assist Reprod. Genet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s10815-017-1099-8","article-title":"Low versus high volume of culture medium during embryo transfer: A randomized clinical trial","volume":"35","author":"Sigalos","year":"2018","journal-title":"J. Assist Reprod. Genet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"214","DOI":"10.4103\/0974-1208.170398","article-title":"Role of EmbryoGlue as a transfer medium in the outcome of fresh non-donor in vitro fertilization cycles","volume":"8","author":"Singh","year":"2015","journal-title":"J. Hum. Reprod. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1055\/s-0041-1730415","article-title":"EmbryoGlue: The use of hyaluronan in embryo transfer media","volume":"39","author":"Atkinson","year":"2021","journal-title":"Semin Reprod. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/01.gco.0000169097.52848.ee","article-title":"Fibroids and in-vitro fertilization: Which comes first?","volume":"17","author":"Rackow","year":"2005","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.semcdb.2007.10.008","article-title":"Uterine receptivity to human embryonic implantation: Histology, biomarkers, and transcriptomics","volume":"19","author":"Aghajanova","year":"2008","journal-title":"Semin Cell Dev. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.fertnstert.2013.05.004","article-title":"The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure","volume":"100","author":"Blesa","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1093\/humrep\/dez139","article-title":"Tissue stiffness at the human maternal-fetal interface","volume":"34","author":"Abbas","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ajog.2007.12.039","article-title":"Fibroids and reproductive outcomes: A systematic literature review from conception to delivery","volume":"198","author":"Klatsky","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1093\/humupd\/8.4.333","article-title":"Conception to ongoing pregnancy: The \u201cblack box\u201d of early pregnancy loss","volume":"8","author":"Macklon","year":"2002","journal-title":"Hum. Reprod. Update"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s10815-012-9758-2","article-title":"Hyaluronan-enriched transfer medium improves outcome in patients with multiple embryo transfer failures","volume":"29","author":"Nakagawa","year":"2012","journal-title":"J. Assist Reprod. Genet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s00404-023-07083-9","article-title":"Hyaluronan-enriched transfer medium (HETM) can improve the implantation rate in morphologically poor euploid blastocyst transfer","volume":"308","author":"Nakagawa","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/jog.13581","article-title":"Effect of hyaluronic acid-enriched transfer medium on frozen-thawed embryo transfer outcomes","volume":"44","author":"Fu","year":"2018","journal-title":"J. Obstet. Gynaecol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7176\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:39:48Z","timestamp":1789497588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":25,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187176"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187176","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}