Effects of Different Endometrial Preparation Regimens during IVF on Incidence of Ischemic Placental Disease for FET Cycles

Abstract

We conducted this retrospective cohort study aiming to compare the different pregnancy outcomes of endometrial preparation regimens on ischemic placental disease in a frozen embryo transfer cycle. The study included a total of 9351 women who had undergone therapy at our single tertiary hospital from January 2015 to July 2020. The women were divided into three groups depending on their endometrial regimens: natural cycle, stimulation cycle, hormone replacement therapy cycle. The data were analyzed after propensity score matching, then we used multiple linear regression to study the relationship between ischemic placental disease and endometrial regimens, adjusted by confounding factors including age, body mass index, and score of propensity score matching. We performed univariate logistic regression, as well as multivariate logistic regression for ischemic placental disease, small for gestational age infant, placental abruption. and pre-eclampsia, respectively, listing the odds ratio and p-values in the table. As a result, risk of ischemic placental disease and small for gestational age infant were detected as higher in stimulation cycles compared to natural cycles before or after adjustment. Hormone replacement therapy cycles conferred a higher risk of pre-eclampsia and preterm delivery compared to natural cycles. No difference was found between stimulation cycles and hormone replacement therapy cycles, regardless of whether they are adjusted or not. In summary, more pharmacological intervention in endometrial preparation was associated with a higher risk of ischemic placental disease related symptoms than natural cycles for endometrial preparation in women undergoing frozen embryo transfer. Our findings supported that minimizing pharmacological interventions during endometrial preparation when conditions permit has positive implications for improving pregnancy outcomes.

Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction

“…However, there was an increase in IPD in stimulation cycles compared with natural cycles (OR, 1.16; 95% CI, 1.11-2.07) and an increase in preeclampsia in cycles using hormone replacement therapy vs natural cycles (OR, 4.41; 95% CI, 1.25-15.51). 49 Each cycle received a similar control for ovarian hyperstimulation, so these findings were likely due to hormonal fluctuations, particularly estrogen. Ovarian hyperstimulation in ART was associated with an increased rate of placental abruption (OR, 6.31; 95% CI, 1.44-27.56).…”

“…A meta-analysis reported an increased risk of placental abruption in natural and programmed FET cycles (OR, 1.23; 95% CI, 0.81-1.89). However, there was an increase in IPD in stimulation cycles compared with natural cycles (OR, 1.16; 95% CI, 1.11-2.07) and an increase in preeclampsia in cycles using hormone replacement therapy vs natural cycles (OR, 4.41; 95% CI, 1.25-15.51) . Each cycle received a similar control for ovarian hyperstimulation, so these findings were likely due to hormonal fluctuations, particularly estrogen.…”

“…95% CI, 1.25-15.51). 49 Each cycle received a similar control for ovarian hyperstimulation, so these findings were likely due to hormonal fluctuations, particularly estrogen. Ovarian hyperstimulation in ART was associated with an increased rate of placental abruption (OR, 6.31; 95% CI, 1.44-27.56).…”

Programmed frozen embryo transfer cycles are associated with a higher risk of abnormal placental development: a retrospective cohort study of singleton live births

“…There are three commonly used endometrial preparation regimens for FETs, natural cycles, modified natural cycles (mNC) and programmed cycles. The different endometrial preparation programs will result in different endometrial environments and changes in implantation and placental formation ( 5 ). Placental data add to the understanding of intrauterine processes and a comprehensive assessment of placental histopathological patterns may shed light on the potential causes of different pregnancy outcomes in different endometrial preparation regimens of FET pregnancies.…”