Embryo transfer associated with hormone replacement therapy cycles using assisted reproductive technology increases placenta accreta spectrum

Abstract

Aim: To evaluate obstetric outcomes in embryo transfer (ET) during estrogen with progestin hormone replacement therapy (HRT) cycles using assisted reproductive technology (ART). Methods: Of the 118 singleton pregnancies conceived with ART and delivered between January 2015 and December 2017, we reviewed the data of 87 cases that had information on HRT at the time of ET. Data on pregnancy outcomes included the presence of small for gestational age fetuses, hypertensive disorders of pregnancy, placenta previa (including low-lying placenta), placental abruption and placenta accreta spectrum (including placenta accreta, placenta increta and placenta percreta). We investigated the relationship between HRT cycles and adverse placental outcomes (placenta accreta spectrum, placental abruption, placenta previa, hypertensive disorders of pregnancy and small for gestational age fetuses). We then analyzed the associations that correlated with adverse placental outcomes. Results: Patients with ET during HRT cycles were more likely to have placenta accreta spectrum. During the study period, 87 out of 118 singleton live births using ART had information on HRT (60 HRT cycles and 27 ovulation cycles). The incidence of placenta accreta spectrum was significantly higher in the HRT cycle group than in the ovulation cycle group (HRT cycle, 31.7% [19 of 60] vs ovulation cycle, 7.4% [2 of 27]; P < 0.01). Conclusion: The obstetric outcomes occurring in pregnancies involving HRT use may differ among ET cycles. ET during HRT cycles were associated with adverse obstetric outcomes due to placenta accreta spectrum. The potential interaction between HRT cycles and adverse placental events is novel and warrants further investigation.

Risks of Placenta Previa and Hypertensive Disorders of Pregnancy Are Associated With Endometrial Preparation Methods in Frozen-Thawed Embryo Transfers

“…Another known risk factor of HDP was maternal age, including young or advanced maternal age (26), in our study, the average maternal age in OS FET group was lower than in HRT FET group, however after adjusted for maternal age and other pregnancy-related cofounders, HRT was still the risk factor of HDP while undergoing FET. Placenta accreta is a serious complication which might lead to serious perinatal obstetric outcomes even maternal death and the surgical histories of uterus and placenta previa are risk factors for placenta accrete (27). Although the rate of placenta previa was found higher in HRT FET group in our study, the frequency of placenta accrete was comparable between the two groups.…”

Manual removal of the placenta and postpartum hemorrhage: A multicenter retrospective study

“…Women in the MROP-PPH group were significantly older than those in the MROP-non-PPH group and were more likely to have conceived by ART and to have undergone labor induction. The duration of the third stage of labor in the MROP-PPH group was significantly longer than that in the MROP-non-PPH group (median [interquartile range]: 26 , 19 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], p = 0.04).…”

“…9,10,12,13,19 In the present study, the use of ART, delivery of small-for-gestationalage infant, history of abortion, and instrumental delivery were identified as independent risk factors for MROP, which is consistent with the findings of previous studies. Although ART has been recognized as a risk factor for placenta accreta and retained products of conception, [20][21][22] few studies have demonstrated that ART is an independent risk factor for retained placenta requiring MROP. 10 Currently, approximately 6% of all pregnancies in Japan, which is 5-fold more than 20 years ago, are conceived using ART, 23 indicating the possibility that cases of retained placenta requiring MROP will increase.…”

Nationwide survey of Japanese breast oncology and reproductive endocrinology departments about the impact of breast cancer treatment on fertility

“…In addition to endometrial pathology by TAM, embryo transfer associated with hormone replacement therapy cycles may be a cause of placenta accreta spectrum. 43 Further investigation is required to clarify the relationship between TAMrelated endometrial changes and placentation.…”

“…Regarding the perinatal outcomes of breast cancer patients, the proportion of full‐term and preterm deliveries was similar to that in women without breast cancer, but the rate of placenta accreta spectrum was 8%, being higher than that in the general population. In addition to endometrial pathology by TAM, embryo transfer associated with hormone replacement therapy cycles may be a cause of placenta accreta spectrum 43 . Further investigation is required to clarify the relationship between TAM‐related endometrial changes and placentation.…”