Maternal Cardiovascular Dysregulation During Early Pregnancy After In Vitro Fertilization Cycles in the Absence of a Corpus Luteum

Abstract

Commonly used in vitro fertilization protocols produce pregnancies without a corpus luteum (CL), a major source of reproductive hormones. In vitro fertilization pregnancies without a CL showed deficient gestational increases of central (aortic) arterial compliance during the first trimester and were at increased risk for developing preeclampsia. Here, we investigated whether there was generalized impairment of cardiovascular adaptation in in vitro fertilization pregnancies without a CL compared with pregnancies conceived spontaneously or through ovarian stimulation, which lead to 1 and >1 CL, respectively (n=19–26 participants per cohort). Prototypical maternal cardiovascular adaptations of gestation were serially evaluated noninvasively, initially during the follicular phase before conception, 6× in pregnancy, and then, on average, 1.6 years post-partum. The expected increases of cardiac output, left atrial dimension, peak left ventricular filling velocity in early diastole (E wave velocity), peripheral/central arterial pulse pressure ratio, and global AC, as well as decrease in augmentation index were significantly attenuated or absent during the first trimester in women who conceived without a CL, when compared with the 1 and >1 CL cohorts, which were comparable. Thereafter, these cardiovascular measures showed recovery in the 0 CL group except for E wave velocity, which remained depressed. These results provided strong support for a critical role of CL factor(s) in the transformation of the maternal cardiovascular system in early gestation. Regimens that lead to the development of a CL or replacement of missing CL factor(s) may be indicated to improve cardiovascular function and reduce preeclampsia risk in in vitro fertilization pregnancies.

Uterine artery Doppler in singleton pregnancies conceived after in‐vitro fertilization or intracytoplasmic sperm injection with fresh vs frozen blastocyst transfer: longitudinal cohort study

“…However, endometrial preparation and absence of corpus luteum (CL) in frozen embryo transfer (FET) might predispose to adverse obstetric outcomes (hypertensive disorders, PE, postpartum hemorrhage, accreta, post‐term birth and macrosomia) 40–45 . Two recent studies showed that absence of CL in FET is associated with increased risk of PE and reduced aortic compliance, demonstrating the critical role of CL in the physiologic transformation of the maternal cardiovascular system in early gestation 46,47 . Since UtA‐PI is also related to maternal cardiovascular adaptation, the apparent contradiction in our finding of reduced UtA‐PI in the FET group, known to have higher risk for PE, may be explained by differences in maternal characteristics and the IVF technique used, which may be proxy markers for worse prepregnancy UtA‐PI and cardiovascular function 48,49 .…”

Evaluation of Uterine Artery Doppler and Estrogen Milieu in Oocyte Donation Pregnancies—A Pilot Study

“…However, it is likely that Doppler and the hormonal alterations described may have a multifactorial etiology, whereby intrinsic differences in the patient's characteristics (e.g., cardiovascular and metabolic function) as well as procedure-related factors may contribute to different extent, favoring or hampering placental and fetal development. In addition, recent work suggests that cardiovascular function is impaired and pre-eclampsia risk is elevated in women conceiving by IVF in the absence of a corpus luteum, which indicates the importance of the hormonal milieu in the early stages of pregnancy [16].…”

Maternal characteristics and pregnancy outcomes of Chinese women with infertility undergoing in vitro fertilization with embryonic cryopreservation : a retrospective cohort study

“…GDM is evidently related to the delivery of an infant with macrosomia, so the incidence of macrosomia is signi cantly higher for pregnant women with PCOS [29]. In addition, neonates of women with PCOS are at greater risk of neonatal complications, including perinatal mortality, prematurity, SGA, lower birth weight and higher NICU admission [31]. Current evidence also suggests that prepregnancy hormonal dysfunction, including hyperandrogenism, progesterone resistance and hyperinsulinism, impairs uterine placentation mechanisms, which may lead to a greater risk of adverse obstetric and neonatal outcomes [31].…”