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Ganer Herman H, Volodarsky-Perel A, Nhung Ton Nu T, Machado-Gedeon A, Cui Y, Shaul J, Dahan MH. P-753 Pregnancy complications and placental histology following embryo transfer with a thinner endometrium. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Our objective was to assess perinatal outcomes and placental findings following in vitro fertilization (IVF) with a thinner endometrium.
Summary answer
Live births following IVF with a thinner endometrium were associated with placental mediated obstetric complications and lower birthweight, yet with no differences in placental histology.
What is known already
A lower average birth weight and higher rate of small for gestational age infants have been demonstrated in both fresh transfer and frozen transfer cycles with thinner endometrial thicknesses. Additional adverse outcomes associated with thin endometrium included hypertensive disorders of pregnancy, placenta previa, cesarean section and overall obstetric complications. Yet, no study has explored placental histology in such cases.
Study design, size, duration
This was a retrospective cohort study of 1057 deliveries following IVF, between 2009 and 2017. All placentas were sent to pathology irrelevant of pregnancy complication status, per protocol at our institution.
Participants/materials, setting, methods
Data was from a university-affiliated tertiary hospital. Included were live singleton births after IVF, compared according to maximum endometrial thickness prior to transfer: thinner endometrium group, defined as < 9-millimeters, as compared to controls, defined as ≥ 9-millimeters. Outcomes were placental findings, including anatomic, inflammatory, vascular malperfusion and villous maturation lesions and obstetric and perinatal outcomes. Continuous and categorial variables were compared as appropriate, and logistic and linear regression analyses employed.to control for confounders.
Main results and the role of chance
A total 292 deliveries in the thinner endometrium group, and 765 in the control (thicker) group were compared. Maternal demographics were similar between the groups, except for main treatment indication, which was more commonly diminished reserve in patients with a thinner endometrium – 17.8% vs. 9.4%, and less commonly male factor – 27.0% vs. 35.6%, p = 0.003. Live births following fresh transfer were more common in the control group, while the thinner endometrium group was notable for a higher rate of single blastocyst transfers. When controlling for confounding effects, thinner endometrium was associated with an increased rate of obstetric complications (preterm delivery, preeclampsia, low birth weight or placental abruption) - 26.0% vs. 17.5%, p = 0.001, while placental histological examination demonstrated no differences in anatomical, inflammatory or vascular lesions. In a linear regression analysis, after adjustment for confounders, thinner endometrium was associated with lower birthweights – β -101.3 grams, 95% CI (-185.0 to -17.6 grams), p = 0.01.
Limitations, reasons for caution
The study was limited by sample size. Missing historical information included obstetric complications in previous deliveries, which would increase the risk of reoccurrence in subsequent pregnancies and data regarding endometrial trauma (curettage for example).
Wider implications of the findings
Transfer with a thinner endometrium was associated with placental mediated complications and lower birthweights, despite similar placental histology. This may result from functional placental changes throughout implantation and placentation. Preventive measures for adverse obstetric outcomes, such as Micropirin, in cases in which endometrial thicknesses are suboptimal are to be determined.
Trial registration number
Not applicable
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Affiliation(s)
- H Ganer Herman
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
- Tel Aviv University, The Sackler faculty of Medicine , Tel Aviv, Israel
| | - A Volodarsky-Perel
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
- Tel Aviv University, The Sackler faculty of Medicine , Tel Aviv, Israel
| | - T Nhung Ton Nu
- McGill University Health Centre, Pathology , Montreal, Canada
| | - A Machado-Gedeon
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
| | - Y Cui
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
| | - J Shaul
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
| | - M. H Dahan
- McGill University Health Centre, Reproductive Endocriniology and Infertility , Montreal, Canada
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Barber E, Ganer Herman H, Kovo M, Tairy D, Schreiber L, Horowitz E, Weissman A, Weiner E, Raziel A. P-353 Placenta previa in In Vitro Fertilization and unassisted pregnancies – is there a difference in perinatal outcomes and placental histology? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Why is In-vitro-fertilization (IVF) an independent risk factor for placenta previa (PP).
Summary answer
While PP in non-assisted pregnancies is probably associated with previous cesarean deliveries (CD), in IVF it is more “sporadic”, and may complicate any index pregnancy.
What is known already
PP is more prevalent following IVF pregnancies as compared with unassisted pregnancies, with an increased risk of three to six-fold according to some authors. The etiology for this increased risk in IVF pregnancies in unclear, and may be related to reproductive procedures performed or to subfertility characteristics which have led to IVF.
Study design, size, duration
A retrospective-cohort study of deliveries with PP between 2008 and 2021. A total of 182 pregnancies were included.
Participants/materials, setting, methods
Placental histopathology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA)> 24. Placental pathology was obtained utilizing the well-accepted Amsterdam criteria.
Main results and the role of chance
Out of 182 pregnancies which were included - 23 IVF pregnancies (IVF group) and 159 in the unassisted pregnancies (Control group). The control group was characterized by higher gravidity (p = 0.007) and parity (p < 0.001), whereas the IVF group- by a higher rate of nulliparity (p < 0.001) and diabetes mellitus (p = 0.04). A higher rate of patients with past CDs was noted in unassisted pregnancies, although not statistically significance (38.9% versus 21.7%, p = 0.10). There was a trend for a lower placental weight in the control group, and a higher incidence of placental weight below the 10thpercentile in this group (47.8% versus 13.9%, p = 0.001). No differences were noted in maternal and fetal vascular lesions. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.
Limitations, reasons for caution
A major limitation was our small sample size in the IVF group. Despite a power calculation, larger study groups would have possibly allowed for the demonstration of additional differences in outcomes, including previous cesarean deliveries and placenta accreta. Moreover, this limitation prevented us from matching against possible cofounders.
Wider implications of the findings
While a growing proportion of pregnancies worldwide are conceived by IVF, possible iatrogenic side effects should be studied. As PP is of clinical importance, it is essential to diagnose it on time, as well as study the mechanisms and risk factors behind it, which could possibly help with its prevention.
Trial registration number
0282-20-WOMC
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Affiliation(s)
- E Barber
- Tel Aviv university, OBGYN , 5834468, Israel
| | - H Ganer Herman
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - M Kovo
- Tel Aviv university, Obstetrics and gynecology , Tel Aviv, Israel
| | - D Tairy
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - L Schreiber
- Wolfson medical center , Pathology, Holon, Israel
| | - E Horowitz
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - A Weissman
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - E Weiner
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
| | - A Raziel
- Wolfson medical center, Obstetrics and gynecology , Holon, Israel
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