Risk factors for placenta accreta spectrum in pregnancies conceived after frozen-thawed embryo transfer in a hormone replacement cycle

Tomoyuki Fujita; Toshiyuki Yoshizato; Hiroshi Mitao; Takuya Shimomura; Takeshi Kuramoto; Hitoshi Obara; Hiroshi Ide; Fumitoshi Koga; Kayoko Kojima; Mari Nomiyama; Mayumi Fukagawa; Yumi Nagata; Atsushi Tanaka; Hiroyuki Yuki; Takafumi Utsunomiya; Hidehiko Matsubayashi; Chikahiro Oka; Kohji Yano; Masahide Shiotani; Masaru Fukuda; Hiromi Hirai; Tatsuyuki Kakuma; Kimio Ushijima

doi:10.1016/j.ejogrb.2024.02.040

Risk factors for placenta accreta spectrum in pregnancies conceived after frozen-thawed embryo transfer in a hormone replacement cycle

Eur J Obstet Gynecol Reprod Biol. 2024 May:296:194-199. doi: 10.1016/j.ejogrb.2024.02.040. Epub 2024 Feb 28.

Authors

Tomoyuki Fujita¹, Toshiyuki Yoshizato², Hiroshi Mitao¹, Takuya Shimomura³, Takeshi Kuramoto⁴, Hitoshi Obara⁵, Hiroshi Ide⁶, Fumitoshi Koga⁷, Kayoko Kojima⁸, Mari Nomiyama⁸, Mayumi Fukagawa¹, Yumi Nagata⁹, Atsushi Tanaka¹⁰, Hiroyuki Yuki¹¹, Takafumi Utsunomiya¹², Hidehiko Matsubayashi¹³, Chikahiro Oka¹⁴, Kohji Yano¹⁵, Masahide Shiotani¹⁶, Masaru Fukuda¹⁷, Hiromi Hirai¹⁸, Tatsuyuki Kakuma⁵, Kimio Ushijima¹

Affiliations

¹ Kurume University, Department of Obstetrics and Gynecology, School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan.
² Kurume University, Department of Obstetrics and Gynecology, School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan. Electronic address: ty_obgyn@kurume-u.ac.jp.
³ Department of Obstetrics and Gynecology, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume 830-8543, Japan.
⁴ Kuramoto Women's Clinic, 1-1-19 Hakataeki-higashi, Hakata-ku, Fukuoka 812-0013, Japan.
⁵ Department of Biostatistics, Kurume University, School of Medicine, 67 Asahimachi Kurume 830-0011, Japan.
⁶ Ide Women's Clinic, 4-1 Tenjinmachi, Kurume 830-0033, Japan.
⁷ Koga Fumitoshi Women's Clinic, 2-3-24 Tenjin, Chuo-ku, Fukuoka 810-0001, Japan.
⁸ Takagi Hospital, Department of Obstetrics and Gynecology, 141-11, Okawa 831-0016, Japan.
⁹ IVF Nagata Clinic, 1-12-1 Tenjin, Chuo-ku, Fukuoka 810-0001, Japan.
¹⁰ Saint Mother Clinic, 4-9-12 Orio, Yahatanishi-ku, Kitakyushu 807-0825, Japan.
¹¹ Chuo Ladies Clinic, 2-4-38 Tenjin, Chuo-ku, Fukuoka 810-0001, Japan.
¹² St. Luke Clinic, 1-4-5 Higashi-omichi, Oita 870-0823, Japan.
¹³ Reproduction Clinic Osaka, 4-20 Ofukacho, Kita-ku, Osaka 530-0011, Japan.
¹⁴ Tokyo HART Clinic, 5-4-19 Minami-aoyama, Minato-ku, Tokyo 107-0062, Japan.
¹⁵ Yano Maternity Clinic, 72-1 Showamachi, Matsuyama 790-0872, Japan.
¹⁶ Hanabusa Women's Clinic, 1-1-2 Sannomiyacho, Chuo-ku, Kobe 650-0021, Japan.
¹⁷ Fukuda Women's Clinic, 549-2 Shinanocho, Totsuka-ku, Yokohama 244-0801, Japan.
¹⁸ Hirai Surgical Obstetrics and Gynecology Clinic, 3-8-7 Meigimachi, Omuta 836-0012, Japan.

PMID: 38458035
DOI: 10.1016/j.ejogrb.2024.02.040

Abstract

Objective: Assisted reproductive technology (ART), especially frozen-thawed embryo transfer (FET) in a hormone replacement cycle (HRC), is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies achieved after FET in an HRC.

Study design: We performed a case-control study in two tertiary perinatal centres in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centres between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed on the basis of the FIGO classification for the clinical diagnosis of PAS or retained products of conception after delivery at ≥24 weeks of gestation. We excluded women with fresh embryo transfer, FET with a spontaneous ovulatory cycle, a donor oocyte cycle, and missing details of the ART treatment. Finally, among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case-control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of caesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos, and endometrial thickness at the initiation of progestin administration.

Results: PAS was associated with ≥2 previous uterine surgeries (adjusted odds ratio, 3.57; 95 % confidence interval, 1.60-7.97) and the stage of embryo transfer (blastocysts: adjusted odds ratio, 2.89; 95 % confidence interval, 1.15-7.26). In patients with <2 previous uterine surgeries, PAS was associated with an endometrial thickness of <7.0 mm (adjusted odds ratio, 5.18; 95 % confidence interval, 1.10-24.44).

Conclusion: Multiple uterine surgeries and the transfer of blastocysts are risk factors for PAS in pregnancies conceived after FET in an HRC. In women with <2 previous uterine surgeries, a thin endometrium before FET is also a risk factor for PAS in these pregnancies.

Keywords: Assisted reproductive technology; Frozen–thawed embryo transfer; Hormone replacement cycle; Placenta accreta spectrum; Risk factor.

MeSH terms

Case-Control Studies
Cesarean Section
Cryopreservation / methods
Embryo Transfer / methods
Female
Humans
Placenta Accreta* / etiology
Pregnancy
Progestins
Retrospective Studies
Risk Factors

Substances

Progestins