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. 2022 Dec;39(12):2711-2718.
doi: 10.1007/s10815-022-02644-4. Epub 2022 Oct 28.

Does a history of recurrent pregnancy loss affect subsequent obstetric outcomes and placental findings in in vitro fertilization?

Hadas Ganer Herman  1   2 , Alexander Volodarsky-Perel  3   4 , Tuyet Nhung Ton Nu  5 , Alexandre Machado-Gedeon  3 , Yiming Cui  3 , Jonathan Shaul  3 , Michael H Dahan  3
Affiliations

Does a history of recurrent pregnancy loss affect subsequent obstetric outcomes and placental findings in in vitro fertilization?

Hadas Ganer Herman et al. J Assist Reprod Genet. 2022 Dec.

Abstract

Purpose: To assess perinatal outcomes and placental findings in in vitro fertilization (IVF) patients with previous recurrent pregnancy loss (RPL).

Methods: This was a retrospective cohort of live singleton births following IVF at a single university-affiliated center between 2009 and 2017. Outcomes were compared between patients with previous RPL, defined as two miscarriages (RPL group), and patients without RPL (control group). Placental examination was performed for all deliveries irrelevant of complications, and findings categorized according to the Amsterdam Placental Workshop Consensus.

Results: One hundred seventy-two deliveries of women with previous RPL (RPL group) were compared to 885 controls. Maternal age, 36.2 ± 4.2 vs. 35.4 ± 4.2 years, p = 0.02, and rate of uterine fibroids, 12.7% vs. 7.3%, p = 0.01, were higher in the RPL group. The rate of nulliparity was lower in the RPL group, 63.3% vs. 74.1%, p = 0.003. Unexplained infertility and diminished ovarian reserve were more common in the RPL group and male factor infertility in controls. There was a lower rate of fresh embryo transfer in the RPL group, 50.5% vs. 64.7%, p < 0.001, and reduced endometrial thickness. Similar obstetric outcomes were noted in the groups after adjustment for confounders. Placental examinations were notable for lower placental thickness, β - 0.17 cm, 95%CI - 0.30-(- 0.0), a lower rate of velamentous cord insertion, aOR 0.44, 95%CI 0.20-0.95, and a higher rate of villous infarction, aOR 2.82, 95%CI 1.28-6.20 in the RPL group.

Conclusion: In IVF patients with a history of RPL, subsequent deliveries were associated with a limited number of placental lesions, yet with similar obstetric outcomes.

Keywords: In vitro fertilization (IVF); Placenta; Recurrent pregnancy loss (RPL).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A Placental accessory lobe. B Velamentous cord insertion. C Villous infarction as demonstrated by Hematoxylin and Eosin staining. D Macroscopic villous infarction
See this image and copyright information in PMC

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