Department of Obstetrics and Gynecology, McGill University, Montreal, Canada.
Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.
Hum Reprod. 2022 Sep 30;37(10):2482-2491. doi: 10.1093/humrep/deac167.
Does embryo vitrification affect placental histopathology pattern and perinatal outcome in singleton live births?
Embryo vitrification has a significant effect on the placental histopathology pattern and is associated with a higher prevalence of dysfunctional labor.
Obstetrical and perinatal outcomes differ between live births resulting from fresh and frozen embryo transfers. The effect of embryo vitrification on the placental histopathology features associated with the development of perinatal complications remains unclear.
STUDY DESIGN, SIZE, DURATION: Retrospective cohort study evaluating data of all live births from one academic tertiary hospital resulting from IVF treatment with autologous oocytes during the period from 2009 to 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All patients had placentas sent for pathological evaluation irrelevant of maternal or fetal complications status. Placental, obstetric and perinatal outcomes of pregnancies resulting from hormone replacement vitrified embryo transfers were compared with those after fresh embryo transfers. A multivariate analysis was conducted to adjust the results for determinants potentially associated with the development of placental histopathology abnormalities.
A total of 1014 singleton live births were included in the final analysis and were allocated to the group of pregnancies resulting from fresh (n = 660) and hormone replacement frozen (n = 354) embryo transfers. After the adjustment for confounding factors the frozen embryo transfers were found to be significantly associated with chorioamnionitis with maternal (odds ratio (OR) 2.0; 95% CI 1.2-3.3) and fetal response (OR 2.6; 95% CI 1.2-5.7), fetal vascular malperfusion (OR 3.9; 95% CI 1.4-9.2), furcate cord insertion (OR 2.3 95% CI 1.2-5.3), villitis of unknown etiology (OR 2.1; 95% CI 1.1-4.2), intervillous thrombi (OR 2.1; 95% CI 1.3-3.7), subchorionic thrombi (OR 3.4; 95% CI 1.6-7.0), as well as with failure of labor progress (OR 2.5; 95% CI 1.5-4.2).
LIMITATIONS, REASONS FOR CAUTION: Since the live births resulted from frozen-thawed embryos included treatment cycles with previously failed embryo transfers, the factors over embryo vitrification may affect implantation and placental histopathology.
The study results contribute to the understanding of the perinatal future of fresh and vitrified embryos. Our findings may have an implication for the clinical decision to perform fresh or frozen-thawed embryo transfer.
STUDY FUNDING/COMPETING INTEREST(S): Authors have not received any funding to support this study. There are no conflicts of interest to declare.
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胚胎玻璃化冷冻是否会影响单胎活产儿的胎盘组织病理学模式和围产结局？
胚胎玻璃化冷冻对胎盘组织病理学模式有显著影响，并与功能失调性分娩的发生率较高相关。
新鲜胚胎和冷冻胚胎移植的活产儿的产科和围产结局不同。胚胎玻璃化冷冻对与围产期并发症发展相关的胎盘组织病理学特征的影响尚不清楚。
研究设计、规模、持续时间：这是一项回顾性队列研究，评估了 2009 年至 2017 年期间在一家学术性三级医院接受自体卵母细胞体外受精治疗的所有活产儿的临床数据。所有患者的胎盘均被送去进行病理评估，无论其母亲或胎儿的并发症状态如何。比较了激素替代冷冻胚胎移植后妊娠的胎盘、产科和围产结局与新鲜胚胎移植后的妊娠。进行了多变量分析，以调整与胎盘组织病理学异常发展相关的潜在决定因素的结果。
共有 1014 例单胎活产儿被纳入最终分析，并分为新鲜（n=660）和激素替代冷冻（n=354）胚胎移植组。在调整混杂因素后，冷冻胚胎移植与绒毛膜羊膜炎（母亲（比值比（OR）2.0；95%可信区间（CI）1.2-3.3）和胎儿反应（OR 2.6；95% CI 1.2-5.7）、胎儿血管灌注不良（OR 3.9；95% CI 1.4-9.2）、分叉脐带插入（OR 2.3；95% CI 1.2-5.3）、不明原因绒毛膜炎（OR 2.1；95% CI 1.1-4.2）、绒毛间血栓（OR 2.1；95% CI 1.3-3.7）、胎盘下血栓（OR 3.4；95% CI 1.6-7.0）以及分娩进展失败（OR 2.5；95% CI 1.5-4.2）显著相关。
局限性、谨慎的原因：由于冷冻-解冻胚胎的活产儿包括以前胚胎移植失败的治疗周期，因此可能有胚胎玻璃化以外的因素影响胚胎着床和胎盘组织病理学。
研究结果对理解新鲜和冷冻胚胎的围产期未来有一定的帮助。我们的研究结果可能对决定进行新鲜或冷冻-解冻胚胎移植有一定的临床意义。
研究资金/利益冲突：作者没有得到任何资金支持来支持这项研究。没有利益冲突需要声明。
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