Preliminary Study On The Risk Factors Of Placenta Accreta In Patients Undergoing In Vitro Fertilization And Embryo Transfer

Objective: This study aimed to investigate the risk factors of placenta accreta among in vitro fertilization and Intracytoplasmic sperm injection(IVF/ICSI)by observing the relationship between factors related to IVF/ICSI and placenta accreta,and reduce the risk of placenta accreta in assisted reproductive technology assisted pregnancy patients.Method:Patients who had successful pregnant and delivered with placenta accreta(PA)and without placenta accreta in The Second Hospital of Hebei Medical University were retrospectively recruited from January 2014 to October 2018.The association between accreta and patient’s age,body mass index(BMI),history of induced abortion,causes of infertility,fetus number,ovulation stimulation protocol,mode of fertilization,embryo transfer(ET)or frozen embryo transfer(FET),endometrial preparation protocol of FET,estrogen level on trigger day,endometrial thickness on trigger day,embryonic stage,assisted hatching were discussed in this study.SPSS 25.0(IBM Corp.,NY)was used for statistical analysis.Result:A total of 200 eligible patients were enrolled in this study,including 50 patients with PA and 150 without PA.There were no significant differences in the basic characteristics of mean age,BMI,days of embryonic development,number of live births,mode of fertilization and causes of infertility between the two groups.1)The thickness of endometrium in PA [9.00(3.00)] was thinner than that in non-PA [10.00(3.00)](P =0.046).The level of E2 in PA [306.50(809.00)] was lower than that in non-PA [1603.00(3137.00)](P =0.001).The number of embryos hatched in PA [13(26%)] was higher than that in non-PA [18(12%)](P =0.018),and the number of FET in PA [35(70.0%)] was higher than that in non-PA [56(37.3%)](P =0.000).2)Univariate logistic regression showed that E2 level on trigger day,endometrial thickness,embryo hatching and ET/FET were all correlated with placental accreta(P =0.049)[OR 2.860(1.004-8.145)].3)FET is a risk factor for placenta accreta(P =0.049)[OR 2.860(1.004-8.145)].4)During FET,univariate analysis showed that only the endometrial preparation protocol was associated with placenta accreta(P = 0.017)[OR 0.08(0.01-0.64)].5)ROC curve showed that E2 level and endometrial thickness on trigger day had evaluation value for PA(AUC=0.593,P =0.049;AUC=0.654,P =0.001)and the cut off value was 504.5pg/ml and 9.5mm.Conclusion:E2 level on trigger day,endometrial thickness on trigger day,embryo hatching,ET/FET,and endometrial preparation protocol in FET are all correlated with PA.FET is independently correlated with PA.E2 level and endometrial thickness on trigger day had evaluation value for PA.however,the data of this study are from a single center.Take the complicated causes of PA into consideration,conclusion of this study might be biased by potential factors which are not concluded in the study.