Abstract
Research question
Does programmed frozen embryo transfer (FET) with high-dose oestrogen affect obstetric
outcomes and placental findings?
Design
A retrospective cohort of live singleton deliveries at a single institution between
2009 and 2017, including deliveries attained by IVF with programmed FET; oocyte recipients
were excluded. High-dose oestrogen was defined as a daily dose >6 mg throughout treatment.
All placentas were evaluated regardless of complication status and the Amsterdam classification
was used to analyse findings.
Results
A total of 57 deliveries in the high-dose oestrogen group were compared with 274 controls.
The high-dose oestrogen group displayed significantly longer duration of oestrogen
treatment (18.8 ± 4.9 versus 13.3 ± 2.7 days, P < 0.001), total cumulative oestrogen dose (149.7 ± 46.1 versus 80.3 ± 16.8 mg, P < 0.001) and lower endometrial thickness (8.5 ± 1.4 versus 9.8 ± 1.7 mm, P < 0.001). After adjustment for confounders, higher dose oestrogen was found to be
associated with a lower average birthweight (coefficient –252.4 g, 95% confidence
interval [CI] –483.5 to –21.2), a higher rate of low-birthweight neonates (adjusted
odds ratio [aOR] 4.88, 95% CI 1.05 to 22.57), bilobated placentas (aOR 3.36, 95% CI
1.04 to 10.89), accessory lobes (aOR 8.74, 95% CI 1.24 to 61.5), accelerated villous
maturation (aOR 2.06, 95% CI 1.09 to 3.87), retroplacental haematoma (aOR 5.39, 95%
CI 1.11 to 26.13) and maternal malperfusion lesions (aOR 1.46, 95% CI 1.04 to 2.05).
Conclusion
A higher daily oestrogen dose in programmed FET is associated with low birthweight
and placental changes, although this may relate to altered endometrial properties
and not to the treatment itself.
Keywords
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Biography
Dr Hadas Ganer Herman is a graduate of Ben Gurion University and completed her OBGYN residency at the Edith Wolfson Medical Center, Israel. She is a senior lecturer at the Tel Aviv University Medical School, Israel, and currently a fellow at the McGill University Reproductive Centre, Montreal, Canada.
Key message
A higher daily oestrogen dose in programmed frozen embryo transfers is associated with a lower birthweight, higher rate of low-birthweight neonates and placental changes. As the effect of duration of treatment on outcomes seems more modest, it may be safer to continue treatment at the same dose if needed.
Article info
Publication history
Published online: January 09, 2023
Accepted:
January 3,
2023
Received in revised form:
November 23,
2022
Received:
October 16,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
