Analysis of influencing factors of intrauterine adhesion separation on obstetric outcomes after frozen-thawed embryo transfer
Objective To analyze the impact of transcervical resection of adhesion(TCRA)on obstetric complications in patients after frozen-thawed embryo transfer(FET)and its associated factors.Methods A retrospective cohort study was conducted by collecting clinical data from patients who underwent autologous oocyte FET treatment and gave birth to at least one live newborn at the Reproductive Medicine Center of Nanjing Women and Children's Healthcare Hospital from April 2015 to May 2022.Based on the uterine condition,patients were divided into three groups:control group with normal uterine morphology(712 cases);the intrauterine adhesion(IUA)group consisting of IUA patients who did not undergo TCRA surgery(45 cases);the TCRA group,which included IUA patients who received TCRA treatment(51 cases).The relationship between uterine conditions and obstetric complications among the three groups was investigated using propensity score matching(PSM).Multivariate logistic regression analysis was applied to identify risk factors associated with obstetric complications related to TCRA.The performance of the constructed multivariate logistic regression model was evaluated using calibration curves and receiver operating characteristic(ROC)curves.Results 1)Before PSM,statistically significant differences were observed among the three groups regarding endometrial thickness,the presence of a scarred uterus,numbers of pregnancies,deliveries,miscarriages,induced abortions,and transferred embryos(all P＜0.05).After PSM,baseline characteristics were balanced across the groups.The rates of placenta accreta spectrum disorders(PAS)in the TCRA group[48.8％(20/41)]and the IUA group[45.2％(19/42)]were significantly higher than those in control group[24.7％(18/73),P=0.016;22.8％(18/79),P=0.019].2)Multivariable logistic regression analysis revealed that endometrial thickness(OR=0.79,95％CI:0.69-0.90,P＜0.001],number of pregnancies(2 times,OR=2.25,95％CI:1.33-3.82,P=0.003),endometrial preparation protocol(gonadotropin-releasing hormone agonist plus hormone replacement therapy,OR=2.29,95％CI:1.16-4.52,P=0.017),the presence of a scarred uterus(OR=2.19,95％CI:1.39-3.45,P＜0.001),and uterine cavity conditions(IUA and TCRA,OR=2.11,95％CI:1.07-4.17,P=0.031;OR=2.70,95％CI:1.37-5.31,P=0.004)were independent predictors of PAS occurrence.3)The area under the ROC curve for this model was 0.732(95％CI:0.686-0.778).Calibration curve results,after internal validation,showed good consistency between predicted risks and actual outcomes,demonstrating good discriminative ability and calibration(P=0.540).Conclusion The incidence of obstetric complications such as placenta previa,postpartum hemorrhage,and premature rupture of membranes in patients who underwent TCRA surgery was comparable to that of patients with a normal uterine morphology.However,TCRA significantly increased the risk of PAS in patients with IUA undergoing FET assisted reproductive treatment.
Intrauterine adhesionTranscervical resection of adhesionFrozen-thawed embryo transferObstetric complicationsPlacenta accreta
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