Effect of embryo stage at transfer on placental histopathology features in singleton live births resulting from fresh embryo transfers

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Alexander Volodarsky-Perel, M.D., Tuyet Nhung Ton Nu, M.D., William Buckett, M.D., Alexandre Machado-Gedeon, M.D., Yiming Cui, M.D., Jonathan Shaul, M.D., Michael H. Dahan, M.D.



To evaluate the effect of embryo stage at transfer on placental histopathology and perinatal outcome in singleton live births resulting from fresh embryo transfers (ETs).


Retrospective cohort study.


Not applicable.


The study population included all live births after fresh ETs during the period from 2009 to 2017.



Main Outcome Measure(s)

Primary outcomes included anatomic, inflammatory, vascular malperfusion, and villous maturation placental features. Secondary outcomes included fetal, maternal, and perinatal complications.


A total of 677 live births were included in the final analysis and were allocated to the cleavage-stage (n = 252) and blastocyst (n = 425) ET groups. After the adjustment for confounding factors, the blastocyst group was found to be associated with a higher incidence of circummarginate membranes insertion (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.2–3.4), delayed villous maturation (OR 8.5, 95% CI 1.2–69.3), chorangiosis (OR 2.0, 95% CI 1.2–3.8), parenchymal calcifications (OR 10.6, 95% CI 1.4–80.2), and intrapartum nonreassuring fetal heart rate tracing (OR 2.4, 95% CI 1.3–4.5). Compared with cleavage-stage ETs, live births resulting from the blastocysts were associated with a lower incidence of velamentous cord insertion (OR 0.5, 95% CI 0.3–0.9), retroplacental hematoma (OR 0.3, 95% CI 0.1–0.8), subchorionic thrombi (OR 0.3, 95% CI 0.1–0.8), and avascular villi (OR 0.2, 95% CI 0.03–0.7).


Live births resulting from fresh cleavage-stage and blastocyst ETs have different placental histopathology features, with a higher rate of intrapartum nonreassuring fetal heart rate tracing in the blastocyst group.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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