In Vitro Fertilization and Placenta Accreta (spectrum): A Systematic Review

In vitro fertilization (IVF) has transformed infertility treatment, providing options for individuals struggling to conceive naturally, with significant success rates, particularly in women under 35. However, IVF pregnancies are associated with potential obstetric complications, notably placenta accreta spectrum (PAS), which necessitates early diagnosis and a multidisciplinary approach to safeguard maternal-fetal health. This systematic review involved a comprehensive search of databases such as PubMed, Cochrane Library, BVS, Embase, Web of Science, and Scopus using specific terms related to IVF and PAS. Original studies comparing spontaneous pregnancies to IVF pregnancies were included, while case reports and non-peer-reviewed articles were excluded. Data extraction was standardized, and study quality was assessed using the Newcastle-Ottawa tool. The analysis covered thirteen articles involving 252,295 assisted reproductive technology pregnancies and over 16 million spontaneous pregnancies. A key finding is the increased risk of PAS in IVF pregnancies, with some studies indicating that frozen embryo transfer (FET) poses a higher risk than fresh embryo transfer. Additional complications include hypertension, preeclampsia, and intrauterine growth restriction (IUGR). Interestingly, some research suggests a lower Intensive Care Unit admission rate for women with placenta accreta after IVF compared to those with spontaneous conception. This indicates that while assisted reproductive technology is an independent risk factor for PAS, it presents a unique risk profile. The review emphasizes the need for further research into maternal outcomes related to PAS after assisted reproductive techniques (ART) and highlights the importance of specialized follow-up and rigorous prenatal diagnosis to minimize complications in these pregnancies.