Factors Affecting Pregnancy Outcomes in Patients Undergoing in vitro Fertilization/Intracytoplasmic Sperm...

To identify the independent risk factors for placenta accreta spectrum (PAS) and assess the impact of endometrial thickness (EMT) on outcomes after transcervical resection of adhesions (TCRA) for intrauterine adhesions(IUA) prior to in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).

This single-center retrospective cohort study included 819 post-TCRA patients between March 2018 and March 2023. Propensity score matching (PSM) was used to balance baseline characteristics. Univariate and multivariate logistic regression analyses identified independent risk factors for PAS. Pregnancy outcomes (biochemical pregnancy, clinical pregnancy, live birth) and adverse obstetric outcomes (PAS, gestational diabetes, preterm delivery, low birth weight) were compared between EMT groups using different cutoffs (6-8 mm).

EMT and moderate-to-severe IUA were independent PAS risk factors (severe IUA: aOR=4.998, 95% CI:2.021~12.362). After PSM, the EMT <7 mm group had significantly lower live birth rates (40.3% vs. 55.7%,P=0.005) and higher rates of gestational diabetes,preterm delivery and low birth weight compared to EMT ≥7 mm. Using an 8 mm cutoff, the EMT <8 mm group consistently showed a higher PAS incidence both before (26.4% vs. 13.9%, P=0.001) and after PSM (26.4% vs. 14.7%, P=0.018).

In post-TCRA IVF/ICSI-ET patients, EMT and IUA severity are independent PAS risk factors. EMT<7 mm worsens pregnancy outcomes, Exploratory analyses suggested that EMT <8 mm may be associated with higher PAS risk,but this finding requires validation in larger, prospective studies. Given the single-center retrospective design, these results should be interpreted as associative rather than causal. We think optimizing endometrial preparation to achieve a thickness of at least 8 mm may be crucial for reducing PAS and improving reproductive prognosis.