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Grand Rounds

Embolism Following IVF: Does Fresh or Frozen-Thawed Transfer Matter?

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BACKGROUND AND PURPOSE:

  • Olausson et al. (Journal of Thrombosis Haemostasis, 2020) compared the incidence of VTE and PE during the first trimester of IVF pregnancies using fresh or frozen-thawed embryo transfer to those of natural pregnancies

METHODS:

  • Population-based cohort study (1992 to 2012)
    • National registries (Sweden) that covers 97% to 99.5% of all deliveries
  • Participants
    • Nulliparous | Ages 15 to 50 years
  • Exposures
    • IVF with fresh embryo transfer
    • IVF with frozen-thawed embryo transfer
    • Natural conception
  • Study design
    • Authors calculated incidences of VTE and PE and estimated time-varying hazard ratio (HR) for all trimesters after fresh or frozen-thawed embryo transfer IVF compared to natural conception
  • Primary outcome
    • Venous thromboembolism and pulmonary embolism in first trimester

RESULTS:

  • 902,891 women included
    • IVF total: 3.5%
      • Fresh transfer: 25,382 women | Median age 33.6 years
      • Frozen-thawed transfer: 4946 women | Median age 34.1 years
      • Natural conception: 872,563 | 28 years
  • Fresh embryo transfer as associated with an increased incidence of
    • VTE: Hazard ratio (HR) 8.96 (95% CI, 6.33 to 12.67)
    • PE: HR 8.69 (95% CI, 3.83 to 19.71)
  • The incidence of thromboembolic events following frozen-thawed embryo transfer was not increased during the first trimester

CONCLUSION:

  • Compared to natural conception, fresh embryo transfer had a more than eightfold increased incidence of VTE and PE in the first trimester
  • The authors suggest that frozen-thawed embryo transfer may be the preferred method of IVF embryo transfer to reduce maternal risk
  • In addition, the authors recommend that

…thromboprophylaxis could also be considered during early pregnancy after IVF with fresh embryo transfer

Learn More – Primary Sources:

Incidence of Pulmonary and Venous Thromboembolism in Pregnancies After in Vitro Fertilization With Fresh Respectively Frozen-Thawed Embryo Transfer: Nationwide Cohort Study

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Can the Pregnancy-Adapted YEARS Algorithm be Used to Rule Out Pulmonary Embolism?
Does ART Increase Risk of Postpartum Hemorrhage?
Are Offspring of IVF/ICSI Pregnancies at Higher Risk for Congenital Heart Defects?

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