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Peer-reviewedCC BY 4.0Reproductive Medicine and Biology

Bleeding‐Related Perinatal Outcomes Following Hormone Replacement Cycle Frozen Embryo Transfer Compared With Non‐ART, Fresh Embryo Transfer, and Ovulatory‐Cycle Frozen Embryo Transfer: A Single‐Center Cohort Study

  • Tatsuya Yoshihara1
  • Yosuke Ono1
  • Dai Miyashita1
  • Maki Ogi1
  • Kota Tanaka1
  • Satoko Sasatsu1
  • Eriko Ogasahara1
  • Yasuhiko Okuda1
  • Osamu Yoshino1
  1. 1Department of Obstetrics and Gynecology University of Yamanashi Yamanashi Japan
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Abstract

Purpose: Frozen embryo transfer (FET) is associated with increased maternal complications, but whether these risks are specific to the hormone replacement cycle (HRC‐FET) protocol or shared broadly across FET pregnancies remains unclear. This study compared perinatal outcomes among non‐ART, fresh embryo transfer, ovulatory‐cycle FET (OC‐FET), and HRC‐FET pregnancies.

Methods: This was a single‐center retrospective cohort study of 5417 singleton deliveries (2017–2025), comprising 4427 non‐ART, 158 fresh embryo transfer, 208 OC‐FET, and 624 HRC‐FET pregnancies. Multivariable logistic regression, adjusted for maternal age, BMI, and parity, was used to calculate adjusted odds ratios (aORs), with non‐ART as the reference group.

Results: Compared with non‐ART, HRC‐FET was associated with significantly increased risks of manual removal of the placenta (aOR 14.54), postpartum hemorrhage (aOR 2.33), and uterine atony (aOR 3.23). These risks remained significant after stratifying by mode of delivery. In contrast, fresh embryo transfer and OC‐FET showed risk profiles resembling non‐ART for most outcomes.

Conclusion: Increased perinatal risk associated with ART is not uniform but concentrated primarily in HRC‐FET. Perinatal management after HRC‐FET should account for bleeding‐related complications.

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Cite

BibTeXRIS
BibTeX
@article{yoshihara2026bleedingrelated,
  title = {{Bleeding‐Related Perinatal Outcomes Following Hormone Replacement Cycle Frozen Embryo Transfer Compared With Non‐ART, Fresh Embryo Transfer, and Ovulatory‐Cycle Frozen Embryo Transfer: A Single‐Center Cohort Study}},
  author = {Tatsuya Yoshihara and Yosuke Ono and Dai Miyashita and Maki Ogi and Kota Tanaka and Satoko Sasatsu and Eriko Ogasahara and Yasuhiko Okuda and Osamu Yoshino},
  journal = {Reproductive Medicine and Biology},
  year = {2026},
  month = oct,
  doi = {10.1002/rmb2.70110},
  url = {https://doi.org/10.1002/rmb2.70110},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Bleeding‐Related Perinatal Outcomes Following Hormone Replacement Cycle Frozen Embryo Transfer Compared With Non‐ART, Fresh Embryo Transfer, and Ovulatory‐Cycle Frozen Embryo Transfer: A Single‐Center Cohort Study
AU  - Tatsuya Yoshihara
AU  - Yosuke Ono
AU  - Dai Miyashita
AU  - Maki Ogi
AU  - Kota Tanaka
AU  - Satoko Sasatsu
AU  - Eriko Ogasahara
AU  - Yasuhiko Okuda
AU  - Osamu Yoshino
PY  - 2026
DA  - 2026/10/29
JO  - Reproductive Medicine and Biology
DO  - 10.1002/rmb2.70110
UR  - https://doi.org/10.1002/rmb2.70110
AB  - Purpose: Frozen embryo transfer (FET) is associated with increased maternal complications, but whether these risks are specific to the hormone replacement cycle (HRC‐FET) protocol or shared broadly across FET pregnancies remains unclear. This study compared perinatal outcomes among non‐ART, fresh embryo transfer, ovulatory‐cycle FET (OC‐FET), and HRC‐FET pregnancies.  Methods: This was a single‐center retrospective cohort study of 5417 singleton deliveries (2017–2025), comprising 4427 non‐ART, 158 fresh embryo transfer, 208 OC‐FET, and 624 HRC‐FET pregnancies. Multivariable logistic regression, adjusted for maternal age, BMI, and parity, was used to calculate adjusted odds ratios (aORs), with non‐ART as the reference group.  Results: Compared with non‐ART, HRC‐FET was associated with significantly increased risks of manual removal of the placenta (aOR 14.54), postpartum hemorrhage (aOR 2.33), and uterine atony (aOR 3.23). These risks remained significant after stratifying by mode of delivery. In contrast, fresh embryo transfer and OC‐FET showed risk profiles resembling non‐ART for most outcomes.  Conclusion: Increased perinatal risk associated with ART is not uniform but concentrated primarily in HRC‐FET. Perinatal management after HRC‐FET should account for bleeding‐related complications.
SN  - 1445-5781
SN  - 1447-0578
ER  -