Placental pathology and pregnancy outcomes in donor and non-donor oocyte in vitro fertilization pregnancies

Sriram C. Perni 1. , Mladen Predanik 2. , Jennifer E. Cho 3. ,  and Rebecca N. Baergen 4.
  • 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA
  • 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA
  • 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA
  • 4. Department of Pathology, Weill Medical College of Cornell University, New York, NY, USA

Abstract

Objective: Intrinsically poor maternal adaptation to pregnancy and dysregulated processes have been postulated to occur as a consequence of an immune response to the feto-placental unit as “foreign” material. The aim of our study was to compare placental pathology and pregnancy outcomes of in vitro fertilization (IVF) pregnancies conceived by donor oocytes with those conceived by non-donor oocytes.

Study design: We conducted a retrospective, case-control study on 91 placentas from IVF pregnancies (36 from donor oocytes and 55 from non-donor cycles). All placentas were examined by a single pathologist for signs indicative of an immune response, including chronic villitis, chronic deciduitis, increased perivillous fibrin, ischemic change/infarction, decidual vasculopathy, increased syncytial knots, intervillous thrombi, and retroplacental hematomas.

Results: Placentas from donor cycles were significantly more likely to demonstrate certain pathologic findings: chronic villitis (P<0.001), chronic deciduitis (P=0.034), increased perivillous fibrin (P=0.001), ischemic change/infarction (P=0.001), and intervillous thrombi (P=0.008). There was no statistical significance with respect to decidual vasculopathy, increased syncytial knots, or retroplacental hematomas.

Conclusion: Pathologic evidence of an immune-mediated process is much more pronounced in donor oocyte IVF pregnancies compared to non-donor cycles. Clinical implications of these findings have yet to be determined.

  • 1

    Benirschke K, P Kaufmann: Pathology of the human placenta, 4th Ed. Springer, New York 2000

  • 2

    Daniel Y, L Schreiber, E Geva, A Amit, D Pausner, MJ Kupferminc, et al.: Do placentae of term singleton pregnancies obtained by assisted reproductive technologies differ from those of spontaneously conceived pregnancies?Hum Reprod 14(4) (1999) 1107

    • Google Scholar
    • Export Citation
  • 3

    Doss BJ, MF Greene, J Hill, LJ Heffner, FR Bieber, DR Genest: Massive chronic intervillositis assocaited with recurrent abortions. Hum Pathol 26 (1995) 1245

    • Google Scholar
    • Export Citation
  • 4

    Englert Y, MC Imbert, E Van Rosendael, J Belaisch, L Segal, W Feichtinger, et al.: Morphological anomalies in the placentae of IVF pregnancies: preliminary report of a multicentric study. Hum Reprod 2(2) (1987) 155

    • Google Scholar
    • Export Citation
  • 5

    Gavriil P, E Jauniaux, F Leroy: Pathologic examination of placentas from singleton and twin pregnancies obtained after in vitro fertilization and embryo transfer. Pediatr Pathol 13 (1993) 453

    • Google Scholar
    • Export Citation
  • 6

    Gersell DJ: Chronic villitis, chronic chorioamnionitis, and maternal floor infarction. Semin Diagn Pathol 10 (1993) 251

    • Google Scholar
    • Export Citation
  • 7

    Jauniaux E, Y Englert, M Vanesse, M Hiden, P Wilkin: Pathologic features of placentas from singleton pregnancies obtained by in vitro fertilization and embryo transfer. Obstet Gynecol 76 (1990) 61

    • Google Scholar
    • Export Citation
  • 8

    Oyelese Y, C Spong, MA Fernandez, RA McLaren: Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa. J Matern Fetal Med 9 (2000) 370

    • Google Scholar
    • Export Citation
  • 9

    Pearson H: Reproductive immunology: immunity's pregnant pause. Nature 420 (2002) 265

  • 10

    Redline RW, CR Abramowsky: Clinical and pathologic aspects of recurrent placental villitis. Hum Pathol 16 (1985) 727

    • Google Scholar
    • Export Citation
  • 11

    Schachter M, Y Tovbin, S Arieli, S Friedler, R Ron-El, D Sherman: In vitro fertilization is a risk factor for vasa previa. Fertil Steril 78(3) (2002) 642

    • Google Scholar
    • Export Citation
  • 12

    Styer AK, HJ Parker, DJ Roberts, D Palmer-Toy, TL Toth, JL Ecker: Placental villitis of unclear etiology during ovum donor in vitro fertilization pregnancy. Am J Obstet Gynecol 189 (2003) 1184

    • Google Scholar
    • Export Citation
  • 13

    Tan SL, P Doyle, S Campbell, V Beral, B Rizk, P Brinsden, et al.: Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies. Am J Obstet Gynecol 167 (1992) 778

    • Google Scholar
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

The Journal of Perinatal Medicine is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research.

Search