Bleeding‐Related Perinatal Outcomes Following Hormone Replacement Cycle Frozen Embryo Transfer Compared With Non‐
                    <scp>ART</scp>
                    , Fresh Embryo Transfer, and Ovulatory‐Cycle Frozen Embryo Transfer: A Single‐Cen

doi:10.1002/rmb2.70110

DOI: 10.1002/rmb2.70110 ISSN: 1445-5781

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‐Cen

Tatsuya Yoshihara, Yosuke Ono, Dai Miyashita, Maki Ogi, Kota Tanaka, Satoko Sasatsu, Eriko Ogasahara, Yasuhiko Okuda, Osamu Yoshino

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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.