This study aims to investigate the impact of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) on the depth of villous invasion and perinatal outcomes in patients diagnosed with placenta accreta spectrum disorders(PAS).

The clinical data of 974 patients diagnosed with placenta accreta by cesarean section in our hospital from January 2018 to March 2023 were analyzed retrospectively.These patients were categorized into two groups based on their conception method: the natural conception group (820 cases) and the IVF/ICSI group (154 cases). A 1∶1 match was performed using the propensity score matching method, resulting in 123 cases in each group. Post-matching, we analyzed the placental implantation grading and perinatal outcomes of patients who conceived via IVF/ICSI.

No significant difference was observed in the grades of invasive placentas between the IVF/ICSI group and the natural conception group (P=0.290). However, the IVF/ICSI group had a higher incidence of postpartum hemorrhage than the natural conception group (18.7% vs 2.4%, χ²=16.02, P<0.001). Other perinatal outcomes, including maternal hysterectomy, red blood cell transfusion ≥4 U, gestational age of newborn, birth weight of newborn, and admission to the neonatal intensive care unit, showed no significant differences (all P>0.05). Risk factor analysis for perinatal outcomes by IVF/ICSI revealed that IVF/ICSI fertilization did not increase the incidence of invasive placenta implantation (aOR=0.64, 95%CI: 0.400~1.007). However, IVF/ICSI was identified as a risk factor for postpartum hemorrhage (aOR=1.40, 95%CI: 1.170~2.552). IVF/ICSI did not increase the risk of maternal hysterectomy (aOR=0.48, 95%CI: 0.192~1.212), maternal blood transfusion ≥4 U (aOR=1.08, 95%CI: 0.54~2.133), preterm births (aOR=0.77, 95%CI: 0.489~1.217), birth weight <2500 g (aOR=1.04, 95%CI: 0.666~1.608), or neonatal admission to the intensive care unit (aOR=0.57, 95%CI: 0.109~2.980).

The IVF/ICSI conception method is not a risk factor affecting the grading of placental implantation, and the risk factors affecting the grading of placental implantation need further exploration. IVF/ICSI pregnancy increases the risk of adverse pregnancy outcomes such as postpartum hemorrhage, but does not increase the risk of hysterectomy, heavy blood transfusion, or neonatal adverse outcomes. Clinical doctors are reminded to comprehensively evaluate the prognosis of such patients based on their medical history, local prenatal management capabilities, and delivery assistance capabilities.