Risk Factors for Ectopic Pregnancy After in Vitro Fertilization and Embryo Transfer

Overview

Journal J Assist Reprod Genet

Publisher Springer

Specialties Genetics
Reproductive Medicine

Date 1995 Oct 1

PMID 8580656

Citations 7

Authors

M Ribic-Pucelj

T Tomazevic

A Vogler

H Meden-Vrtovec

Affiliations

Soon will be listed here.

Abstract

Purpose: To find the incidence of ectopic pregnancy (EP) in patients who conceived in the IVF-ET program, and risk factors affecting the occurrence of EP.

Methods: We analyzed the effects of the indication for IVF, type of ovarian stimulation (hMG + hCG vs. GnRH + hMG + hCG), type of embryo transfer (transcervical intratubal, intrauterine in chest-knee position and intrauterine in lithotomy position) and number of embryos transferred on the occurrence of EP. EP was treated by laparotomy, prostaglandin E2 or laparoscopic surgery.

Results: In 7991 stimulated and 92 natural cycles treated in the Ljubljana IVF-ET program between May 1983 and June 1994 we achieved 1059 pregnancies, of which 44 were ectopic (incidence 4.1%), the main risk being tubal factor infertility. There were 38 (86.3%) tubal, 3 (6.8%) heterotopic, 1 (2.4%) ovarian, and 2 (4.5%) cornual EP. In two patients multiple tubal EP occurred (1 twin, 1 triplet). Forty-two patients (95.4%) had tubal factor infertility, 1 (2.3%) unexplained, and 1 (2.3%) patient had male factor. The incidence of EP in patients with tubal infertility was 5.4%, in patients with unexplained infertility 2.0% and in those with male factor 0.9%. There appeared to be no correlation between the two superovulatory methods. With transcervical intrauterine ET the incidence of EP was 0 of 5 clinical pregnancies (CP); with intrauterine in chest-knee position it was 26 (3.5%) of 738 CP; with intrauterine in lithotomy position it was 17 (5.4%) of 316 CP. The difference between the two types of intrauterine ET is not statistically significant. The incidence of EP did not correlate with the number of embryos transferred. The average initial values of beta hCG performed 17 days after ET were significantly lower in patients with EP than in those with normal singleton pregnancy (157 +/- 143 mIU/ml vs. 408 +/- 148 mIU/ml).

Conclusions: EP can complicate the IVF procedure. The main risk factor is tubal infertility with or without previous tubal surgery. The low initial value of beta hCG has a strong predictive value in the diagnosis of EP.

Citing Articles

An endometrium of type C along with an endometrial thickness of < 8 mm are risk factors for ectopic pregnancy after stimulated cycles with fresh embryo transfer.

Zhao Y, Xu A, Liu D, Liu N, Li Y, Yao Z BMC Pregnancy Childbirth. 2023; 23(1):713.

PMID: 37803277 PMC: 10557322. DOI: 10.1186/s12884-023-05920-y.

The Predictive Value of Serum ß-HCG Levels in The Detection of Ectopic Pregnancy Sixteen Days after Embryo Transfer: A Cross-Sectional Study.

Hashemi S, Arabipoor A, Kohestani S, Zolfaghary Z, Vesali S, Ghaffari F Int J Fertil Steril. 2023; 17(3):181-186.

PMID: 37183844 PMC: 10189163. DOI: 10.22074/ijfs.2022.546087.1247.

Is early-follicular long-acting GnRH agonist protocol an alternative for patients with polycystic ovary syndrome undergoing in vitro fertilization?.

Wang D, Chu T, Yu T, Zhai J Reprod Biol Endocrinol. 2022; 20(1):137.

PMID: 36088329 PMC: 9463774. DOI: 10.1186/s12958-022-01007-z.

An Endometrial Thickness < 8 mm Was Associated With a Significantly Increased Risk of EP After Freeze-Thaw Transfer: An Analysis of 5,960 Pregnancy Cycles.

Zhao Y, Liu D, Liu N, Li Y, Yao Z, Tian F Front Endocrinol (Lausanne). 2022; 13:884553.

PMID: 35813636 PMC: 9261458. DOI: 10.3389/fendo.2022.884553.

Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011.

Perkins K, Boulet S, Kissin D, Jamieson D Obstet Gynecol. 2015; 125(1):70-78.

PMID: 25560107 PMC: 4315158. DOI: 10.1097/AOG.0000000000000584.

References

Molloy D, Deambrosis W, Keeping D, Hynes J, Harrison K, Hennessey J . Multiple-sited (heterotopic) pregnancy after in vitro fertilization and gamete intrafallopian transfer. Fertil Steril. 1990; 53(6):1068-71. DOI: 10.1016/s0015-0282(16)53587-0. View

McBain J, Evans J, Pepperell R, ROBINSON H, Smith M, Brown J . An unexpectedly high rate of ectopic pregnancy following the induction of ovulation with human pituitary and chorionic gonadotrophin. Br J Obstet Gynaecol. 1980; 87(1):5-9. DOI: 10.1111/j.1471-0528.1980.tb04417.x. View

Diedrich K, Van der Ven H, Al-Hasani S, Krebs D . Establishment of pregnancy related to embryo transfer techniques after in-vitro fertilization. Hum Reprod. 1989; 4(8 Suppl):111-4. DOI: 10.1093/humrep/4.suppl_1.111. View

Tomazevic T, Ribic-Pucelj M . Ectopic pregnancy following the treatment of tubal infertility. J Reprod Med. 1992; 37(7):611-4. View

Karande V, Flood J, Heard N, Veeck L, Muasher S . Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer. Hum Reprod. 1991; 6(3):446-9. DOI: 10.1093/oxfordjournals.humrep.a137356. View

STEPTOE P, Edwards R . Reimplantation of a human embryo with subsequent tubal pregnancy. Lancet. 1976; 1(7965):880-2. DOI: 10.1016/s0140-6736(76)92096-1. View

Tomazevic T, Meden-Vrtovec H, Ribic-Pucelj M, Bernjak I, Zamva Z . Transvaginal ultrasound or laparoscopy for oocyte retrieval (experiences in the Ljubljana IVF program). Acta Eur Fertil. 1988; 19(4):209-11. View

Bennett S, Waterstone J, Parsons J, Creighton S . Two cases of cervical pregnancy following in vitro fertilization and embryo transfer to the lower uterine cavity. J Assist Reprod Genet. 1993; 10(1):100-3. DOI: 10.1007/BF01204450. View

Fernandez H, Coste J, Job-Spira N . Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy. Obstet Gynecol. 1991; 78(4):656-9. View

10.

Martinez F, Trounson A . An analysis of factors associated with ectopic pregnancy in a human in vitro fertilization program. Fertil Steril. 1986; 45(1):79-87. DOI: 10.1016/s0015-0282(16)49101-6. View

11.

Saunders D, Lancaster P, Pedisich E . Increased pregnancy failure rates after clomiphene following assisted reproductive technology. Hum Reprod. 1992; 7(8):1154-8. DOI: 10.1093/oxfordjournals.humrep.a137812. View

12.

Nazari A, Askari H, Check J, OShaughnessy A . Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. Fertil Steril. 1993; 60(5):919-21. View

13.

Confino E, Demir R, Friberg J, Gleicher N . The predictive value of hCG beta subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: an international collaborative study. Fertil Steril. 1986; 45(4):526-31. View

14.

Dubuisson J, Aubriot F, Mathieu L, Foulot H, Mandelbrot L, de Joliere J . Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: implications for preventive management. Fertil Steril. 1991; 56(4):686-90. DOI: 10.1016/s0015-0282(16)54600-7. View

15.

Bernaschek G, Rudelstorfer R, Csaicsich P . Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. Am J Obstet Gynecol. 1988; 158(3 Pt 1):608-12. DOI: 10.1016/0002-9378(88)90039-7. View

16.

Yovich J, Turner S, Murphy A . Embryo transfer technique as a cause of ectopic pregnancies in in vitro fertilization. Fertil Steril. 1985; 44(3):318-21. DOI: 10.1016/s0015-0282(16)48854-0. View

17.

Balen A, MacDougall J, Tan S . The influence of the number of embryos transferred in 1060 in-vitro fertilization pregnancies on miscarriage rates and pregnancy outcome. Hum Reprod. 1993; 8(8):1324-8. DOI: 10.1093/oxfordjournals.humrep.a138250. View

18.

Zouves C, Erenus M, Gomel V . Tubal ectopic pregnancy after in vitro fertilization and embryo transfer: a role for proximal occlusion or salpingectomy after failed distal tubal surgery?. Fertil Steril. 1991; 56(4):691-5. DOI: 10.1016/s0015-0282(16)54601-9. View

19.

Azem F, Yaron Y, Botchan A, Amit A, Yovel I, David M . Ectopic pregnancy after in vitro fertilization-embryo transfer (IVF-ET): the possible role of the ET technique. J Assist Reprod Genet. 1993; 10(4):302-4. DOI: 10.1007/BF01204946. View

20.

Jansen R, Anderson J . Catheterisation of the fallopian tubes from the vagina. Lancet. 1987; 2(8554):309-10. DOI: 10.1016/s0140-6736(87)90893-2. View