Abdominal ectopic pregnancy after in vitro fertilization and single embryo transfer: a case report and systematic review

Abstract

BackgroundEctopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5–2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified.ResultsPatients’ ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies.ConclusionsOur systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks.

Abdominal Pregnancy, Case Report from Latifa Hospital DHA, Dubai, UAE

“…This could happen because of a fimbria abortion, or rarely due to uterine rupture from previous scar or from a rudimentary horn of the uterus. A rare case following perforation of uterus during embryo transfer during IVF has also been reported [2]. Implantation could be in any abdominal peritoneum like the pelvic side walls, parietal peritoneum over the uterus, the pouch of Douglas, omentum, bowel and mesentery, mesosalpinx etc.…”

Manejo expectante de gestación ectópica abdominal tras fecundación in vitro en paciente con salpinguectomía bilateral. Reporte de un caso.

“…En nuestra paciente encontramos varios de ellos: cirugía abdominal previa, salpinguectomía bilateral y haber sido sometida a múltiples técnicas de reproducción asistida. La incidencia de las gestaciones ectópicas ha aumentado en las últimas décadas, debido en parte al aumento de las técnicas de reproducción asistida 6,7,8,9 . Sin embargo, la morbimortalidad se ha visto reducida dada la mejora en los métodos diagnósticos, lo que nos permite realizar un diagnóstico más temprano y preciso.…”

An abdominal ectopic pregnancy following a frozen-thawed ART cycle: a case report and review of the literature

“…A history of prior tubal surgery was also particularly common (50%) among abdominal ectopic cases in their systematic review. Fresh embryo transfer was far more common in abdominal ectopic cases than frozen embryo transfer (11% of cases) [8]. …”

“…As over 90% of EP are tubal pregnancies, abdominal ectopic pregnancies (AEP) constitute a rare form of EP, with increasing morbidity and difficulty in diagnosis [5, 8]. In this article a case of AEP is presented, which occurred following a single T-ET cycle of ICSI in a woman with non-tubal infertility.…”