Analysis of the incidence and risk factors associated with ectopic pregnancy following in-vitro fertilization and embryo transfer

Abstract

Ectopic pregnancy is a well known complication of in-vitro fertilization (IVF) and embryo transfer. From March 1983 to December 1993, 3000 clinical pregnancies were achieved at Bourn Hall Clinic, including 135 ectopic pregnancies (4.5%). Of these ectopics 20 were heterotopic, eight ovarian, six bilateral tubal and the remainder were singleton tubal pregnancies. The main risk factor identified in the series was a history of pelvic inflammatory disease (P < 0.001). The data also showed that ectopic pregnancy is at present more prevalent among patients in whom tubal damage is the reason for treatment. There was slight statistical evidence (P = 0.05) that patients having ectopic pregnancies received a higher volume of culture medium than those having normal deliveries. There was also an apparent trend (P = 0.07, not significant) that high progesterone/oestradiol ratio on the day of embryo transfer was associated with ectopic pregnancy. There was no statistical evidence of association between ectopic pregnancy and a history of ectopic pregnancy, abortion, still birth, termination of pregnancy, neonatal death, tubal surgery, ovarian stimulation protocol, plasma concentration of oestradiol, luteinizing hormone and progesterone, number of oocytes retrieved, number or quality of embryos transferred, administration of general anaesthesia for embryo transfer, and the number of patent Fallopian tubes. Awareness of the risk factors associated with ectopic pregnancy plays an important part in the early diagnosis of this potentially fatal condition.

Complications in pregnancies after in vitro fertilization and embryo transfer

“…Risk of ectopic pregnancy has been reported to be at least 2-fold higher in IVF-ET pregnancies. 14 The cause of increased chances of ectopic pregnancy is presumed to be the migration of embryos or direct transfer into fallopian tubes. Heterotopic pregnancies are extremely rare in spontaneous pregnancies but far more common in infertile women who conceive after ovulation induction or IVF.…”

A case of primary ovarian pregnancy after in vitro fertilization and embryo transfer

“…Ovarian pregnancy following IVF-ET was first demonstrated by Marcus and Brinsden (2) but is still rare despite the increased incidence of ectopic pregnancies, accounting for 2 to 11% after IVF-ET (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Concurrent ovarian and ipsilateral tubal ectopic pregnancies after a double embryo transfer: a case report

“…Though of little clinical use today, there are specific diagnostic criteria for an ovarian ectopic described by Spiegelberg in 1878: (1) an intact ipsilateral tube, clearly separate from the ovary; (2) a gestational sac occupying the position of the ovary; (3) a gestational sac connected to the uterus by the ovarian ligament; and (4) ovarian tissue in the wall of the gestational sac [5]. The risk of ovarian pregnancy after assisted reproductive techniques is approximately 0.3 % and is likely to increase with widespread use of these procedures [6][7][8]. However, given the extremely low incidence of an ovarian ectopic pregnancy, even after ovulation induction and assisted reproduction, it still remains a very rare diagnosis.…”