Heterotopic Pregnancy Secondary to in vitro Fertilization-Embryo Transfer: Risk Factors and Pregnancy Outcomes

Abstract

BackgroundWith the widespread application of assisted reproduction technology (ART) and increased pelvic inflammatory disease, the incidence of heterotopic pregnancy (HP) has risen. However, the risk factors and treatment of HP remain indefinite.ObjectivesTo explore risk factors affecting the incidence of HP secondary to in vitro fertilization-embryo transfer (IVF-ET) and pregnancy outcomes after surgical treatment of HP.Methods29 patients with HP and 116 with an intrauterine-only pregnancy (IUP) after IVF-ET during the same period were included retrospectively from January 2015 to September 2020.ResultsPatients with HP had a higher proportion of previous ectopic pregnancies, multiple abortion history (≧2 times) and tubal indication for IVF than IUP. Besides, they had a greater possibility to end in spontaneous abortion (31.03 vs.13.79%, P = 0.028) and preterm delivery (25.00 vs. 7.00%, P = 0.035), less possibility to result in a live birth (58.62 vs. 78.45%, P = 0.028). History of multiple abortions (≥2 times) [odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087–8.453; P = 0.034], tubal infertility (OR 3.844, 95% CI 1.268–11.656; P = 0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625–8.490; P = 0.021) and number of embryo transfer (OR 0.300, 95% CI 0.092–0.983; P = 0.037) resulted in an elevated proportion of HP in IVF treatment. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment.ConclusionsPrevious history of ectopic pregnancy, multiple abortions, tubal infertility and multiple-embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.

Effect of endometrial thickness on the risk of ectopic pregnancy for frozen embryo transfer

“…Therefore, blastocysts with better endometrial receptivity and higher embryo implantation potential than those at the cleavage stage [31] might be the most biologically correct stage for embryos in the uterus [32] . Our study is consistent with most studies showing that the risk of EP may increase with the number of transferred embryos [4,6,33–36] . In addition, our results showed that the number of high-quality embryos transferred was not a protective factor against EP, which is consistent with the studies by Kim et al .…”

Heterotopic pregnancy after a single embryo transfer with successful perinatal outcome: case report and literature review

“…In terms of the choice of treatment, laparoscopic salpingectomy was performed in all five of the above patients. Researches show that salpingectomy is the first choice for women with HP after IVF-ET [ 14 ]. Moreover, this approach can greatly shorten the operation time, reduce intraoperative stimulation of the uterus, and reduce the probability of another ectopic pregnancy [ 15 ].…”

Ultrasound manifestations and clinical analysis of 50 cases of heterotopic pregnancy

“…Tubal damage caused by factors such as history of ectopic pregnancy, pelvic adhesions, and tubal surgery is the main cause of tubal infertility. 13 Changes in the structure and function of the fallopian tube further increase the risk of HP.…”

“…Tubal infertility is the main indication for IVF‐ET, and it is also considered to be a high‐risk factor for ectopic pregnancy and HP. Tubal damage caused by factors such as history of ectopic pregnancy, pelvic adhesions, and tubal surgery is the main cause of tubal infertility 13 . Changes in the structure and function of the fallopian tube further increase the risk of HP.…”