Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer

Lv, Shangge; Wang, Zhe; Liu, Hailing; Peng, Jin; Song, Jialun; Liu, Wei; Yan, Lei

doi:10.1016/j.tjog.2019.11.010

Cited by 17 publications

(22 citation statements)

References 20 publications

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“…However, a heterotopic pregnancy occurred. The incidence of heterotopic pregnancy has gradually increased with the widespread use of assisted reproductive technology (22). The risk factors for heterotopic pregnancy are similar to those associated with ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor

Chi

Liang

et al. 2021

Front. Oncol.

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We report a rare subtype of adult cystic granulosa cell tumor (AGCT) characterized by elevated anti-Mullerian hormone and hyperandrogenism. A 35-year-old woman with primary infertility, hyperandrogenism, and irregular menses who was previously diagnosed with polycystic ovarian syndrome was diagnosed with AGCT based on histopathological examination and FOXL2 genetic test after laparoscopy. Due to fertility aspirations, she underwent controlled ovarian stimulation followed by embryo cryopreservation before salpingo-oophorectomy, and two embryos were frozen-thawed and transferred after surgery. A healthy female infant was delivered at 40 weeks’ gestation. Cystic granulosa cell tumors should be considered a differential diagnosis in patients with persistent ovarian cysts and hyperandrogenism. Younger patients with AGCT with fertility goals should consider active assisted reproduction measures to preserve fertility before treatment for AGCT.

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Section: Discussionmentioning

confidence: 99%

Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor

Chi

Liang

et al. 2021

Front. Oncol.

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“…11,12 Pi et al 4 also reported that tubal infertility and pelvic adhesion increase the risk of HP among patients undergoing IVF treatment; however, a cohort study conducted by Xiao et al 13 reported no significant difference in the incidence of HP in fresh IVF cycles versus frozenthawed cycles. In a retrospective study by Lv et al, 14 the authors found that a history of EP and previous tubal surgery may increase the risk of HP. In addition, low levels of serum hCG and oestrogen in the patient on Day 14 after ET could indicate the incidence of HP.…”

Section: Risk Factorsmentioning

confidence: 99%

Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

2022

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Heterotopic pregnancy (HP) is the simultaneous occurrence of intrauterine and ectopic pregnancies (EP). The incidence of HPs occurring spontaneously ranges from 1 in 10,000 to 1 in 30,000. However, this incidence is reported to be 1 in 100 pregnancies following artificial reproductive techniques. HP is a potentially life-threatening condition that is frequently misdiagnosed, as most diagnoses for HPs are delayed, and are only made after rupture of the EP. A high index of suspicion is, therefore, required for an accurate and timely diagnosis in order to reduce maternal morbidity and mortality, which currently stands at 1 in 200,000 live births. The most common risk factors include pelvic inflammatory disease, previous EP, assisted reproduction techniques, and ovarian hyperstimulation syndrome. Transvaginal ultrasound is the gold standard for diagnosis. As detection of an intrauterine pregnancy often leads to the mistaken exclusion of a concomitant EP, a careful transvaginal scanning of the uterus and appendages should be performed in all females of reproductive age with a positive pregnancy test and red flags in anamnesis, and/or with clinical symptoms. Routine transvaginal ultrasound at Day 27 after embryo transfer could facilitate the diagnosis of HP; however, symptoms onset before or after Day 27 are clues to early diagnosis. MRI can be very helpful in diagnosing atypical cases.

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“…Women undergoing ART are also more likely to have tubal pathology, thereby increasing their risk of an ectopic pregnancy ( Parashi et al , 2014 ; Li et al , 2015 ). Factors that may compromise tubal patency include a previous ectopic pregnancy ( Jeon et al , 2016 ), tubal surgery ( Lv et al , 2020 ), pelvic surgery ( Malak et al , 2011 ), pelvic inflammatory disease ( Xiao et al , 2018 ) and hydrosalpinges ( Liu et al , 2015 ). Failed tubal sterilization and intrauterine devices can also increase the risk of an ectopic pregnancy ( Li et al , 2015 ).…”

Section: Introductionmentioning

confidence: 99%

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Solangon

Otify

Gaughran

et al. 2022

Human Reproduction Open

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Study Question What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? Summary Answer In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. What Is Known Already Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. Study Design, Size, Duration A retrospective observational case-control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London Early Pregnancy Units covering a twenty-year period between November 2019 and April 2000. Participants/Materials, Setting, Methods All women attended early pregnancy units because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management. There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. Main Results And The Role Of Chance In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2-30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7-32) miscarriages in those treated surgically. In the control group there were 28/156 (18%, 95% CI 12.2-24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically (OR 1.03 95% CI 0.44-2.36). There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9-90.2) and 38/48 (79%, 95% CI 65-89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4-87.2) live-births in the control group (OR 0.87, 95% CI 0.39-1.94). Limitations, Reasons For Caution This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. Wider Implications Of The Findings This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. Study Funding/Competing Interest(s) This work did not receive any funding. None of the authors has any conflict of interest to declare. Trial Registration Number Research Registry: researchregistry6430.

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Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer

Cited by 17 publications

References 20 publications

Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor

Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor

Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

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