Risk factors and clinical features of ovarian pregnancy: a case–control study

Abstract

ObjectiveTo identify risk factors for ovarian pregnancy (OP) and compare clinical features between OP and tubal pregnancy (TP) patients.DesignCase–control study.SettingUniversity hospital.ParticipantsA case–control study was conducted from January 2005 to May 2014. Women diagnosed with OP were recruited as the case group (n=71), 145 women with TP and 146 with intrauterine pregnancy (IUP) were matched as controls at a ratio of 1:2:2. Women who refused interviews or provided incomplete information were excluded.ResultsOP risk was lower than TP risk in women with serological evidence of Chlamydia trachomatis infection (adjusted OR1 0.17, 95% CI 0.06 to 0.52), previous adnexal surgery (adjusted OR1 0.25, 95% CI 0.07 to 0.95), and current levonorgestrel emergency contraceptive use (adjusted OR1 0.24, 95% CI 0.07 to 0.78). In vitro fertilisation-embryo transfer (IVF-ET) carried a higher risk of OP (adjusted OR1 12.18, 95% CI 2.23 to 66.58) than natural conception. When Controlled by IUP women, current users of intrauterine devices (IUDs) carried a higher risk of OP than non-users of any contraceptives (adjusted OR2 9.60, 95% CI 1.76 to 42.20). β-Human chorionic gonadotropin (hCG) levels on the day of surgery were higher in OP patients than in TP patients (p<0.01). Women with OP were less likely to initially present with vaginal bleeding than those with TP (p=0.02). Moreover, shock (p=0.02), rupture (p<0.01), haemoperitoneum (p<0.01) and emergency laparotomy (p<0.01) were more common in the OP group than in the TP group.ConclusionsIVF-ET and IUD use may be risk factors for OP, and OP patients tend to have high β-hCG levels and a poor clinical outcome (shock, rupture, haemoperitoneum and need for emergency laparotomy). Our findings may contribute to the prevention and early diagnosis of OP.

Ovarian apoplexy resulting from ruptured heterotopic pregnancy following intrauterine insemination

“…Risk factors for ovarian pregnancy include pelvic inflammatory disease, previous gynecologic surgery, endometriosis, intrauterine device usage, and in vitro fertilization (IVF). 11,12 Ovarian implantation may occur secondary to reflux of the fertilized egg from the fallopian tube or following intrafollicular fertilization. The mechanism of reverse migration, which explains the occurrence of ovarian pregnancies following IVF, may not be solely elucidative, for a literature search yielded several reports of ovarian pregnancies following IVF but only seven following IUI (Table 1).…”

Ovarian Pregnancy after IVF and Embryo Transfer – Case Report

“…However, some researchers consider that the risk factors for ovarian pregnancy are different from the traditional risk factors for tubular pregnancy. In studies it has been found that in vitro fertilization-embryo transfer (IVF-ET) and use of current intrauterine device (IUD) are the risk factors of ovarian pregnancy (12). The incidence of ovarian pregnancy following IVF-ET has been much higher than following natural conception, respectively 6% and 3% of all ectopic pregnancies (12).…”

Ovarian pregnancy associated with a fresh blastocyst transfer following in vitro fertilization

“…Although the embryos are transferred into the endometrial cavity following IVF, retrograde migration of the embryo toward the tube may cause an ectopic implantation in the tube, ovary, or peritoneum. Therefore, IVF‐embryo transfer (ET) has been reported as a risk factor for ectopic pregnancy, including ovarian pregnancy . The cleaving embryo transferred into the endometrial cavity seems to migrate toward the tube during its cleavage to a blastocyst .…”

“…Therefore, IVFembryo transfer (ET) has been reported as a risk factor for ectopic pregnancy, including ovarian pregnancy. 4,5 The cleaving embryo transferred into the endometrial cavity seems to migrate toward the tube during its cleavage to a blastocyst. 6 In contrast, a fully matured blastocyst seems to implant quickly in the endometrium once it is transferred into the endometrial cavity.…”