Advertisement

Journal of Assisted Reproduction and Genetics

, Volume 11, Issue 2, pp 79–84 | Cite as

Ectopic pregnancies after in vitro fertilization and embryo transfer

  • Emmanuel Pyrgiotis
  • Khalid M. Sultan
  • Gregory S. Neal
  • Hung -Ching Liu
  • James A. Grifo
  • Zev Rosenwaks
Clinical Assisted Reproduction

Abstract

Objective

Our objective was to analyze the risk factors, stimulation characteristics, and future fecundity of patients with ectopic pregnancies after in vitro fertilization (IVF).

Methods

We retrospectively evaluated all cases of ectopic pregnancy occurring between January 1989 and March 1993 (Cornell series 1 to 17). A case-control group of intrauterine pregnancies was used for comparison of the stimulation and transfer characteristics.

Results

Twenty-seven of 1123 pregnancies (2.4%) were ectopic, following 2812 fresh IVF embryo transfers, while 8 of 105 pregnancies (7.6%) were ectopic, following 405 frozen-thawed embryo transfers. Tubal factor was the cause of infertility in the majority (85.7%) of ectopic pregnancies. No difference was found between the ectopics and the matched controls in stimulation and transfer characteristics. Thirty ectopic pregnancies were ampullary, two were interstitial, two were cervical, and one was heterotopic. Twenty of the patients subsequently underwent 29 IVF attempts, with a pregnancy rate of 41.4% per transfer.

Conclusions

Ectopic pregnancy after IVF appears to be related to preexisting tubal pathology; embryo transfer of cryopreserved thawed embryos in a natural cycle may result in a higher ectopic rate in these patients; in subsequent IVF cycles the intrauterine pregnancy rate of these patients is not decreased.

Key words

ectopic pregnancy in vitro fertilization-embryo transfer 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Steptoe P, Edwards R: Reimplantation of a human embryo with subsequent tubal pregnancy. Lancet 1976;1:880–882Google Scholar
  2. 2.
    Karande VC, Flood JT, Heard N, Veeck L, Muasher SJ: Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer. Hum Reprod 1991;6:446–449PubMedGoogle Scholar
  3. 3.
    Dubuisson MD, Aubriot FX, Mathieu L, Foulot H, Mandelbrot L, Bouquet de Joliniere J: Risk factors for ectopic pregnancy in 556 pregnancies after in-vitro fertilization: implications for preventive management. Fertil Steril 1991;56:686–690PubMedGoogle Scholar
  4. 4.
    Cohen J, Mayaux MJ, Guihard-Moscato ML, Schwartz D: In-vitro fertilization and embryo transfer: A collaborative study of 1163 pregnancies on the incidence and risk factors of ectopic pregnancies. Hum Reprod 1986;1:255–258PubMedGoogle Scholar
  5. 5.
    Medical Research International and the Society for Assisted Reproductive Technology, American Fertility Society: In vitro fertilization-embryo transfer in the United States: 1988 results from the IVF-ET registry. Fertil Steril 1990;53:13–20Google Scholar
  6. 6.
    Medical Research International and the Society for Assisted Reproductive Technology, American Fertility Society: In vitro fertilization-embryo transfer in the United States: 1989 results from the IVF-ET registry. Fertil Steril 1991;55:14–23Google Scholar
  7. 7.
    Medical Research International and the Society for Assisted Reproductive Technology, American Fertility Society: In vitro fertilization-embryo transfer in the United States: 1990 results from the IVF-ET registry. Fertil Steril 1992;57:15–24Google Scholar
  8. 8.
    Society for Assisted Reproductive Technology and American Fertility Society: Assisted reproductive technology in the United States and Canada: 1991 results from the SART generated from the AFS registry. Fertil Steril 1993;59:956–962Google Scholar
  9. 9.
    Martinez F, Trounson A: An analysis of factors associated with ectopic pregnancy in a human in vitro fertilization program. Fertil Steril 1986;45:79–87PubMedGoogle Scholar
  10. 10.
    Cohen J, Mayaux MJ, Guihard-Moscato ML: Pregnancy outcomes after in-vitro fertilization: A collaborative study on 2342 pregnancies. Ann NY Acad Sci 1988, 541:1–6Google Scholar
  11. 11.
    Herman A, Ron-El R, Golan A, Weinraub Z, Bukovsky I, Caspi E: The role of tubal pathology and other parameters in ectopic pregnancies occurring in in vitro fertilization and embryo transfer. Fertil Steril 1990;54:864–868PubMedGoogle Scholar
  12. 12.
    Zouves C, Erenus M, Gomel V: Tubal ectopic pregnancy after in vitro fertilization and ectopic transfer: A role for proximal occlusion or salpingectomy after failed distal tubal surgery? Fertil Steril 1991;56:691–695PubMedGoogle Scholar
  13. 13.
    Correy JF, Watkins RA, Bradfield GF, Garner S, Watson S, Gray G: Spontaneous pregnancies and pregnancies as a result of treatment on an in vitro fertilization program terminating in ectopic pregnancies or spontaneous abortions. Fertil Steril 1988;50:85–88PubMedGoogle Scholar
  14. 14.
    Russell JB: The etiology of ectopic pregnancy. Clin Obstet Gynecol 1987;30:181–190PubMedGoogle Scholar
  15. 15.
    Yovich JL, Turner SR, Murphy AJ: Embryo transfer technique as a cause of ectopic pregnancies in in vitro fertilization. Fertil Steril 1985;44:318–321PubMedGoogle Scholar
  16. 16.
    Knutzen UK, Sotto-Albors CE, Fuller D, Sher G, Shyrock K, Behr B: Mock embryo transfer (MET) in early luteal phase, the cycle prior to in vitro fertilization and embryo transfer (IVF/ET). Presented at the 45th Annual Meeting of the American Fertility Society, San Francisco, CA, Nov 13 to 16, 1989. American Fertility Society, Program supplement 1989;pS152:299Google Scholar
  17. 17.
    Fernandez H, Coste J, Job-Spira N: Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy. Obstet Gynecol 1991;78:656–659PubMedGoogle Scholar
  18. 18.
    Liu HC, Rosenwaks Z: Early pregnancy wastage in IVF (in vitro fertilization) patients. J Vitro Fert Embryo Transfer 1991, 8:65–72CrossRefGoogle Scholar
  19. 19.
    Confino E, Demir RH, Friberg J, Gleicher N: The predictive value of hCG-β subunit levels in pregnancies achieved in in vitro fertilization and embryo transfer: An international collaborative study. Fertil Steril 1986;45:526–531PubMedGoogle Scholar
  20. 20.
    Okamoto SH, Healy DL, Morrow LM, Rogers PA, Trounson AO, Wood EC: Predictive value of plasma human chorionic gonadotropin β-subunit in diagnosis ectopic pregnancy after in vitro fertilization and embryo transfer. Br Med J 1987;294:667–670Google Scholar
  21. 21.
    Yamashita T, Okamoto S, Thomas A, MacLachlan V, Healy DL: Predicting pregnancy outcome after in vitro fertilization and embryo transfer using estradiol, progesterone, and human chorionic gonadotropin β-subunit. Fertil Steril 1989;51:304–309PubMedGoogle Scholar
  22. 22.
    Stovall TG, Ling FW, Cope BJ, Buster JE: Preventing ruptured ectopic pregnancy with a single serum progesterone with a single serum progesterone. Am J Obstet Gynecol 1989;160:1425–1431PubMedGoogle Scholar
  23. 23.
    Yeko TR, Gorrill MJ, Hughes LH, Rodi IA, Buster JE, Sauer MV: Timely diagnosis of early ectopic pregnancy using a single blood progesterone measurement. Fertil Steril 1987;48:1048–1050PubMedGoogle Scholar
  24. 24.
    Dimitry ES, Subak-Sharpe R, Mills M, Margara R, Winston R: Nine cases of heterotopic pregnancies in 4 years of in vitro fertilization. Fertil Steril 1990;53:107–110PubMedGoogle Scholar
  25. 25.
    Rizk B, Tan SL, Morcos S, Riddle A, Brinsden P, Mason BA, Edwards RG: Heterotopic pregnancies after in vitro fertilization and embryo transfer. Am J Obstet Gynecol 1991: 164Google Scholar
  26. 26.
    Steptoe PC: Pregnancies following implantation of human embryos grown in culture. Presented at the Scientific Meeting of the Royal College of Obstetricians and Gynaecologists, London, Jan 26, 1979. Royal College of Obstetricians and Gynaecologists, Program SupplementGoogle Scholar
  27. 27.
    Svare J, Norup P, Grove Thomsen S,et al.: Heterotopic pregnancies after in vitro fertilization and embryo transfer—A Danish survey. Hum Reprod 1993;8:116–118PubMedGoogle Scholar
  28. 28.
    Tucker M, Smith D, Pike I, Kemp J, Picker R, Saunders D: Ectopic pregnancy following in vitro fertilization and embryo transfer. Lancet 1981;2:1278CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Emmanuel Pyrgiotis
    • 1
  • Khalid M. Sultan
    • 1
  • Gregory S. Neal
    • 1
  • Hung -Ching Liu
    • 1
  • James A. Grifo
    • 1
  • Zev Rosenwaks
    • 1
  1. 1.Center for Reproductive Medicine and Infertility, Department of Obstetrics and GynecologyCornell University Medical CollegeNew York

Personalised recommendations