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Zhang M, Zhao C, Zheng J, Li Z, Yin M, Li H, Wang Y, Huang X. Ovarian pregnancy after bilateral salpingectomy in a patient with in vitro fertilization: a case report. J Int Med Res 2022; 50:3000605221123683. [PMID: 36124921 PMCID: PMC9500280 DOI: 10.1177/03000605221123683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ovarian pregnancy is rare but may occur with in vitro
fertilization-embryo transfer in women who have undergone bilateral
salpingectomy. We report a case of an approximately 30-year-old woman who had
in vitro fertilization and a history of bilateral
salpingectomy, and was diagnosed with an ovarian pregnancy. Laparoscopic
enucleation of the gestational product in the ovary and ovarian remnant
reconstruction were performed. The patient recovered well after surgery and was
discharged home 5 days postoperatively. ß-human chorionic gonadotropin was
undetectable 3 weeks after the surgery. Awareness of the possibility of ovarian
pregnancy after in vitro fertilization-embryo transfer is the
most important step in an early diagnosis and treatment. Salpingectomy should be
carefully performed to eliminate the risk of heterotopic pregnancy, especially
in cases where a subsequent gestation is desired.
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Affiliation(s)
- Mingle Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Caijun Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jiahua Zheng
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhongkang Li
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Meiyun Yin
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Haiyan Li
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xianghua Huang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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OuYang Z, Yin Q, Wu J, Zhong B, Zhang M, Li F. Ectopic pregnancy following in vitro fertilization after bilateral salpingectomy: A review of the literature. Eur J Obstet Gynecol Reprod Biol 2020; 254:11-14. [PMID: 32898753 DOI: 10.1016/j.ejogrb.2020.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 11/19/2022]
Abstract
Ectopic pregnancy after bilateral salpingectomy is rare and is therefore easily misdiagnosed. To provide information regarding the clinical manifestations, diagnosis, management, mechanism and prognosis of this condition, we reviewed all cases reported in the English literature. All English language reports on ectopic pregnancy after bilateral salpingectomy were retrieved from the PubMed database. A total of 19 English language articles were collected and 20 cases of ectopic pregnancy were reported. Eleven of the 19 patients had a history of tubal pregnancy on one or both sides. All of these pregnancies were by IVF-ET. The site of ectopic pregnancy was the tubal stump in 8 cases, the abdominal cavity in 4 cases, the ovary in 3 cases, the retroperitoneum in 3 cases, and the uterine cornua in 2 cases. All patients underwent successful resection of the ectopic pregnancy, of which 10 were laparoscopic surgery and 10 were laparotomy. Six of 8 cases of heterotopic pregnancy were successful gestation to the last trimester and were delivered after treatment. Ectopic pregnancy is still possible following IVF-ET after bilateral salpingectomy. The location of these ectopic pregnancies is complex and it is necessary to beware of the possibility of a heterotopic pregnancy.
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Affiliation(s)
- Zhenbo OuYang
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Qian Yin
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Jiawen Wu
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Biting Zhong
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Min Zhang
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Feng Li
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
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3
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Xu A, Hao T, Wei X, Li C, Niu L, Deng X. Effect of Surgical Adhesive on the Uterus of Rabbits Following Occlusion. J INVEST SURG 2018; 32:697-705. [PMID: 29611773 DOI: 10.1080/08941939.2018.1453892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose/Aim of the Study: The present study investigated the effect of surgical adhesives on the uterus of rabbits and the histomorphology alterations following occlusion, to improve the clinical treatment of abnormal fallopian tube with surgical adhesives for in vitro fertilization and embryo transfer (IVF-ET). Materials and Methods: The experimental rabbits received laparotomy and occlusion of the uterus by surgical adhesive adjacent to the two fallopian tubes, while the control rabbits only received laparotomy. The body weight, hysterosalpingography, and histomorphology were measured to evaluate the uterine occlusion at 1 and 6 months after surgery. Results: There was no significant difference in the mortality rate or body weight between the experimental and control groups. In the experimental group, 38 uterine cavities were identified in 19 rabbits, of which 97.37% were occluded, with expanded uterine cavity and tissue oppression at 1 month after surgery. In total, 33 uterine cavities out of the 36 in the control group were occluded, with proliferation of new stratified epithelial cells observed at 6 months after surgery. In the control group, 20 uterine cavities of 10 rabbits were observed to be absent of occlusion at 1 month after surgery, while 18 uterine cavities in the remaining 9 rabbits were also absent of occlusion at 6 months after the surgery. Conclusion: Surgical adhesives are effective in occluding the uterus of rabbits without adverse effects, supporting their potential clinical use to treat the occlusion in abnormal fallopian tubes prior to IVF-ET.
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Affiliation(s)
- Anran Xu
- Infertility Center, Qilu Hospital of Shandong University, Jinan, China.,Center for Reproductive Medicine, The General Hospital of Jinan Military Command, Jinan, China
| | - Tianyu Hao
- Center for Reproductive Medicine, The General Hospital of Jinan Military Command, Jinan, China
| | - Xiaoqing Wei
- Center for Reproductive Medicine, Hospital for Maternity and Child Care of Jinan City, Jinan, China
| | - Chuanfen Li
- Neurology Lab, The General Hospital of Jinan Military Command, Jinan, China
| | - Lihua Niu
- Center for Reproductive Medicine, Henan Provincial Reproductive Hospital, Zhengzhou, China
| | - Xiaohui Deng
- Infertility Center, Qilu Hospital of Shandong University, Jinan, China
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Irani M, Robles A, Gunnala V, Spandorfer SD. Unilateral Salpingectomy and Methotrexate Are Associated With a Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing In Vitro Fertilization. J Minim Invasive Gynecol 2017; 24:777-782. [PMID: 28285056 DOI: 10.1016/j.jmig.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF). DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING An academic medical center. PATIENTS Patients with a history of a previous EP who achieved pregnancy after IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for a previous EP. INTERVENTIONS IVF. MEASUREMENTS AND MAIN RESULTS A total of 594 patients were included. Seventeen patients had a recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with 1 previous EP (8.5% vs. 1.8%; p = .01; odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2-4.4). Patients who underwent unilateral salpingectomy (n = 245) had a comparable recurrence rate of EP after IVF with those who received methotrexate (n = 283) (3.6% vs. 2.8%; p = .5; OR = 1.3; 95% CI, 0.4-3.4). This OR remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (adjusted OR = 1.4; 95% CI, 0.5-3.8). None of the patients who underwent bilateral salpingectomy (n = 45) or salpingostomy (n = 21) had a recurrence of EP after IVF. CONCLUSION The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP after IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population.
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Affiliation(s)
- Mohamad Irani
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Alex Robles
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Vinay Gunnala
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Steven D Spandorfer
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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5
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Samara N, Bentov Y. Case Report of Ectopic Ovarian Pregnancy Following Fresh Embryo Transfer. CLINICAL MEDICINE INSIGHTS: REPRODUCTIVE HEALTH 2016; 10:29-32. [PMID: 27867306 PMCID: PMC5110221 DOI: 10.4137/cmrh.s40593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Ovarian pregnancy is a rare and challenging clinical phenomenon. Recent studies have identified assisted reproductive treatments and infertility as risk factors. However, neither a definite mechanism nor clear risk factors were identified and therefore prevention strategies are yet unavailable. CLINICAL CASE In this article, we present a case of ovarian pregnancy occurring following in vitro fertilization treatment and a fresh embryo transfer. The couple was diagnosed with unexplained infertility and no identifiable risk factors for extrauterine pregnancy. The diagnosis of ovarian pregnancy was made during explorative laparoscopy performed due to suspected extrauterine pregnancy. The patient had normal intra- and postoperative course. CONCLUSION Ovarian pregnancy is an infrequent and a challenging diagnosis. Yet, late diagnosis and lack of appropriate intervention may have long-term implications. Several mechanisms and risk factors are proposed, and their acknowledgment may improve early diagnosis and prevention of complications.
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Affiliation(s)
- Nivin Samara
- Department of Obstetrics and Gynecology, TRIO Fertility Clinic, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Yaakov Bentov
- Department of Obstetrics and Gynecology, TRIO Fertility Clinic, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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6
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Barbosa MW, Sotiriadis A, Papatheodorou SI, Mijatovic V, Nastri CO, Martins WP. High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:556-565. [PMID: 27854386 DOI: 10.1002/uog.15960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx. METHODS We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model. RESULTS Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)). CONCLUSIONS The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M W Barbosa
- University of Sao Paulo, Department of Obstetrics and Gynecology, Ribeirao Preto Medical School (FMRP-USP), Ribeirao Preto, Brazil
| | - A Sotiriadis
- Aristotle University of Thessaloniki, 2nd Department of Obstetrics and Gynecology, Thessaloniki, Greece
| | - S I Papatheodorou
- Department of Health Sciences, Cyprus Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - V Mijatovic
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C O Nastri
- SEMEAR Fertilidade, Human Reproduction, Ribeirao Preto, Brazil
| | - W P Martins
- University of Sao Paulo, Department of Obstetrics and Gynecology, Ribeirao Preto Medical School (FMRP-USP), Ribeirao Preto, Brazil
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7
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Parker VL, Srinivas M. Non-tubal ectopic pregnancy. Arch Gynecol Obstet 2016; 294:19-27. [DOI: 10.1007/s00404-016-4069-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
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8
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Heterotopic Pregnancy After In Vitro Fertilization and Embryo Transfer After Bilateral Total Salpingectomy/Tubal Ligation: Case Report and Literature Review. J Minim Invasive Gynecol 2015; 23:338-45. [PMID: 26687016 DOI: 10.1016/j.jmig.2015.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/20/2022]
Abstract
Heterotopic pregnancy is defined as the simultaneous occurrence of intrauterine and ectopic pregnancy, either of which may be single or multiple. It occurs in up to 1% of pregnancies after in vitro fertilization and embryo transfer. This article reports 2 rare cases of heterotopic pregnancy after in vitro fertilization and presents a literature review. In the first case, a 28-year-old woman had previous laparoscopic bilateral total salpingectomy for a right tubal pregnancy and a left hydrosalpinx. However, she had ovarian heterotopic pregnancy after a third in vitro fertilization cycle. Emergency laparotomy was performed. The synchronous intrauterine pregnancy continued with no further complications and ended in the delivery of a singleton term pregnancy. The second case combined interstitial and intrauterine pregnancies after bilateral tubal ligation for hydrosalpinges followed by in vitro fertilization and frozen embryo transfer. The possibility of heterotopic pregnancy after bilateral total salpingectomy/tubal ligation, although extremely rare, should also be considered by gynecologists when they treat an in vitro fertilization patient even though an intrauterine pregnancy has been confirmed.
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Successful laparoscopic management of a rare complication after embryo transfer: ovarian pregnancy. A case report and up-to-date literature review. Wideochir Inne Tech Maloinwazyjne 2015; 10:574-9. [PMID: 26865895 PMCID: PMC4729730 DOI: 10.5114/wiitm.2015.55893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
Ovarian pregnancy (OP) after embryo transfer is very rare. Due to the rarity and the asymptomatic nature, there are still difficulties in diagnosis and treatment. The traditional operative treatment for OP has been oophorectomy. However, the desire to maintain reproductive capability and improvements in laparoscopy have more recently led to conservative laparoscopic techniques. This rare complication could be diagnosed early and managed by a conservative laparoscopic approach. Here we present a survey of the literature and a case of successful laparoscopic management of ovarian pregnancy after intracytoplasmic sperm injection and embryo transfer. The current case is the first case in the literature in which ovarian pregnancy occurred after a single embryo transfer. We also summarize the literature about management of ovarian pregnancy after embryo transfer.
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10
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Feit H, Leibovitz Z, Kerner R, Keidar R, Sagiv R. Ovarian Pregnancy Following in Vitro Fertilization in a Woman After Bilateral Salpingectomy: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2015; 22:675-7. [DOI: 10.1016/j.jmig.2015.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 02/08/2023]
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An ovarian pregnancy in a patient with a history of bilateral salpingectomies: a rare case. Case Rep Obstet Gynecol 2015; 2015:740376. [PMID: 25852956 PMCID: PMC4380089 DOI: 10.1155/2015/740376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 12/04/2022] Open
Abstract
Background. 1 in 200 ectopic pregnancies are true ovarian pregnancies that fulfill the Spiegelberg criteria. Despite being rare, multiple case reports and series have been reported. Few cases have been published in which the event was preceded by salpingectomy. Case. The patient is a 32-year-old female who presented to the emergency room with abdominal pain. She was found to be pregnant, despite a history of two previous ectopic pregnancies treated with salpingectomies. Sonography confirmed a left adnexal mass and free fluid. Surgery revealed a ruptured ovarian pregnancy which was also confirmed by pathology. Conclusion. This is a case of an ovarian pregnancy in a patient with two previous salpingectomies. It underscores the importance of searching for an ectopic pregnancy in patients with abdominal pain after fertility impairing surgery.
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Ko PC, Lo LM, Hsieh TT, Cheng PJ. Twenty-one years of experience with ovarian ectopic pregnancy at one institution in Taiwan. Int J Gynaecol Obstet 2012; 119:154-8. [PMID: 22921271 DOI: 10.1016/j.ijgo.2012.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/08/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review the experience with patients with ovarian ectopic pregnancy (OEP) at Chang Gung Memorial Hospital, Lin-Kou Medical Center, Tao-Yuan, Taiwan, between 1989 and 2009. METHODS A retrospective review of the presentation, prevalence, diagnosis, and trends in treatment of patients with OEP, and the use of assisted reproductive technology (ART) procedures and intrauterine devices (IUD). The incidence rate ratios (IRR) of ectopic pregnancies (EPs) per live births, OEPs per EPs, and OEPs per live births were analyzed. RESULTS The 110 OEPs diagnosed comprised 2.0% of all EPs (n=5408) and 1:1543 of all live births, leading to a mean OEP per year of 5.24. Seventy-eight patients were managed with laparoscopy and 32 underwent laparotomy. Twenty-six (23.6%) patients used an IUD and 12 (10.9%) had undergone ART. OEP associated with ART increased in the last 10 years of the study period. The IRR of EPs per live births, OEPs per EPs, and OEPs per live births all increased between 1989 and 2009. Management of OEP tended to favor laparoscopy in the later years. CONCLUSION There was a trend toward better management of OEP with laparoscopy. ART has become a risk factor for OEP. The IRR of EPs per live births, OEPs per EPs, and OEPs per live births all increased over the 21-year period.
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Affiliation(s)
- Po-Chun Ko
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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13
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Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases. Wien Klin Wochenschr 2012; 124:193-7. [PMID: 22210442 DOI: 10.1007/s00508-011-0115-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The increased use of assisted reproduction techniques has been accompanied by an increase in ectopic pregnancies with unusual location being associated with significant maternal morbidity and mortality. This article reports on seven cases of ectopic pregnancies with unusual location and an angular pregnancy. Diagnostic and therapeutic strategies are discussed and a brief review of literature is presented. STUDY DESIGN Case series of seven cases with ectopic pregnancy in unusual location, following assisted reproductive technique or conceived spontaneously (cesarean scar pregnancy and early abdominal pregnancy in mesoappendix) and an angular pregnancy, having presented at our hospital during the last eight years. Retrospective analyses. RESULTS Interstitial pregnancy, cornual pregnancy, cesarean scar pregnancy, early abdominal pregnancy in omentum majus, heterotopic (cervical) pregnancy, early abdominal pregnancy in mesoappendix, angular pregnancy. All patients were surgically treated. CONCLUSION Diagnosis of ectopic pregnancy with unusual location may be difficult, and differentiation of intact intrauterine or extrauterine pregnancy with adequate consideration of the area of uterine ostium of the fallopian tube may be delicate. Moreover, varying treatment strategies and high rates of complications aggravate the situation.
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Cruciani L, Gerli S, Baiocchi G, Clerici G, Antonelli C, Di Renzo GC. Ovarian pregnancy afterin vitrofertilisation in a woman with previous bilateral salpingectomy. J OBSTET GYNAECOL 2011; 31:270-1. [DOI: 10.3109/01443615.2011.554613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Seshadri S, Shirley P, Jaiganesh T, Uchil D, Jolaoso A. In vitro fertilisation and embryo transfer for bilateral salpingectomies results in a ruptured ovarian ectopic pregnancy due to a tubal stump fistula: a case report and review of the literature. BMJ Case Rep 2010; 2010:2010/apr27_1/bcr0920092291. [PMID: 22736389 DOI: 10.1136/bcr.09.2009.2291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Ectopic pregnancy is a leading cause of maternal mortality. A high index of suspicion of an ectopic pregnancy must be borne in mind, especially when a woman of reproductive age presents to the emergency department with abdominal pain and a positive pregnancy test. An ectopic pregnancy can occur in unusual sites, particularly when assisted reproductive techniques have been used. Most ectopic pregnancies occur in the fallopian tube (so-called tubal pregnancies), but implantation can also occur in the uterine cornua, cervix, ovaries, and abdomen, including the retroperitoneum. We present only the second reported case of ovarian ectopic pregnancy in a 37-year-old woman following an in vitro fertilisation and embryo transfer for bilateral salpingectomies.
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Affiliation(s)
- Srividya Seshadri
- Univesity Hospital Lewisham, Obstetrics and Gynaecology, London, UK.
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16
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Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BWJ. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2010; 2010:CD002125. [PMID: 20091531 PMCID: PMC7154223 DOI: 10.1002/14651858.cd002125.pub3] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in-vitro fertilisation (IVF). Performing a surgical intervention such as salpingectomy, tubal occlusion, aspiration of the hydrosalpinx fluid, or salpingostomy, prior to the IVF procedure in women with hydrosalpinges is thought improve the likelihood of successful outcome. OBJECTIVES To assess and compare the value of surgical treatments for tubal disease prior to IVF. SEARCH STRATEGY Trials were sought in the Cochrane Menstrual Disorders and Subfertility Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PSYCHMED and in Conference proceedings and reference lists up until Ocober 28 2009. Researchers in the field were contacted to reveal unpublished studies. SELECTION CRITERIA All trials comparing a surgical treatment for tubal disease with a control group generated by randomisation were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. The studied outcomes were live birth, ongoing pregnancy, viable-, clinical- and biochemical pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy, ovarian function and complications. MAIN RESULTS Five randomised controlled trials involving 646 women were included in this review. Four studies assessed salpingectomy versus no treatment, two of which also included a tubal occlusion arm, and one trial assessed aspiration versus no treatment. No trials reported on the primary outcome: live birth. The odds of ongoing pregnancy (Peto OR 2.14, 95%CI 1.23 to 3.73) and of clinical pregnancy (Peto OR 2.31, 95%CI 1.48 to 3.62) however were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. Laparoscopic occlusion of the fallopian tube versus no intervention did not increase the odds of ongoing pregnancy significantly (Peto OR 7.24, 95%CI 0.87 to 59.57) but the odds of clinical pregnancy (Peto OR 4.66, 95%CI 2.47 to 10.01) had sufficient power to show a significant increase. Comparison of tubal occlusion to salpingectomy did not show a significant advantage of either surgical procedure in terms of ongoing pregnancy (Peto OR: 1.65, 95%CI 0.74, 3.71) or clinical pregnancy (Peto OR 1.28, 95%CI 0,76 to 2.14). One RCT reported efficacy of ultrasound guided aspiration, however the odds of pregnancy did not show a significant increase in the odds of clinical pregnancy (Peto OR 1.97, 95%CI 0.62 to 6.29), and confidence intervals were wide. Throughout the different comparisons no significant differences were seen in adverse effects of surgical treatments. AUTHORS' CONCLUSIONS Surgical treatment should be considered for all women with hydrosalpinges prior to IVF treatment. Previous evidence supported only unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges). This review now provides evidence that laparoscopic tubal occlusion is an alternative to laparoscopic salpingectomy in improving IVF pregnancy rates in women with hydrosalpinges. Further research is required to assess the value of aspiration of hydrosalpinges prior to or during IVF procedures and also the value of tubal restorative surgery as an alternative (or as a preliminary) to IVF.
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Affiliation(s)
- Neil Johnson
- University of AucklandDepartment of Obstetrics & GynaecologyPO Box 92019AucklandNew Zealand1003
| | | | | | - Annika Strandell
- University of GothenburgObstetrics and GynecologyKungälv HospitalKungälvSweden
| | - Ben Willem J Mol
- Máxima Medical CenterObstetrics and GynaecologyPostbox 7777VeldhovenNetherlands5500 MB
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Hsu CC, Lee IW, Su MT, Lin YC, Hsieh C, Chen PY, Tsai HW, Kuo PL. Triple genetic identities for the complete hydatidiform mole, placenta and co-existing fetus after transfer of a single in vitro fertilized oocyte: Case report and possible mechanisms. Hum Reprod 2008; 23:2686-91. [DOI: 10.1093/humrep/den270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hsu CC, Hsu CT, Gu Q, Wang ST. Intermittent vaginal injections of gonadotrophins for ovarian stimulation in IVF treatment. Reprod Biomed Online 2008; 16:617-20. [PMID: 18492363 DOI: 10.1016/s1472-6483(10)60473-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intermittent vaginal administration of recombinant human FSH (rhFSH), for ovarian stimulation in IVF employing the concept of uterine first-pass effect and mesotherapy, was investigated. Injection of rhFSH (437 IU, counted as six ampoules) was carried out every 3 days into the vaginal mucosa of 66 participants receiving IVF treatment between November 2004 and August 2006. The primary outcomes were number of mature oocytes, number of good grade embryos, and term live birth rate (>/=37 weeks gestation). On average, 2.94 days of injection and 16.35 ampoules of rhFSH were required to achieve proper follicular growth. Although fewer mature oocytes (5.27 +/- 3.69) were retrieved, the number of good grade embryos (3.05 +/- 1.95), number of embryos transferred (2.66 +/- 1.70), pregnancy rate per cycle started [37.9%; 95% confidence interval (CI), 27.1-49.9], implantation rate (25.5%; 95% CI, 18.0-33.0), and term live birth rate (31.8 %; 95% CI, 21.8-43.8) were comparable with conventional IVF treatments in this clinic.
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Affiliation(s)
- Chao-Chin Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan 701, Taiwan
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Dursun P, Gultekin M, Zeyneloglu HB. Ovarian ectopic pregnancy after ICSI-ET: a case report and literature review. Arch Gynecol Obstet 2008; 278:191-3. [PMID: 18236060 DOI: 10.1007/s00404-008-0562-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 01/03/2008] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Primary ovarian ectopic pregnancy (OEP) is one of the the rarest form of extratubal pregnancies and its pathophysciological mechanism is not fully understood. On the other hand, OEP after intra-cytoplasmic sperm injection with embryo transfer (ICSI-ET) is even more rare and just a few cases have been reported in literature. MATERIALS AND METHODS A case with OEP after ICSI-ET presented and managed by conservative laparoscopic approach. Also, literature associated with OEP after ICSI-ET have been summarized. Pubmed search using "Ovarian ectopic pregnancy" and "ICSI-ET" keywords revealed four similar case in the literature. CONCLUSION Underlying pathophysiological mechanism of OEP after ICSI-ET is unclear. Indeed, gynecologists should be aware about the development of the OEP after ICSI-ET. Early diagnosis will give the opportunity to use conservative managements for these infertile patients.
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Affiliation(s)
- Polat Dursun
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Kubilay Sk. No:36 Maltepe, Ankara, Turkey.
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Abstract
A case report of ovarian pregnancy is presented. A 38 year old woman, gravida 3 para 2, was admitted to the hospital for suspected ectopic pregnancy, with vaginal bleeding at 12 weeks after her last menstrual period, associated with pelvic pain. An ultra-sonography led to the diagnosis of ovarian right ectopic pregnancy with dead fetus associated with a compartmentalized hemoperitoneum. Unilateral oophorectomy was carried out by laparotomy. Histological studies confirmed an ovarian pregnancy.
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Affiliation(s)
- F Naghshvar
- Department of Pathobiology, Mazandaran University of Medical Science, Iran
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Abstract
PURPOSE OF REVIEW Patients with hydrosalpinx are a recognized group with poor prognosis in in-vitro fertilization. This review presents evidence for the effectiveness of different treatment options. RECENT FINDINGS Theories explaining the mechanisms behind the impaired outcome of in-vitro fertilization still focus on the hydrosalpingeal fluid. Gamete and embryotoxic effects have been demonstrated, but it is not a consistent finding. Endometrial receptivity may be altered by the reduced expression of cytokines and integrins important to implantation, and reduced endometrial and subendometrial blood flows may play a role. The rationale for treatments to improve the results of in-vitro fertilization is based on interruption of the leakage of hydrosalpinx fluid into the uterine cavity. Laparoscopic salpingectomy has been evaluated in a large randomized trial and proved effective in restoring birth rates. Proximal tubal ligation may also be effective according to one smaller randomized trial. Other suggested methods such as transvaginal drainage have been poorly investigated. SUMMARY Pre-in-vitro fertilization salpingectomy is the only method that has proved effective in restoring birth rates in patients with hydrosalpinx. The underlying mechanism explaining reduced implantation and embryo development awaits further research.
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Affiliation(s)
- Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Goteborg, Sweden.
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Hsu CC, Hsu CT. Conception using vaginal administration of gonadotrophins in IVF: a case report. Reprod Biomed Online 2006; 12:170-3. [PMID: 16478580 DOI: 10.1016/s1472-6483(10)60857-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A method has been developed of injecting gonadotrophins vaginally every 3-4 days, to reduce both the dose and frequency of injections. A couple with primary infertility for 5 years with a previous failed IVF cycle was recruited. A total dose of 1200 IU gonadotrophins was administered in three injections. Ten mature oocytes were recovered and six fertilized two-pronuclear stage zygotes resulted. The patient conceived after replacement of three good quality embryos.
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Affiliation(s)
- Chao-Chin Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University, Tainan, and Department of Obstetrics and Gynecology, China Medical University and Hospital, 91 Shueh-Shih Road Tai-Chung, 404 Taiwan.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000194327.87451.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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