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Aref Hamam Y, Zimmo M, Alqeeq BF, Hijazi YM, Hamam M, Al-Hajjar M. Advanced secondary abdominal ectopic pregnancy with live fetus at 26-weeks' gestation following in vitro fertilization: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241226776. [PMID: 38292876 PMCID: PMC10826391 DOI: 10.1177/2050313x241226776] [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] [Received: 10/12/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Abdominal ectopic pregnancy is a rare type of ectopic pregnancy that is associated with high morbidity and mortality. This study reports a case of advanced abdominal ectopic pregnancy at 26-weeks' gestation in a 31-year-old primigravida whose conception was a result of in vitro fertilization because of infertility due to male factors. Her past history is significant for a congenital Horseshoe kidney. Initially, she presented at the 8th week of gestation with a clinical picture that is consistent with ectopic abdominal pregnancy; however, she refused to terminate her pregnancy despite medical advice. At 26 weeks gestation, she presented to the emergency department again complaining of lower abdominal pain and vaginal spotting, and underwent an abdominal laparotomy without any complications. The postoperative period was unremarkable, and she was discharged after 7 days. In conclusion, early diagnosis and management of such cases are of paramount importance and lead to favorable outcomes. Nevertheless, we stress the importance of providing effective counseling to patients presenting with serious conditions through clear information along with proper psychological support for couples.
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Affiliation(s)
| | - Mohammad Zimmo
- Obstetrics and Gynecology Department, Al-Shifa Medical Complex, Gaza, Palestine
| | - Basel F Alqeeq
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Yara M Hijazi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mohammed Hamam
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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Li Q, Deng X, Liu A, Shen H, Zhang X. Establishment of a prediction model for the impact of endometrial thickness on the day of embryo transfer on ectopic pregnancy in frozen-thawed embryo transfer cycle. Front Endocrinol (Lausanne) 2023; 14:1259608. [PMID: 38027161 PMCID: PMC10666774 DOI: 10.3389/fendo.2023.1259608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to investigate the factors affecting the ectopic pregnancy (EP) rate in the frozen-thawed embryo transfer (FET) cycle. Methods This study retrospectively analyzed 5606 FET cycles, including 5496 cycles resulting in intrauterine pregnancy and 110 cycles resulting in EP. Smooth curve fitting and piece-wise linear regression were utilized to evaluate a non-linear association between endometrial thickness (EMT) and EP. Multiple logistic regression analysis was used to study the effect of EMT on the embryo transfer (ET) day and other indexes on EP rate after adjusting for confounding factors. A nomographic prediction model was employed to predict EP occurrence. The predictive efficacy of the model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), utilizing the bootstrap sampling method for internal validation. Results After accounting for the confounding factors, the segmented linear regression analysis indicated that the EMT inflection point was 9 mm; the EP rate significantly decreased by 28% with each additional millimeter of EMT up to 9 mm (odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.53-0.99; P = 0.0412) while insignificantly decreased when the EMT was greater than 9 mm (OR = 0.91; 95% CI, 0.76-1.08; P = 0.2487). Multivariate logistic regression analysis revealed that after adjusting for confounders, EP risk significantly increased in the number of previous EPs ≥ 1 (OR = 2.29; 95% CI, 1.26-4.16; P = 0.0064) and tubal factor infertility (OR = 3.86; 95% CI, 2.06-7.24; P < 0.0001). Conversely, EP risk was significantly reduced by the increased EMT (OR = 0.84; 95% CI, 0.74-0.96; P = 0.0078) and the blastocyst transfer (OR = 0.45; 95% CI, 0.27-0.76; P = 0.0027). These variables were used as independent variables in a nomogram prediction model, resulting in an AUC of 0.685. The nomination models were internally verified using self-sampling (bootstrap sampling resampling times = 500). This validation yielded an AUC of 0.689, with a sensitivity of 0.6915 and a specificity of 0.5790. The internal validation indicated minimal fluctuations in the AUC, signifying a relatively stable model. Conclusion Undergoing EMT on the day of ET poses a separate EP risk in the FET cycle; to mitigate the EP incidence, the EMT should exceed 9 mm before ET. Furthermore, previous EPs and tubal factor infertility were additional factors independently increasing EP risk. Furthermore, implementing blastocyst transfer demonstrated that EP incidence was significantly reduced. Utilizing a nomogram predicting system enables EP risk evaluation before ET for individual patients, establishing a basis for devising clinical strategies for ET.
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Affiliation(s)
- Qiuyuan Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiyuan Deng
- Gansu Province Prenatal Diagnosis Center, Key Laboratory of Prevention and Control of Birth Defects of Gansu Province, Gansu Provincial Maternity and Child-Care Hospital/Central Hospital of Gansu Province, Lanzhou, China
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology of Gansu Province, Lanzhou, China
| | - Ahui Liu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haofei Shen
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xuehong Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, China
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Smith KA, Parvinian A, Ainsworth AJ, Shenoy CC, Packard AT. Normal and Abnormal Appearances of the Ovaries during Assisted Reproduction: Multimodality Imaging Review. Radiographics 2023; 43:e230089. [PMID: 37883303 DOI: 10.1148/rg.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Infertility is a common diagnosis that prompts many couples and individuals to seek assisted reproductive technology (ART) for assistance with conception. These technologies have become increasingly used in the United States in the past several decades, with 326 468 ART cycles performed in 2020, resulting in 75 023 live births. This ubiquity of ART also increases the likelihood that radiologists will encounter both normal and abnormal imaging findings associated with these treatments. Thus, radiologists of all subspecialties should be familiar with the multimodality appearance of the ovaries and pelvis in patients undergoing ART treatments. Furthermore, it is imperative that radiologists understand the appearance expected during different stages of the ART process. During stimulated ovulatory cycles, it is normal and expected for the ovaries to appear enlarged and to contain numerous cystic follicles, often with a small to moderate volume of pelvic free fluid. After oocyte retrieval, hemorrhagic ovarian follicles and a small to moderate volume of blood products in the cul-de-sac can be expected to be seen. Multiple nonemergency and emergency complications are related to ART, many of which can be seen at imaging. The most encountered emergency complications of ART include ovarian hyperstimulation syndrome, ectopic pregnancy, heterotopic pregnancy, multiple gestations, ovarian torsion, and procedural complications related to oocyte retrieval. These complications have important clinical implications, thus necessitating accurate and timely detection by the radiologist and the clinical team. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Katherine A Smith
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ahmad Parvinian
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Alessandra J Ainsworth
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Chandra C Shenoy
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ann T Packard
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Zhao Y, Xu A, Liu D, Liu N, Li Y, Yao Z, Tian F, Tang H, Li Y. An endometrium of type C along with an endometrial thickness of < 8 mm are risk factors for ectopic pregnancy after stimulated cycles with fresh embryo transfer. BMC Pregnancy Childbirth 2023; 23:713. [PMID: 37803277 PMCID: PMC10557322 DOI: 10.1186/s12884-023-05920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/14/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The study investigated whether specific ultrasonographically observed endometrial features (including endometrium type and thickness) were linked to ectopic pregnancy after stimulated cycles with fresh embryo transfer. METHOD Of 6246 pregnancy cycles after fresh embryo transfer, 6076 resulted in intrauterine pregnancy and 170 in ectopic pregnancy. The primary outcome of the study was ectopic pregnancy, with the main variables being endometrium type and endometrial thickness. Univariate and subsequent multiple-stepwise logistic regression analyses were used to identify the risk factors of ectopic pregnancy. RESULTS 1. Compared with patients with an endometrial thickness ≥ 8 mm, the adjusted odds ratio for those with an endometrial thickness < 8 mm was 3.368 (P < 0.001). The adjusted odds ratio for women with a type-C endometrium was 1.897 (P = 0.019) compared with non-type C. 2. A larger dose of gonadotropin used during controlled ovarian hyperstimulation was a protective factor against ectopic pregnancy (P = 0.008). 3. The GnRH antagonist protocol (P = 0.007) was a risk factor for ectopic pregnancy, compared with the use of GnRH agonists. CONCLUSION (1) An endometrial thickness < 8 mm coupled with a type C endometrium significantly increased the risk of ectopic pregnancy after fresh embryo transfer. (2) A thin endometrial thickness and a type C endometrium could be further related to an abnormal endometrial receptivity/peristaltic wave. (3) Patients at a high risk of ectopic pregnancy should therefore be given special attention, with early diagnosis during the peri-transplantation period may assist in the prevention of ectopic pregnancy.
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Affiliation(s)
- Ying Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Aizhuang Xu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Dong'e Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Nenghui Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Yumei Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Zhongyuan Yao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Fen Tian
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China
| | - Hongying Tang
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China.
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China.
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410000, People's Republic of China.
- Clinical Research Center for Women' s Reproductive Health in Hunan Province, Changsha, Hunan, 410000, China.
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Ke X, He L, Zheng JF, Lin YH, Wang F. Rare Occurrence of Left Ampullary Ectopic Pregnancy After Ligation of the Left Fallopian Tube: A Case Report. Int J Womens Health 2023; 15:965-970. [PMID: 37424698 PMCID: PMC10329432 DOI: 10.2147/ijwh.s417186] [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] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Ectopic pregnancy (EP) is rare among patients having received tubal ligation; in these cases, a fertilized ovum is implanted in the proximal tube stump. Distal tubal EP cases in patients having undergone ipsilateral tubal ligation and who have relatively intact contralateral adnexa are extremely rare. Here, we report a case of pregnancy in the distal stump of the ipsilateral fallopian tube following fallopian tubal isthmus ligation. Case Presentation A 28-year-old woman was admitted after having experienced lower abdominal pain for 10 days and amenorrhea for 1 week and receiving a transvaginal color ultrasonography finding of a heterogeneous echo (2.1 × 1.2 × 1.4 cm) near the left ovary. The patient had a medical history of transvaginal left tubal ligation under single-port laparoscopy for a left hydrosalpinx. Postoperatively, the patient had undergone in vitro fertilization for assisted reproduction. After ovum retrieval, whole-embryo cryopreservation had been performed due to the ovarian hyperstimulation syndrome trend. This pregnancy was natural after embryo cryopreservation. After the patient was admitted, laparoscopic exploration revealed an elevated ampulla in the distal stump of the left fallopian tube. Left salpingectomy with removal of the ectopic pregnancy in the distal remnant tube was performed under the guidance of transvaginal single-port laparoscopy. Serum β-human chorionic gonadotropin levels gradually decreased. Thereafter, the patient underwent two cycles of frozen embryo transfer, both of which resulted in chemical pregnancies. Conclusion This case suggests that gynecologists should pay attention to the possibility of fallopian tube ectopic pregnancy in the distal tubal segment post-tubal ligation.
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Affiliation(s)
- Xue Ke
- Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Li He
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Jia-Feng Zheng
- Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Yong-Hong Lin
- Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Fang Wang
- Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
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Huang C, Shen X, Yan Y, Shan H, Shi Q, Mei J, Xing J. The relationship between dominant follicle development and clinical outcomes of hormone replacement therapy-frozen embryo transfer: a retrospective clinical study. Front Endocrinol (Lausanne) 2023; 14:1192696. [PMID: 37388209 PMCID: PMC10306306 DOI: 10.3389/fendo.2023.1192696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023] Open
Abstract
Research question Hormone replacement therapy (HRT) is one of the most used endometrial preparation protocols for frozen embryo transfer (FET) due to the convenience of its administration and stability of pregnancy outcomes. There are several HRT cycles accompanied by the development of dominant follicles. However, the relationship between dominant follicle development and clinical outcomes in HRT-FET cycles remains unclear. Design We carried out a retrospective cohort study of 13251 cycles at our reproductive medicine center from 2012 to 2019. Total cycles were divided into two groups according to whether there was dominant follicular development. In addition, we conducted a secondary analysis that used propensity-score matching to reduce confounding variables. A univariate and multivariable logistic regression model was further employed to analyze the effect of dominant follicle development in HRT cycles on clinical pregnancy outcomes. Results There was no significant correlation between dominant follicle development in HRT-FET cycles and the clinical pregnancy rate (adjusted OR = 1.162, 95% CI: 0.737-1.832, P = 0.52). In addition, there was a positive correlation between the basic follicle-stimulating hormone (FSH) level and the development of dominant follicles, while there was a negative correlation between antral follicle count (AFC), menstrual cycle length and the development of dominant follicles in HRT cycles. Conclusions The development of dominant follicles in HRT-FET cycles does not affect the clinical pregnancy rate, early miscarriage rate and live birth rate. Therefore, it is not necessary to immediately cancel the FET cycle immediately when dominant follicle development is monitored in the HRT-FET cycle.
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Affiliation(s)
- Chenyang Huang
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaoyue Shen
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Yuan Yan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Huizhi Shan
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Qingqing Shi
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Jie Mei
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
| | - Jun Xing
- Center for Reproductive Medicine and Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, China
- Center for Reproductive Medicine and Obstetrics and Gynecology, Drum Tower Clinic Medical College of Nanjing Medical University, Nanjing, China
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Elsayed S, Farah N, Anglim M. Heterotopic Pregnancy: Case Series and Review of Diagnosis and Management. Case Rep Obstet Gynecol 2023; 2023:2124191. [PMID: 37187915 PMCID: PMC10181901 DOI: 10.1155/2023/2124191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy, which is very rare but potentially life-threatening. The spontaneous incidence of HP in the general population is 1/30,000. With the widespread use of assisted reproductive technology (ART), the incidence rises to 1/1,000. Aims and Methods. This is a prospective case series looking at the cases of heterotopic pregnancies presenting to the early pregnancy unit (EPU) in a tertiary maternity hospital, from November 2015 to November 2016. The clinical presentation, ultrasound findings, and laparoscopy findings were all documented. The incidence of HP was calculated and compared with the quoted incidence in the literature. Outcomes. Five women with HP presented to the EPU over the course of a year. The first case describes a spontaneous HP with a previous salpingostomy. The second case describes an HP following ovulation induction. The third case describes a spontaneous HP with no known risk factors. The fourth and fifth cases describe heterotopic pregnancies following in vitro fertilisation with more than one embryo. All five cases of HP underwent laparoscopy and salpingectomy with uneventful recovery. The three women who had a viable IUP had no further complications in their pregnancies. Conclusion Early and accurate diagnosis of HP can be challenging. An early transvaginal ultrasound plays an important role in making the diagnosis in women with risk factors and following ART. A high index of suspicion is required for timely diagnosis and appropriate intervention, especially in spontaneous HP.
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Affiliation(s)
- Somaia Elsayed
- The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Nadine Farah
- The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Mary Anglim
- The Coombe Women and Infants University Hospital, Dublin, Ireland
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Kakinuma T, Kakinuma K, Matsuda Y, Yanagida K, Ohwada M, Kaijima H. Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites. World J Clin Cases 2023; 11:788-796. [PMID: 36818618 PMCID: PMC9928688 DOI: 10.12998/wjcc.v11.i4.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/27/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported.
AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.
METHODS In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.
RESULTS There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026).
CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
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Hu KL, Li S, Hunt S, Yang R, Xu H, Li R. High anti-Müllerian hormone (AMH) is associated with increased risks of ectopic pregnancy in women undergoing fresh embryo transfer cycle, a cohort study. Reprod Biol Endocrinol 2023; 21:18. [PMID: 36737777 PMCID: PMC9896741 DOI: 10.1186/s12958-022-01038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ectopic pregnancy is more common amongst assisted reproduction cycles and is a cause of significant maternal morbidity. Few predictive markers exist to help identify and modify risk of ectopic pregnancy in preparing for embryo transfer. The relationship between serum and AMH and ectopic pregnancy rate is unknown. METHODS This was a retrospective cohort study investigating women who underwent fresh embryo transfer cycles from January 2017 to December 2019 in Peking University Third Hospital. The primary outcome was ectopic pregnancy. Restricted cubic splines with four knots for AMH concentration (0-3, 3-6, 6-12, 12-max) were used to map out the non-linear relationship between the predicted ectopic pregnancy rate and the serum AMH concentration. Log binomial regression was used to test the crude risk ratio (cRR) and the adjusted risk ratio (aRR) after adjustment for confounders with 95% confidence intervals (CI) to determine the difference across various groups. RESULTS A total of 13,718 cycles in women undergoing fresh embryo transfer were eligible for analysis. The ectopic pregnancy rate was 1.3% per embryo transfer cycle initiated and 3.3% per pregnancy. Serum AMH concentrations were higher amongst women with ectopic pregnancy than in women with a confirmed intrauterine pregnancy or heterotopic pregnancy or who did not become pregnant (Mean levels: 4.0 ng/ml vs 3.2 ng/ml, 1.7 ng/ml, and 2.8 ng/ml). An AMH concentration of 7 ng/ml represented the best cut-off value to predict ectopic pregnancy. The ectopic pregnancy rate was 3.4% per cycle and 7.5% per pregnancy in women with AMH levels ≥ 7 ng/ml; and 1.2% per cycle and 2.9% per pregnancy in women with AMH levels < 7 ng/ml. Serum AMH concentration ≥ 7 ng/ml was associated with an increased risk of ectopic pregnancy in all fresh embryo transfer cycles started (aRR = 2.35 (1.45, 3.58)) as well in women who became pregnant (aRR = 2.23 (1.49, 3.33). CONCLUSIONS Baseline AMH concentration ≥ 7 ng/ml is associated with an increased risk of ectopic pregnancy in fresh embryo transfer cycles.
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Affiliation(s)
- Kai-Lun Hu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Shan Li
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Rui Yang
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Huiyu Xu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
| | - Rong Li
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 HuaYuan North Road, HaiDian District, Beijing, 100191, People's Republic of China.
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Cirillo F, Paladino I, Ronchetti C, Busnelli A, Morenghi E, Grilli L, Patrizio P, Zannoni E, Levi-Setti PE. Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience. Sci Rep 2022; 12:20473. [PMID: 36443354 PMCID: PMC9705323 DOI: 10.1038/s41598-022-24649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
The present retrospective study included both intrauterine insemination and in vitro assisted reproductive technologies (ART) procedures performed from January 2009 to December 2018 at a tertiary-care Fertility Centre. The purpose was to assess the incidence of ectopic pregnancy (EP) in infertile population who undergoes ART and to identify any risk factor impacting the occurrence of EP after ART. Among 27,376 cycles, 7352 pregnancies were achieved, of which 132 were EPs, the 1.80% (95% CI 1.5-2.1) of all pregnancies. In fresh embryo transfer cycles, a history of prior pelvic adhesions showed the greatest impact on the incidence of EP (aOR 2.49 95% CI 1.53-4.07 p < 0.001). Other factors associated with EP incidence were also identified, such as female age, basal FSH, the transfer of blastocyst embryos and difficulties during the embryo transfer procedure. In frozen embryo transfer cycles, the only factor influencing the incidence of EP was anti Müllerian hormone (AMH) serum concentration (aOR 0.81 95% CI 0.65-1.00, p = 0.048). To conclude, the incidence of EP observed was comparable to that reported after natural conception. On the other hand, pre-existing risk factors, traditionally more common in infertile population, appeared to influence the incidence of EP and should thus be modified if possible.
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Affiliation(s)
- Federico Cirillo
- grid.417728.f0000 0004 1756 8807Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ilaria Paladino
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Camilla Ronchetti
- grid.417728.f0000 0004 1756 8807Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Busnelli
- grid.417728.f0000 0004 1756 8807Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Emanuela Morenghi
- grid.417728.f0000 0004 1756 8807Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Leonora Grilli
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pasquale Patrizio
- grid.26790.3a0000 0004 1936 8606Division Reproductive Endocrinology and Infertility, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Elena Zannoni
- grid.417728.f0000 0004 1756 8807Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- grid.417728.f0000 0004 1756 8807Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Alhajjeh M, Jomaa S, Kanj R, Al Halabi N, Adwan D. An abdominal ectopic pregnancy following in vitro fertilization: a rare case report. J Surg Case Rep 2022; 2022:rjac437. [PMID: 36196131 PMCID: PMC9522410 DOI: 10.1093/jscr/rjac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/04/2022] [Indexed: 12/02/2022] Open
Abstract
A significant rise in the incidence of abdominal pregnancy has been reported following in vitro fertilization techniques. Herein, we present a healthy 30-year-old woman, primigravida, conceived through in vitro fertilization–embryo transfer for male factor infertility. Six weeks later, she reported abdominal pain and discomfort. Ultrasonography revealed an empty uterus and a heterogenic abdominal mass in the anterior aspect of the uterus with normal adnexa. Computed tomography scan revealed a mass outside the uterus measuring 11 × 8 cm. Under general anesthesia, laparotomy exposed a gestational sac implanted outside the uterus on the anterior abdominal wall and contained an unviable fetus. Blood clots and pieces of placental tissue were also noticed. The patient had an uneventful course of recovery and was discharged after six days. Therefore, abdominal ectopic pregnancy must be considered in all patients with vaginal bleeding and/or abdominal pain who have undergone assisted reproductive technology.
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Affiliation(s)
- Martha Alhajjeh
- University Hospital of Obstetrics and Gynecology, Damascus University , Damascus , Syria
| | - Sami Jomaa
- Faculty of Medicine, Damascus University , Damascus , Syria
| | - Razan Kanj
- University Hospital of Obstetrics and Gynecology, Damascus University , Damascus , Syria
| | - Nahed Al Halabi
- University Hospital of Obstetrics and Gynecology, Damascus University , Damascus , Syria
| | - Dema Adwan
- Emergency Department , University Hospital of Obstetrics and Gynecology, , Damascus , Syria
- Damascus University , University Hospital of Obstetrics and Gynecology, , Damascus , Syria
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12
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Pregnancy outcomes following in vitro fertilization treatment in women with previous recurrent ectopic pregnancy. PLoS One 2022; 17:e0272949. [PMID: 35969533 PMCID: PMC9377625 DOI: 10.1371/journal.pone.0272949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study was to investigate the impact of a history of recurrent ectopic pregnancy (EP) on pregnancy outcomes of subsequent in vitro fertilization (IVF) treatment. Methods A retrospective cohort study involving 457 women with a history of recurrent EP (REP group), 912 women with a history of single EP (SEP group), and 1169 women with a history of intrauterine pregnancy (IUP group) as the control group, was conducted. IVF outcomes were compared for each cohort. Results The incidence of EP in the REP group after IVF treatment was significantly lower than those in the SEP group (2.4% vs. 6.8%, P = 0.011), and similar to those in the IUP group (2.4% vs. 2.1%, P = 0.830). No significant differences were observed in the clinical pregnancy rate, miscarriage rate, and live birth rate among the three groups. There was no statistically significant difference in the recurrent EP rate between the salpingectomy and salpingostomy treatments. Adjusting for maternal and treatment factors did not influence live birth rates for women with previous REP compared with women with previous SEP and those with IUP. The odds of EP were 82.2% lower (OR 0.178, 95% CI 0.042–0.762; P = 0.020) in women who had blastocyst transfer compared with cleavage embryo transfer in the SEP group. The odds of EP were over six times (OR 6.260, 95% CI 1.255–31.220; P = 0.025) in women who underwent double embryo transfer as opposed to single embryo transfer in the IUP group. Conclusion Our results indicate that women with previous recurrent EP have a lower risk of EP after IVF in comparison with women with previous single EP. Previous EP has no significant adverse effect on the main IVF outcomes. The salpingostomy and salpingectomy treatments of EP do not significantly affect the incidence of recurrent EP after IVF.
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The impact of a previous tubal ectopic pregnancy on subsequent live birth and perinatal outcomes mostly resulting from cleavage-stage embryo transfers in frozen-thawed cycles: a retrospective cohort study using propensity score analysis. Reprod Biomed Online 2022; 45:1266-1273. [DOI: 10.1016/j.rbmo.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
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Hu Z, Li D, Chen Q, Chai W, Lyu Q, Cai R, Kuang Y, Lu X. Differences in Ectopic Pregnancy Rates between Fresh and Frozen Embryo Transfer after In Vitro Fertilization: A Large Retrospective Study. J Clin Med 2022; 11:jcm11123386. [PMID: 35743455 PMCID: PMC9225258 DOI: 10.3390/jcm11123386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Ectopic pregnancy (EP) is increasingly found in women treated with in vitro fertilization and embryo transfer (IVF−ET). With the development of the freeze-all policy in reproductive medicine, it is controversial whether frozen embryo transfer (FET) could reduce the rate of EP. In this single-center, large-sample retrospective study, we analyzed 16,048 human chorionic gonadotrophin (hCG)-positive patients who underwent fresh embryo transfer (ET) or FET cycles between January 2013 and March 2022. Throughout the study, the total EP rate was 2.09% (336/16,048), 2.16% (82/3803) in the ET group, and 2.07% (254/12,245) in the FET group. After adjustment for age, infertility causes, and other confounding factors, logistic regression results showed no statistical difference in EP rates between FET and ET groups (odds ratio (OR) 0.93 (0.71−1.22), p > 0.05). However, among the 3808 patients who underwent fresh ET cycles, the OR for EP was significantly lower in the long agonist protocol group than in the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol group (OR 0.45 (0.22−0.93), p < 0.05). Through a large retrospective study, we demonstrated a slightly lower EP rate in FET cycles than in fresh ET cycles, but there was no significant difference. The long agonist protocol in ET cycles had a significantly lower risk of EP than the GnRH-ant protocol.
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Affiliation(s)
| | | | | | | | | | | | - Yanping Kuang
- Correspondence: (Y.K.); (X.L.); Tel.: +86-21-23271699 (ext. 5539) (Y.K.); Fax: +86-21-53078108 (Y.K.)
| | - Xuefeng Lu
- Correspondence: (Y.K.); (X.L.); Tel.: +86-21-23271699 (ext. 5539) (Y.K.); Fax: +86-21-53078108 (Y.K.)
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15
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Huang Y, Huang Q, Liu J, Guo M, Liu Y, Lai D. Concurrent Ovarian and Tubal Ectopic Pregnancy After IVF-ET: Case Report and Literature Review. Front Physiol 2022; 13:850180. [PMID: 35444560 PMCID: PMC9013932 DOI: 10.3389/fphys.2022.850180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Ovarian pregnancy (OP) coupled with tubal ectopic pregnancy is rare. We present a case of coexistent ovarian and tubal ectopic pregnancies in the same adnexa resulting from in vitro fertilization and embryo transfer (IVF-ET) for tubal occlusion. The patient presented with mild vaginal bleeding without abdominal pain. OP was diagnosed via sonographic findings of an ectopic gestational sac (GS) and yolk sac that seemed to be inside her left ovary. Laparoscopic exploration confirmed this diagnosis, and ipsilateral tubal ectopic pregnancy was suspected during surgery. The patient underwent left salpingectomy and resection of the ovarian lesion. A subsequent histopathological examination verified the diagnosis of coexistent ovarian and tubal ectopic pregnancy. Though the mechanism underlying concurrent OP and tubal ectopic pregnancy is still unclear, clinicians should be cautious of potential combined ectopic pregnancy when dealing with patients who have received more than one embryo transfer.
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Affiliation(s)
- Yating Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jinglan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mengxi Guo
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yuan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dongmei Lai
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Dongmei Lai,
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Ku CW, Ong I, Chan JKY, Ee TX. Abdominal heterotopic pregnancy post-IVF double embryo transfer. BMJ Case Rep 2022; 15:15/2/e246649. [PMID: 35131787 PMCID: PMC8823037 DOI: 10.1136/bcr-2021-246649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Uterosacral ligament (USL) is an uncommon site of implantation for abdominal ectopic pregnancies. This is the first case of USL heterotopic pregnancy post invitro fertilisation (IVF). The patient presented 6 weeks after a double embryo transfer with acute onset abdominal pain and was diagnosed with a suspected live tubal ectopic pregnancy with a viable intrauterine pregnancy on ultrasound. A diagnostic laparoscopy revealed an ectopic pregnancy implanted on the left USL which was resected and confirmed on histology. The patient was discharged well on postoperative day 2 with a viable intrauterine pregnancy. This case highlights the importance of considering non-tubal heterotopic pregnancies in the context of risk factors including IVF with double embryo transfer presenting with abdominal pain.
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Affiliation(s)
- Chee Wai Ku
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Isabella Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tat Xin Ee
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
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17
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Tang S, Du T, Huang J, Ye H, Zhao M, Lin J, Kuang Y. Effect of previous wedge resection for interstitial pregnancy on pregnancy and neonatal outcomes following frozen-thawed embryo transfer (FET) cycles of IVF/ICSI: a retrospective study. Reprod Biol Endocrinol 2022; 20:23. [PMID: 35105356 PMCID: PMC8805226 DOI: 10.1186/s12958-022-00896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate pregnancy and neonatal outcomes in women, with a previous history of wedge resection for interstitial pregnancy, in frozen-thawed embryo transfer (FET) cycles of IVF/ICSI. METHODS The present study involved a retrospective case-control assessment of 75 cases and 375 control subjects over 6 years in a single center. To compare pregnancy and neonatal outcomes between cases, treated using wedge resection, and controls without any previous history of ectopic pregnancy, propensity score matching (1:5) was utilized. The study also compared subgroups in the case group. RESULTS Women with previous wedge resection exhibited higher rates of ectopic pregnancy and uterine rupture rate as compared to control subjects (9.1% vs 1.3%, P = 0.025 and 4.5% vs 0%, P = 0.035, respectively). No statistically significant differences were recorded between the two cohorts with regard to clinical pregnancy rate, live birth rate, and neonatal outcomes. For pregnancy type subgroup analysis, Z-score and rates of large for gestational age were recorded to be significantly lower in twin pregnancy subgroup when compared with singleton pregnancy subgroup (0.10 (- 0.59, 0.25) vs 0.50 (- 0.97, 1.39), P = 0.005; 4.5% vs 26.1%, P = 0.047, respectively). CONCLUSION The results of the present study indicated that previous wedge resection correlated to a higher risk of ectopic pregnancy and uterine rupture. However, it might not be related to an increased risk of adverse neonatal outcomes. The study recommended cesarean section in these patients. Further studies are required to verify the validity of current recommendations.
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Affiliation(s)
- Shengluan Tang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongjuan Ye
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Zhao
- Shanghai Towako Hospital, No. 477, Fute West 1st Road, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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18
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Zhao Y, Liu D, Liu N, Li Y, Yao Z, Tian F, Xu A, Li Y. An Endometrial Thickness < 8 mm Was Associated With a Significantly Increased Risk of EP After Freeze-Thaw Transfer: An Analysis of 5,960 Pregnancy Cycles. Front Endocrinol (Lausanne) 2022; 13:884553. [PMID: 35813636 PMCID: PMC9261458 DOI: 10.3389/fendo.2022.884553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endometrium characteristics that are most likely to induce ectopic pregnancy were investigated on the basis of the data of 5,960 pregnant freeze-thaw cycles. METHODS A total of 5,960 pregnancy cycles after freeze-thaw embryos transfer were included, with the number of intrauterine and ectopic pregnancies being 5,777 and 183, respectively. Ectopic pregnancy was the primary outcome. Endometrial thickness was the main measured variable. The risk factors of ectopic pregnancy were eventually determined based on univariate analysis and subsequent multiple-stepwise logistic regression analysis. RESULTS 1. After adjusting for confounders, endometrial thickness could independently predict ectopic pregnancy. The adjusted odd ratios for women with endometrial thickness in the ranges of < 8 mm, 8-9.9 mm, and 10-11.9 mm were 3.270 [95% confidence interval (CI), 1.113-9.605, P = 0.031], 2.758 (95% CI, 0.987-7.707, P = 0.053), and 1.456 (95% CI, 0.502-4.225, P = 0.489), respectively, when compared with those having an endometrial thickness of 12-13.9 mm. 2. Endometrial type and preparation protocol were however not identified as risk factors for ectopic pregnancy. DISCUSSION 1. After freeze-thaw embryo transfer, risks of ectopic pregnancy were significantly higher when the endometrial thickness was < 8 mm. 2. A thin endometrial thickness could be linked with abnormal endometrial peristaltic waves or abnormal endometrial receptivity. 3. Adequate attention should therefore be paid to patients with a thin endometrial thickness to prevent EP or to achieve early diagnosis during the peri-transplantation period.
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Affiliation(s)
- Ying Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Dong’e Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Nenghui Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Yumei Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Zhongyuan Yao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Fen Tian
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Aizhuang Xu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
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OUP accepted manuscript. Hum Reprod 2022; 37:1388-1393. [DOI: 10.1093/humrep/deac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Indexed: 11/14/2022] Open
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20
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Krishnamoorthy K, Greenberg P, Perlman BE, Morelli SS, Jindal SK, McGovern PG. The incidence of ectopic/heterotopic pregnancies after blastocyst-stage frozen-thawed embryo transfers compared with that after cleavage-stage: a Society for Assisted Reproductive Technologies Clinical Outcomes Reporting System study. F S Rep 2021; 2:421-427. [PMID: 34934982 PMCID: PMC8655396 DOI: 10.1016/j.xfre.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/05/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate whether there is a difference in the ectopic/heterotopic pregnancy rate of blastocyst-stage frozen-thawed embryo transfers (FETs) compared with that of cleavage-stage FETs. Design A retrospective cohort study. Setting Not applicable. Patient(s) Women undergoing autologous FETs at either the blastocyst stage (n = 118,572) or the cleavage stage (n = 117,619), as reported to the Society for Assisted Reproductive Technology from 2004 to 2013. Intervention(s) None. Main Outcome Measure(s) Pregnancy outcomes, specifically ectopic pregnancy rates and heterotopic pregnancy rates. Result(s) Among those who became pregnant, there was a significantly lower incidence of ectopic/heterotopic pregnancies in blastocyst-stage FETs versus that in cleavage-stage FETs (0.8% vs. 1.1%). The differences in ectopic/heterotopic pregnancy rates remained statistically significant after controlling for confounders such as tubal factor infertility and number of embryos transferred. Conclusion(s) Blastocyst-stage FET was associated with a lower ectopic/heterotopic pregnancy rate compared with cleavage-stage FET.
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Affiliation(s)
- Kavitha Krishnamoorthy
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Patricia Greenberg
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Barry E Perlman
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sara S Morelli
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sangita K Jindal
- Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| | - Peter G McGovern
- University Reproductive Associates, Hasbrouck Heights, New Jersey
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21
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Naredi N, Singh S, Gurmeet P, Kumar P, Sharma R. Fresh versus frozen embryo transfer after an in vitro fertilization cycle: Is there a difference in the ectopic pregnancy rate? Med J Armed Forces India 2021; 77:175-180. [PMID: 33867634 DOI: 10.1016/j.mjafi.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 03/24/2020] [Indexed: 10/23/2022] Open
Abstract
Background Ectopic pregnancy (EP) occurring because of an abnormal site of embryo implantation is a major cause of maternal morbidity and mortality if not timely diagnosed and intervened. To avert the increase in the rates of EP through in vitro fertilization cycles as compared to spontaneous conception, fertility experts have resorted to multiple measures, of which the most studied is shifting to frozen embryo transfer (ET) in place of fresh transfer. The aim of this study was to evaluate the difference in the risk of ectopic implantation in women undergoing fresh versus frozen-thawed ETs. Methods It was a retrospective single-center cohort study wherein 802 of the 853 patients who underwent ET during the study period were analyzed. These patients were further subdivided into fresh transfer group (n = 339) and frozen transfer group (n = 443). The primary outcome measure was to study the difference in EP rates in the two groups and the secondary outcome measure was to analyze the clinico-therapeutic profile of the two subgroups of EPs. Results Of the 802 women who underwent ETs, 19 women had an ectopic implantation with an overall incidence of 2.3%. Among the 19 EPs, there were eight EPs (2.23%) in the fresh transfer group and 11 EPs (2.48%) in the frozen transfer group, but the difference was not statistically significant (P > 0.05). The clinico-therapeutic profile of the patients was comparable in both the groups. Conclusion Frozen ET cycle does not mandatorily reduce the incidence of EP in spite of the maintenance of the intrauterine milieu compared to a stimulated cycle. Larger and more robust studies are needed for recommending frozen ET cycle as a preventive modality for EP.
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Affiliation(s)
- Nikita Naredi
- Senior Advisor (Obs & Gynae) & IVF Specialist, Command Hospital (Southern Command), Pune 411040, India
| | - Sanjay Singh
- Senior Advisor (Obs & Gynae), Base Hospital, Delhi Cantt 110010, India
| | - Pranay Gurmeet
- Classified Specialist (Obst & Gynae) & IVF Specialist, Military Hospital Jalandhar, Jalandhar Cantt 144005, India
| | - Praveen Kumar
- Classified Specialist (Obst & Gynae) & IVF Specialist, Command Hospital (Southern Command), Pune 411040, India
| | - Rajesh Sharma
- Classified Specialist (Obst & Gynae) & IVF Specialist, Army Hospital (R&R), New Delhi 110010, India
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Lattes K, López S, Checa MA, Brassesco M, García D, Vassena R. A freeze-all strategy does not increase live birth rates in women of advanced reproductive age. J Assist Reprod Genet 2020; 37:2443-2451. [PMID: 32876800 DOI: 10.1007/s10815-020-01934-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
RESEARCH QUESTION Does a freeze-all strategy improve live birth rates in women of different age groups? DESIGN Retrospective cohort study of 1882 first embryo transfer cycles, performed between January 2013 and December 2015. Reproductive outcomes between fresh (FRESH) or frozen (FROZEN) embryo transfers were compared in patients stratified by age: < 35, between 35 and 38, or > 38 years. Student's t test for independent samples and χ2 analyses were used as needed. A multivariable logistic regression analysis was performed adjusting for age, triggering drug, number of retrieved oocytes, number of transferred embryos, and percentage of top-quality embryos. MAIN RESULTS AND THE ROLE OF CHANCE Live birth rates (LBR) were significantly higher for FROZEN in the < 35 years group (43.7% vs 24%; p < 0.001). In both the 35-38 and > 38 years groups, LBR for FROZEN vs FRESH were not statistically different (30.9% in the FROZEN group vs 29.3% in the FRESH group, p = 0.70, and 19.8% in the FROZEN group vs 12.7% in the FRESH group, p = 0.07, respectively). The multivariate analysis found a significantly positive effect of performing FROZEN on LBR in the younger group (OR 2.46, 95% CI 1.31-4.62; p = 0.005) but had no impact in women between 35 and 38 years (OR 1.01, 95% CI 0.55-1.83; p = 0.98) or older (OR 0.96, 95% CI 0.43-2.13; p = 0.92). CONCLUSIONS Performing a freeze-all strategy seems to result in better reproductive outcomes when compared with a fresh ET in women under 35 years, with no significant impact on older women.
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Affiliation(s)
- K Lattes
- Centro de Infertilidad y Reproducción Humana (CIRH), 08017, Barcelona, Spain
| | - S López
- Centro de Infertilidad y Reproducción Humana (CIRH), 08017, Barcelona, Spain
| | - M A Checa
- Department of Obstetrics and Gynecology, Parc de Salut Mar, Universitat Autònoma de Barcelona, 08003, Barcelona, Spain.,Barcelona Infertility Research Group (GRI-BCN), 08005, Barcelona, Spain
| | - M Brassesco
- Centro de Infertilidad y Reproducción Humana (CIRH), 08017, Barcelona, Spain
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23
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Chen H, Cai J, Liu L, Sun X. Roles of estradiol levels on the day of human chorionic gonadotrophin administration in the live birth of patients with frozen embryo transfer. J Clin Lab Anal 2020; 34:e23422. [PMID: 32715506 PMCID: PMC7521236 DOI: 10.1002/jcla.23422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background Estradiol (E2) is an important hormone in women. Changes of serum E2 levels may affect the endometrial receptivity for embryo implantation and thus affect pregnancy outcomes. This study was to assess the association between serum E2 levels on the day of human chorionic gonadotrophin (HCG) administration and live‐birth rates in patients with frozen embryo transfer (FET). Methods Totally 2071 women receiving long protocols of long‐acting gonadotropin‐releasing hormone (GnRH) agonists were enrolled. According to the E2 levels on the day of HCG administration, these patients were divided into four groups: 676 cases of E2 ≤ 3051 pg/mL in Q1 group, 676 cases of 3051 pg/mL < E2 ≤ 4558 pg/mL in Q2 group, 675 cases of 4558 pg/mL < E2 ≤ 6718 pg/mL in Q3 group, and 674 cases of E2 > 6718 pg/mL in Q4 group. The clinical indicators including female age, body mass index (BMI), duration of infertility, infertility styles, treatment protocols, hormone levels, total antral follicle count, endometrial thickness, top‐level embryos, and live‐birth rates were analyzed, and multivariable logistic model was conducted to select significant variables. Results Significant differences were observed for the female age (OR = 0.965, 95% CI: 0.946‐0.985, P < .001), total antral follicle counts (OR = 1.025, 95% CI: 1.008‐1.043, P = .004), transferring what day of embryos (OR = 1.242, 95% CI: 1.137‐1.356, P < .001), endometrial thickness (OR = 1.058, 95% CI: 1.004‐1.115, P = .035), top‐level embryos (OR = 1.416, 95% CI: 1.157‐1.731, P = .001), and E2 levels on HCG day >6781 pg/mL (OR = 1.344, 95% CI: 1.069‐1.690, P = .011) between live‐birth and non‐live‐birth groups. The area under the curve (AUC) for E2 levels on HCG day was 0.558, the sensitivity was 54.75%, and the specificity was 55.10%. Conclusion Serum E2 level on HCG day was an independent predictor of live‐birth achievement in patients with FET.
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Affiliation(s)
- Haixiao Chen
- Reproductive Medicine Center, Chenggong Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jiali Cai
- Reproductive Medicine Center, Chenggong Hospital Affiliated to Xiamen University, Xiamen, China
| | - Lanlan Liu
- Reproductive Medicine Center, Chenggong Hospital Affiliated to Xiamen University, Xiamen, China
| | - Xiaohua Sun
- Reproductive Medicine Center, Chenggong Hospital Affiliated to Xiamen University, Xiamen, China
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24
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Cai J, Liu L, Jiang X, Li P, Sha A, Ren J. Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study. BJOG 2020; 128:540-550. [PMID: 32575153 DOI: 10.1111/1471-0528.16378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET). DESIGN Retrospective cohort study. SETTING University-affiliated hospital. POPULATION A total of 16 378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017. METHODS We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies. MAIN OUTCOME MEASURES Ectopic pregnancy. RESULTS According to the WHO criteria, the number of cycles with low (<18.5 kg/m2 ), normal (18.5-24.9 kg/m2 ) and high (≥25 kg/m2 ) BMI were 2155, 13 447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76). CONCLUSIONS Low BMI is associated with an increased risk of EP. TWEETABLE ABSTRACT The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.
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Affiliation(s)
- J Cai
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - L Liu
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China.,School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - X Jiang
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - P Li
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - A Sha
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - J Ren
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
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25
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The live birth and neonatal outcomes in the subsequent pregnancy among patients with adverse pregnancy outcomes in first frozen embryo transfer cycles. Arch Gynecol Obstet 2020; 302:731-740. [PMID: 32468163 DOI: 10.1007/s00404-020-05608-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore whether the adverse pregnancy outcomes in first frozen embryo transfer (FET) cycles affect live birth and neonatal outcomes in the subsequent pregnancy? METHODS This was a retrospective study. Women with a history of adverse pregnancy outcomes in first FET cycles started their subsequent embryo transfer cycles. The adverse pregnancy outcomes included biochemical pregnancy, ectopic pregnancy, and first-trimester pregnancy loss. The main outcomes of present study were live birth rate and neonatal outcomes. RESULTS Results showed patients with first-trimester pregnancy loss in first FET cycles had a 95 percent greater chance of live birth in subsequent FET cycles (OR 1.95, 95% CI 1.33-2.88). However, the biochemical pregnancy/ectopic pregnancy in initial FET cycles did not affect the chance of live birth in second cycles (biochemical pregnancy: OR 1.21, 95% CI 0.82-1.77; ectopic pregnancy: OR 1.06, 95% CI 0.55-2.05). The neonatal outcomes of singletons were not affected by the number of embryo transfer cycles. CONCLUSIONS Patients with first-trimester pregnancy loss in first FET cycle had a greater chance of live birth in second FET cycles, but the biochemical pregnancy/ectopic pregnancy in first FET cycles did not significantly affect the live birth in second FET cycles. The three types of adverse pregnancy outcomes in first FET cycles did not affect neonatal outcomes in the second cycles.
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26
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Vitale SG, Riemma G, Cianci A. Unraveling the “double whammy” dilemma: do concomitant tubal infertility and previous ectopic pregnancy shrink the possibility of live birth? Fertil Steril 2020; 113:934-935. [DOI: 10.1016/j.fertnstert.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
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Murtinger M, Wirleitner B, Schuff M, Damko AR, Vanderzwalmen P, Stecher A, Spitzer D. Suboptimal endometrial-embryonal synchronization is a risk factor for ectopic pregnancy in assisted reproduction techniques. Reprod Biomed Online 2020; 41:254-262. [PMID: 32540431 DOI: 10.1016/j.rbmo.2020.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
RESEARCH QUESTION What are the main risk factors associated with ectopic pregnancy and what is the true incidence of ectopic pregnancies in an IVF programme? DESIGN Retrospective single-centre study of 12,429 blastocyst transfers (8182 fresh and 4247 frozen embryo transfers) conducted between January 2010 and December 2017. IVF outcome was analysed, and ectopic pregnancy risk evaluated according to patient's characteristics and assisted reproductive technology treatment factors. RESULTS Of 5061 patients reporting a positive pregnancy test, 43 were diagnosed with ectopic pregnancy (0.85%). Neither female age (36.7 versus 35.8 years), body mass index, quality of transfer nor stimulation protocol affected the ectopic pregnancy rate, but history of previous ectopic pregnancy (OR 3.26; P = 0.0080), tubal surgery, or both (OR 6.20; P < 0.0001) did. The incidence of ectopic pregnancy was increased in women with uterine malformations (OR 3.85; P = 0.0052), uterine pathologies (OR 5.35; P = 0.0001), uterine surgeries (OR 2.29; P = 0.0154) or sub-optimal endometrial build-up (OR 4.46 to 5.31; P < 0.0001). Transfer of slow-developing blastocysts (expressed by expansion) significantly increased the risk of ectopic pregnancy (OR 2.59; P = 0.0102). CONCLUSIONS Unfavourable uterine environment, including uterine pathologies, uterine or tubal surgery and suboptimal endometrial build-up were related to ectopic pregnancy. Low expansion grade of blastocysts was identified as an additional putative risk factor for ectopic pregnancy, indicating the importance of proper embryonal-maternal synchronization. The overall ectopic pregnancy rate after blastocyst transfer was low, comparable with reported ectopic pregnancy rates in spontaneous conceptions. Proper evaluation of tubal and uterine pathologies, optimizing endometrial preparation and the transfer of expanded blastocysts in a frozen embryo transfer cycle, might be beneficial.
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Affiliation(s)
- Maximilian Murtinger
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria.
| | - Barbara Wirleitner
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria
| | - Maximilian Schuff
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria
| | - Adriane Rima Damko
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria
| | - Pierre Vanderzwalmen
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria; Centre Hospitalier Inter Régional Edith Cavell (CHIREC), Braine-l'Alleud, Bruxelles, Belgium
| | - Astrid Stecher
- NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria
| | - Dietmar Spitzer
- IVF Zentren Prof. Zech -Salzburg - Member of NEXTCLINICS, Innsbrucker Bundesstrasse 35, Salzburg 5020, Austria
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Effect of the time for embryo transfer from oocyte retrieval on clinical outcomes in freeze-all cycles: a retrospective cohort study. Arch Gynecol Obstet 2020; 301:303-308. [DOI: 10.1007/s00404-019-05405-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
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29
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Liu X, Qu P, Bai H, Shi W, Shi J. Endometrial thickness as a predictor of ectopic pregnancy in 1125 in vitro fertilization-embryo transfer cycles: a matched case-control study. Arch Gynecol Obstet 2019; 300:1797-1803. [PMID: 31720777 DOI: 10.1007/s00404-019-05353-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 10/17/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The ectopic pregnancy (EP) rate after in vitro fertilization-embryo transfer (IVF-ET) is higher than after spontaneous conception. The reason for the increased risk of EP is not clear. We aimed to determine the risk factors associated with EP in patients undergoing IVF-ET. METHODS This was a 1:4 matched case-control study that enrolled 225 EP patients and 900 matched intrauterine pregnancy patients from the ART center of Northwest Women's and Children's Hospital from January 2014 to April 2018. Conditional logistic regression was used to analyze the association between risk factors and EP, and a receiver-operating characteristic (ROC) curve was generated for the predictors of EP. RESULTS Our findings showed that tubal factor (OR 1.61; 95% CI 1.12-2.31) and pelvic surgery other than cesarean section (OR 2.04; 95% CI 1.26-3.29) were associated with a higher risk of EP (p = 0.001). An endometrial thickness > 12 mm prior to embryo transfer (OR 0.27; 95% CI 0.13-0.56) and the number of transferable embryos (OR 0.71; 95% CI 0.65-0.78) were protective factors against EP (p < 0.001). The other factors did not have a significant effect on the probability of developing ectopic pregnancy. The area under the curve of the endometrial thickness and the number of transferable embryos for EP prediction were higher than those for tubal factor and pelvic surgery other than cesarean section. CONCLUSIONS An endometrial thickness > 12 mm is a strong protective factor against ectopic pregnancy. Attention should be paid to women with specific characteristics who have undergone IVF-ET.
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Affiliation(s)
- Xitong Liu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Pengfei Qu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xi'an, 710003, Shaanxi, People's Republic of China.
| | - Haiyan Bai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Wenhao Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xi'an, 710003, Shaanxi, People's Republic of China.
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xi'an, 710003, Shaanxi, People's Republic of China.
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Liu H, Zhang J, Wang B, Kuang Y. Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles. Fertil Steril 2019; 113:131-139. [PMID: 31727414 DOI: 10.1016/j.fertnstert.2019.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/03/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate whether endometrial thickness (EMT) influences the incidence of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. DESIGN Retrospective cohort study. SETTING Academic tertiary-care medical center. PATIENT(S) A total of 16,556 patients were enrolled between January 2010 and December 2017, comprising 16,701 intrauterine, 488 ectopic, and 45 heterotopic pregnancy cycles after FET. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) EP was the primary outcome. EMT was the main measured variable. Data were analyzed with the binary logistic general estimating equations model to calculate the adjusted odds ratio (aOR) for EP. RESULT(S) After adjusting for confounders, EMT remained statistically significant as an independent risk factor for EP. Compared with women with an EMT of ≥14 mm, the aORs for women with EMT in the ranges 7-7.9, 8-9.9, and 10-11.9 mm were 2.70 (95% confidence interval [CI], 1.65-4.40), 2.06 (95% CI, 1.33-3.20), and 1.66 (95% CI, 1.07-2.58), respectively. Hormone replacement treatment for endometrial preparation during FET increased the risk of EP after adjustment for confounding variables. CONCLUSION(S) EMT is inversely proportional to EP rate in FET cycles and is therefore a potential quantitative marker of endometrial receptivity and uterine contractibility in an FET cycle. The predictive validity of EMT value must be evaluated in further studies.
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Affiliation(s)
- Hongfang Liu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jie Zhang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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31
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Increased pregnancy complications following frozen-thawed embryo transfer during an artificial cycle. J Assist Reprod Genet 2019; 36:925-933. [PMID: 30924053 DOI: 10.1007/s10815-019-01420-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/07/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to clarify the risks of adverse pregnancy outcomes in patients and their offspring after frozen embryo transfer (FET) during an artificial cycle (AC). METHODS We conducted a retrospective cohort study that included all FET cycles and subsequent deliveries in a single centre between August 2013 and March 2016. Pregnancy, obstetric and neonatal outcomes were compared among patients treated during an AC or a natural cycle with luteal phase support (NC-LPS). Multivariate logistic regression was performed to evaluate the relationship between endometrial preparation schemes and pregnancy, obstetric and neonatal outcomes. RESULTS AC-FET was not a significant risk factor for clinical pregnancy rate, multiple birth rate or miscarriage rate after adjusting for potential confounders. However, AC-FET was a significant risk factor for ectopic pregnancy rate (adjusted odds ratio (AOR), 1.738; 95% confidence interval (CI), 1.086-2.781) and live birth rate (AOR, 0.709; 95% CI, 0.626-0.802). Regarding obstetric outcomes, AC-FET was found to be associated with an increased risk for hypertension disorder (AOR, 1.780; 95% CI, 1.262-2.510) and caesarean section (AOR, 1.507; 95% CI, 1.195-1.900). In multiples, birth weight (2550 g (2150-2900 g) in AC-FET vs. 2600 g (2350-2900 g) in NC-LPS; P = 0.023), gestational age (36.6 weeks (35.3-37.6 weeks) vs. 37.1 weeks (36.1-37.9 weeks); P < 0.001), and z-score (- 0.5 (- 1.1, - 0.0) vs. - 0.4 (- 1.0, 0.2); P = 0.009) were higher in the NC-LPS group than in the AC-FET group, although there were no differences in these variables among singletons. CONCLUSION Compared with NC-LPS, AC-FET seemed to have a negative effect on obstetric outcomes.
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32
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Zeng MF, Li LM. Frozen blastocyst transfer reduces incidence of ectopic pregnancy compared with fresh blastocyst transfer: a meta-analysis. Gynecol Endocrinol 2019; 35:93-99. [PMID: 30129787 DOI: 10.1080/09513590.2018.1497154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is the main cause of maternal death during early pregnancy. Blastocyst transfer (BT) reduces EP rates compared with cleavage stage embryo transfer (ET), and frozen ET reduces EP rates compared with fresh ET. However, data comparing the EP rate of fresh BT and frozen BT are limited. The objective of this meta-analysis was to determine whether frozen BT decreases the EP rate compared with fresh BT. MATERIALS AND METHODS PUBMED, EMBASE, and Cochrane Library databases were searched for papers with no limitation on language and publication year. A systemic literature search identified 14 studies which met the inclusion criteria for further analysis. EP rate is our only outcome measure. All statistical analyses were carried out using RevMan software [version 5.3]. Random effects models were chosen to calculate the odds ratio (OR). RESULTS Fourteen retrospective studies (n = 251,762 cycles) were finally analyzed, including 154,214 and 97,548 cycles undergoing fresh and frozen BT, respectively. Compared with fresh BT, the frozen BT was associated with an decrease in EP rate [OR = 1.79; 95% confidence interval (CI) = 1.37-2.34, heterogeneity was 71%], the EP rate was 1.74% (2683/154,214 pregnancies) for fresh BT and 0.97% (949/97,548 pregnancies) for frozen BT. The number of embryos transferred in subgroup analysis found that the incidence of EP in frozen BT is lower than fresh BT (OR = 1.62; 95% CI = 1.38-1.91), the EP rate was 1.2% (206/16,610 pregnancies) for one fresh BT and 0.8% (153/19,569 pregnancies) for one frozen BT, also the EP rate was 1.9% (78/4043 pregnancies) for two fresh BT and 1.1% (19/1790 pregnancies) for two frozen BT. CONCLUSIONS Our meta-analysis found that frozen BT was associated with an decrease in EP rate compared with fresh BT in IVF/ICSI patients. We also found that a single frozen BT is the better choice as a method to reduce the incidence of EP.
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Affiliation(s)
- Mei Fang Zeng
- a Reproductive Medicine Center , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - Liu Ming Li
- a Reproductive Medicine Center , Guangxi Medical University First Affiliated Hospital , Nanning , China
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Luke B, Brown MB, Wantman E, Baker VL, Doody KJ, Seifer DB, Spector LG. Risk of severe maternal morbidity by maternal fertility status: a US study in 8 states. Am J Obstet Gynecol 2019; 220:195.e1-195.e12. [PMID: 30321527 DOI: 10.1016/j.ajog.2018.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Over the past 2 decades the characteristics of women giving birth in the United States and the nature of the births themselves have changed dramatically, with increases in older maternal age, plural births, cesarean deliveries, and conception from infertility treatment. OBJECTIVE We sought to evaluate the risk of severe maternal morbidity by maternal fertility status, and for in vitro fertilization pregnancies, by oocyte source and embryo state combinations. STUDY DESIGN Women in 8 states who underwent in vitro fertilization cycles resulting in a live birth during 2004 through 2013 were linked to their infant's birth certificates; a 10:1 sample of births from non-in vitro fertilization deliveries were selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. In vitro fertilization pregnancies were additionally categorized by oocyte source (autologous vs donor) and embryo state (fresh vs thawed). Maternal morbidity was identified from the birth certificate, modeled using logistic regression, and reported as adjusted odds ratios [95% confidence intervals]. The reference group was fertile women. RESULTS The study population included 1,477,522 pregnancies (1,346,118 fertile, 11,298 subfertile, 80,254 in vitro fertilization autologous-fresh, 21,964 in vitro fertilization autologous-thawed, 13,218 in vitro fertilization donor-fresh, and 4670 in vitro fertilization donor-thawed pregnancies): 1,420,529 singleton, 54,573 twin, and 2420 triplet+ pregnancies. Compared to fertile women, subfertile and the 4 groups of in vitro fertilization-treated women had increased risks for blood transfusion and third- or fourth-degree perineal laceration (subfertile, 1.58 [1.23-2.02] and 2.08 [1.79-2.43]; autologous-fresh, 1.33 [1.14-1.54] and 1.37 [1.26-1.49]; autologous-thawed, 1.94 [1.60-2.36] and 2.10 [1.84-2.40]; donor-fresh, 2.16 [1.69-2.75] and 2.11 [1.66-2.69]; and donor-thawed, 2.01 [1.38-2.92] and 1.28 [0.79-2.08]). Also compared to fertile women, the risk of unplanned hysterectomy was increased for in vitro fertilization-treated women in the autologous-thawed group (2.80 [1.96-4.00]), donor-fresh group (2.14 [1.33-3.44]), and the donor-thawed group (2.46 [1.33-4.54]). The risk of ruptured uterus was increased for in vitro fertilization-treated women in the autologous-fresh group (1.62 [1.14-2.29]). Among women with a prior birth, the risk of blood transfusion after a vaginal birth was increased for subfertile women (2.91 [1.38-6.15]), and women in all 4 in vitro fertilization groups (autologous-fresh, 1.93 [1.23-3.01]; autologous-thawed, 2.99 [1.78-5.02]; donor-fresh, 5.13 [2.39-11.02]; and donor-thawed, 5.20 [1.83-14.82]); the risk after a cesarean delivery was increased in the autologous-thawed group (1.74 [1.29-2.33]) and the donor-fresh group (1.62 [1.07-2.45]). Unplanned hysterectomy was increased in the autologous-thawed (2.31 [1.43-3.71]) and donor-thawed (2.45 [1.06-5.67]) groups. CONCLUSION The risks of severe maternal morbidity are increased for subfertile and in vitro fertilization births, particularly in pregnancies that are not from autologous, fresh cycles.
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Errázuriz J, Racca A, Schutyser V, Frederix B, Blockeel C. Cornual twin pregnancy following IVF/ICSI treatment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:287-288. [PMID: 29876991 DOI: 10.1002/uog.19109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Affiliation(s)
- J Errázuriz
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Brussels, Belgium
- Reproductive Medicine Unit, Clínica Alemana, Santiago, Chile
| | - A Racca
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Brussels, Belgium
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, University of Genoa, Genova, Italy
| | - V Schutyser
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Brussels, Belgium
| | - B Frederix
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Brussels, Belgium
| | - C Blockeel
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine, Brussels, Belgium
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邓 玲, 陈 薪, 叶 德, 陈 士. [Effect of serum estradiol level before progesterone administration on pregnancy outcomes of frozen-thawed embryo transfer cycles]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:601-605. [PMID: 29891459 PMCID: PMC6743893 DOI: 10.3969/j.issn.1673-4254.2018.05.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore whether a high serum estradiol (E2) level before progesterone administration adversely affects the pregnancy outcomes of frozen-thawed embryo transfer (FET) cycles. METHODS We retrospectively analyzed 205 hormone replacement therapy (HRT)-FET cycles in our Center between February, 2017 and August, 2017. With a cutoff value of serum E2 level of 600 pg/mL before progesterone administration, the cases were divided into high E2 level group and control group with normal E2 level, and the clinical characteristics and pregnancy outcomes were compared between the two groups. RESULTS No significant difference was found between the two groups in the patients'age during IVF/ICSI cycle, body mass index (BMI) or endometrial thickness at the time of FET (P>0.05). The patients with high E2 levels had a significantly younger age (P<0.05) and a significantly longer duration of estradiol administration than those in the control group (P<0.05). The clinical pregnancy rates, ongoing pregnancy rates, early miscarriage rates, late abortion rates and live birth rates were all comparable between the two groups (P>0.05). After controlling for the compounding factors including the age at FET cycle and the duration of estradiol administration, all these pregnancy outcomes were still comparable between the two groups. CONCLUSION A high serum E2 level before progesterone administration does not adversely affect the pregnancy outcomes of HRT-FET cycles.
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Affiliation(s)
- 玲 邓
- />南方医科大学南方医院妇产科生殖医学中心,广东 广州 510515Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 薪 陈
- />南方医科大学南方医院妇产科生殖医学中心,广东 广州 510515Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 德盛 叶
- />南方医科大学南方医院妇产科生殖医学中心,广东 广州 510515Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 士岭 陈
- />南方医科大学南方医院妇产科生殖医学中心,广东 广州 510515Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Xing W, Ou J, Cai L. Thawed embryo transfer and ectopic pregnancy: a meta-analysis. Arch Gynecol Obstet 2018; 297:1345-1352. [PMID: 29502243 DOI: 10.1007/s00404-018-4724-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 02/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine whether thawed embryo transfers can reduce the rate of EP. METHODS The PubMed, EMBASE, Cochrane Library databases and two randomized controlled trials registration centers were thoroughly searched until March 2017. The clinical outcomes of IVF/ICSI cycles were compared between thawed and fresh embryo transfer. RESULTS Twenty-one articles were included in this meta-analysis. There were 801,464 pregnancies totally (thawed-ET: n = 158,967, fresh-ET: n = 642,497). The ectopic pregnancy rate was significantly lower in the group of thawed-ET than that in the group of fresh-ET (OR 0.69, 95% CI 0.57-0.82; I2 = 83%). We subdivided the data into subgroups for D3 embryo transfer and D5 embryo transfer. We also found that the ectopic pregnancy rate was significantly lower with thawed-ET on D3 than that with fresh-ET (OR 0.67, 95% CI 0.53-0.85; I2 = 0%). The risk of ectopic pregnancy was significantly decreased with thawed-ET on D5 than that with fresh-ET (OR 0.57, 95% CI 0.50-0.64; I2 = 45%). CONCLUSION Our results indicate that in contrast to fresh embryo transfers, thawed D3 or D5 embryo transfers can reduce the rate of EP.
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Affiliation(s)
- Weijie Xing
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Jianping Ou
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liuhong Cai
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Xiao S, Mo M, Hu X, Zhang H, Xu S, Wang Z, Zeng Y. Study on the incidence and influences on heterotopic pregnancy from embryo transfer of fresh cycles and frozen-thawed cycles. J Assist Reprod Genet 2018; 35:677-681. [PMID: 29322346 DOI: 10.1007/s10815-017-1109-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the heterotopic pregnancy rate using fresh versus frozen-thawed embryo transfers and factors associated with heterotopic pregnancy (HP). Management and clinical outcomes after heterotopic pregnancy were also evaluated. METHODS In this retrospective cohort study, we included 12,484 women who had clinical pregnancies after in vitro fertilization treatment at our fertility center between 2012 and 2017. Patients received fresh day 3 embryos (F-D3 group), fresh day 5 blastocysts (F-D5 group), frozen-thawed day 3 embryos (T-D3 group), or frozen-thawed day 5 or 6 blastocysts (T-D5/6 groups) transfers. The primary outcome measure was the occurrence of heterotopic pregnancy. Factors associated with heterotopic pregnancy were analyzed using logistic regression. RESULTS The heterotopic pregnancy rates were 0.58% in the F-D3, 0.39% in F-D5, 0.56% in T-D3, and 0.33% in T-D5/6 groups, but no differences were found between groups. The risk factors of HP included a history of previous ectopic pregnancy (odds ratio [OR] 5.805, 95% CI 4.578-9.553, P = 0.016) and pelvic inflammation diseases (OR 1.129, 95% CI 1.021-3.178, P = 0.047). Salpingectomy was performed in 62.9% patients either through laparoscopy or through laparotomy. The early abortion rate and late abortion rate were 29.03% and 1.61%, respectively. In total, 66.13% of the patients had a live birth, either a singleton (90.24%) or twins (9.76%). CONCLUSION No significant difference in the incidence of heterotopic pregnancy in fresh IVF cycles vs. frozen-thawed cycles could be demonstrated in a large cohort of patients. The risk factors of HP included history of ectopic pregnancy and PID. The clinical outcome after heterotopic pregnancy appears to be favorable.
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Affiliation(s)
- Shan Xiao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Xiaodong Hu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Hongzhan Zhang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Shiru Xu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Zhuran Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 510080, Guangdong, People's Republic of China.
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Abstract
PURPOSE OF REVIEW There's some preclinical evidence of an adverse effect of multifollicular growth on endometrial function in assisted reproductive technology cycles. Universal elective frozen embryo transfer (eFET) in an unstimulated cycle is being promoted as a panacea, regardless of patient, and cycle characteristics. We review the clinical evidence on the effectiveness and safety of eFETs. RECENT FINDINGS Randomized controlled trials (RCTs) comparing fresh and eFET yield contradictory results in terms of live birth rates. RCTs mainly involve women with an excessive response to ovarian stimulation. Studies including women with a normal or low ovarian response are either patient/physician preference or retrospective studies, prone to bias. Yet, they yield contradictory results as well. Overall, eFET seems to have limited potential to improve effectiveness of assisted reproductive technology, which could be limited to hyper-responders. Other suggested advantages of eFET include better obstetric and perinatal outcome. However, recent studies show that frozen embryo transfers can be associated with serious complications including hypertensive disorders during pregnancy, placenta accreta, or increased perinatal mortality. SUMMARY The evidence behind advantages of eFET is of low quality. As such, switching to a universal eFET strategy does not seem justified. New RCTs including women from different strata of ovarian response are needed.
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Du T, Chen H, Fu R, Chen Q, Wang Y, Mol BW, Kuang Y, Lyu Q. Comparison of ectopic pregnancy risk among transfers of embryos vitrified on day 3, day 5, and day 6. Fertil Steril 2017; 108:108-116.e1. [DOI: 10.1016/j.fertnstert.2017.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/06/2017] [Accepted: 05/22/2017] [Indexed: 01/29/2023]
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Zhang B, Cao L, Ding L, Yan L, Chen ZJ. Effect of different ectopic pregnancy treatments on cryopreserved embryo transfer outcomes: A retrospective cohort study. Gynecol Minim Invasive Ther 2017; 6:103-107. [PMID: 30254890 PMCID: PMC6135176 DOI: 10.1016/j.gmit.2017.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the effects of different treatment methods for previous ectopic pregnancies (EP) on cryopreserved embryo transfer (CET) outcomes. Materials and Methods This was a retrospective cohort study. Patients with EP histories were divided into four groups based on their previous EP treatments: Group 1-unilateral tubal removal; Group: 2-bilateral tubal removal or unilateral tubal removal with contralateral tubal ligation; Group: 3-conservative surgery group; and Group 4-conservative medication group. A total of 1333 women with previous histories of being admitted to the hospital for CET treatment were consecutively enrolled between January 2009 and December 2014. Results Patients who underwent bilateral tubal ligation or removal had a lower miscarriage rate [8.88% vs. 3.46%, p = 0.006, odds ratio = 2.718, 95% confidence interval (CI) = 1.301-5.677] than those who underwent unilateral tubal removal. No significant difference was observed in the rate of EP after CET in the four groups in women with EP histories. (p1 = 0.258, 95%CI = 0.113-1.836; p2 = 0.137, 95%CI = 0.975-0.997; p3 = 0.314, 95%CI = 0.987-1.001; p4 = 0.198, 95%CI = 0.987-1.001). The groups were not different with regard to other pregnancy outcomes. Conclusion There was no significant difference among EP treatment methods with regard to their impacts on CET outcomes in women with EP histories. Bilateral tubal ligation or removal surgery can decrease the miscarriage rate after CET.
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Affiliation(s)
- Bingqian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
| | - Lianbao Cao
- Center for Reproductive Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
| | - Lingling Ding
- Center for Reproductive Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
- Corresponding authors. Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, 157 Jingliu Road, Jinan 250021, China. E-mail addresses: (L. Yan), (Z.-J. Chen)
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
- Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
- Corresponding authors. Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, 157 Jingliu Road, Jinan 250021, China. E-mail addresses: (L. Yan), (Z.-J. Chen)
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García-Ferreyra J, Hilario R, Dueñas J. Ectopic ovarian pregnancy after intracytoplasmic sperm injection with testicular spermatozoa - a case report. JBRA Assist Reprod 2017; 21:135-136. [PMID: 28609281 PMCID: PMC5473707 DOI: 10.5935/1518-0557.20170029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ovarian ectopic pregnancy is a rare event in both natural and assisted human
reproduction settings. There are few reports of this event after in
vitro fertilization. Diagnosis can be challenging, since it
requires specific medical expertise. Patients with this condition call for
careful management during treatment so as to not affect their fertility
potential. This paper describes the case of a woman submitted to ICSI and embryo
transfer who subsequently had an ovarian ectopic pregnancy and underwent a
laparoscopic partial right oophorectomy
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Affiliation(s)
| | | | - Julio Dueñas
- FERTILAB Assisted Reproduction Laboratories, Lima, Peru.,PROCREAR Fertility Center, Lima, Peru
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Deferred Frozen Embryo Transfer: What Benefits can be Expected from this Strategy in Patients with and without Endometriosis? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Progress with cryopreservation techniques have enabled development of the deferred frozen-thawed embryo transfer (DET) strategy as an alternative to relying on fresh embryo transfers. With DET, the entire embryo cohort is cryopreserved, and embryo transfer is then performed in a subsequent cycle that takes place separately from the controlled ovarian stimulation (COS). Initially developed to limit the risk of ovarian hyperstimulation syndrome that occurs with high responders, this strategy has been applied extensively with other populations in an effort to improve implantation rates. The assumption is that COS, which is essential for in vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) procedures to obtain a multi-follicular development, could have a detrimental impact on the endometrium as a result of greatly elevated levels of steroids. It is currently not clear whether the DET strategy can be generally applied to all women requiring an IVF/ICSI procedure. The objectives of this literature review regarding DET, were hence: (i) to present the scientific background that contributed to extensive adoption of this technique, (ii) to detail the pregnancy outcomes and potential obstetric and neonatal consequences, (iii) to report on its ability to prevent risks induced by COS, and (iv) to propose indications for the DET strategy in clinical practice.
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Wang ET, Kathiresan ASQ, Bresee C, Greene N, Alexander C, Pisarska MD. Abnormal implantation after fresh and frozen in vitro fertilization cycles. Fertil Steril 2017; 107:1153-1158. [PMID: 28433367 PMCID: PMC5628741 DOI: 10.1016/j.fertnstert.2017.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/19/2017] [Accepted: 03/06/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether fresh embryo transfers are at a higher risk of abnormal implantation compared with frozen embryo transfers while accounting for the embryo stage at transfer. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) We used data from the Society for Assisted Reproductive Technologies to identify all fresh and frozen autologous IVF cycles from 2004-2013 resulting in a positive pregnancy test. The cycles were parameterized into a four-level predictor of [1] fresh blastocyst transfer, [2] fresh non-blastocyst transfer, [3] frozen blastocyst transfer, and [4] frozen non-blastocyst transfer. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) We examined a composite outcome of abnormal implantation, defined as biochemical pregnancy, ectopic/heterotopic pregnancy, and first-trimester pregnancy loss. Regression modeling was performed with repeated measures multivariable logistic regression, adjusted for age, parity, number of embryos transferred, infertility diagnosis, and calendar year of treatment. RESULT(S) Of 509,938 cycles analyzed, 31.8% resulted in abnormal implantation. Compared with a fresh blastocyst transfer, a fresh non-blastocyst transfer had a 22% increase risk of abnormal implantation, a frozen blastocyst transfer had a 36% increase risk, and a frozen non-blastocyst transfer had a 57% increase risk. When individual outcomes were analyzed, fresh embryo transfers had a lower risk of biochemical pregnancy and pregnancy loss but a higher risk for ectopic/heterotopic pregnancy. CONCLUSION(S) Fresh blastocyst transfers had the lowest overall risk of abnormal implantation but a higher risk of ectopic/heterotopic pregnancy. Although embryo cryopreservation is indicated in certain treatment cycles, elective embryo cryopreservation may not be the optimal strategy to adopt for all cycles.
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Affiliation(s)
- Erica T Wang
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anupama S Q Kathiresan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Cedars Sinai Biostatistics & Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, California
| | - Naomi Greene
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carolyn Alexander
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
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Yanaihara A, Ohgi S, Motomura K, Hagiwara Y, Mogami T, Saito K, Yanaihara T. An abdominal ectopic pregnancy following a frozen-thawed ART cycle: a case report and review of the literature. BMC Pregnancy Childbirth 2017; 17:108. [PMID: 28388882 PMCID: PMC5383944 DOI: 10.1186/s12884-017-1294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ectopic pregnancy (EP) occurs in 1% of pregnancies and is reported to be more common in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies. An abdominal ectopic pregnancy (AEP) is a rare form of EP, and there are few reports of an AEP after IVF/ICSI. In this case report, a rare case of AEP after frozen-thawed cycle of ICSI is presented. Case presentation After a frozen-thawed cycle of ICSI, the beta-human chorionic gonadotropin (HCG) level at 4 weeks 0 days of gestation was 3.4 IU/L. Subsequent dysfunctional uterine bleeding was mistaken for menstruation; however, an AEP of 9 weeks with a fetal heart beat was observed by ultrasound. After the AEP was observed by ultrasound, it was extracted laparoscopically. Conclusion A rare case of an AEP, which developed after frozen-thawed cycle of ICSI, presented with a very low serum HCG level. Even if the HCG titer is low, follow-up HCG levels and frequent medical examinations are necessary.
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Affiliation(s)
- Atsushi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan.
| | - Shirei Ohgi
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Kenichirou Motomura
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Yuko Hagiwara
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Tae Mogami
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Keisuke Saito
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Takumi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
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Brady PC, Ginsburg ES. An Updated Review of Ectopic Pregnancies Resulting from Assisted Reproduction. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roque M, Valle M, Kostolias A, Sampaio M, Geber S. Freeze-all cycle in reproductive medicine: current perspectives. JBRA Assist Reprod 2017; 21:49-53. [PMID: 28333033 PMCID: PMC5365201 DOI: 10.5935/1518-0557.20170012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The freeze-all strategy has emerged as an alternative to fresh embryo transfer
(ET) during in vitro fertilization (IVF) cycles. Although fresh
ET is the norm during assisted reproductive therapies (ART), there are many
concerns about the possible adverse effects of controlled ovarian stimulation
(COS) over the endometrium. The supra-physiologic hormonal levels that occur
during a conventional COS are associated with modifications in the
peri-implantation endometrium, which may be related to a decrease in pregnancy
rates and poorer obstetric and perinatal outcomes when comparing fresh to
frozen-thawed embryo transfers. The main objective of this study was to assess
the available literature regarding the freeze-all strategy in IVF cycles, in
regards to effectiveness and safety. Although there are many potential
advantages in performing a freeze-all cycle over a fresh ET, it seems that the
freeze-all strategy is not designed for all IVF patients. There is a need to
develop a non-invasive clinical tool to evaluate the endometrial receptivity
during a fresh cycle, which enables the selection of patients that would benefit
from this strategy. Today, it is reasonable to perform elective cryopreservation
of all oocytes/embryos in cases with a risk of OHSS development, and in patients
with supra-physiologic hormonal levels during the follicular phase of COS. It is
not clear if all normal responders and poor responders may benefit from this
strategy.
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Affiliation(s)
- Matheus Roque
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil.,UFMG, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcello Valle
- ORIGEN - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | | | - Marcos Sampaio
- ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
| | - Selmo Geber
- UFMG, Federal University of Minas Gerais, Belo Horizonte, Brazil.,ORIGEN - Center for Reproductive Medicine, Belo Horizonte, Brazil
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Palomba S, Homburg R, Santagni S, La Sala GB, Orvieto R. Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review. Reprod Biol Endocrinol 2016; 14:76. [PMID: 27814762 PMCID: PMC5097409 DOI: 10.1186/s12958-016-0211-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
In the literature, there is growing evidence that subfertile patients who conceived after infertility treatments have an increased risk of pregnancy and perinatal complications and this is particularly true for patients who conceived through use of high technology infertility treatments. Moreover, high technology infertility treatments include many concomitant clinical and biological risk factors. This review aims to summarize in a systematic fashion the current evidence regarding the relative effect of the different procedures for high technology infertility treatments on the risk of adverse pregnancy and perinatal outcome. A literature search up to August 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar and an evidence-based hierarchy was used to determine which articles to include and analyze. Data on prepregnancy maternal factors, low technology interventions, specific procedures for male factor, ovarian tissue/ovary and uterus transplantation, and chromosomal abnormalities and malformations of the offspring were excluded. The available evidences were analyzed assessing the level and the quality of evidence according to the Oxford Centre for Evidence-Based Medicine guidelines and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. Current review highlights that every single procedure of high technology infertility treatments can play a crucial role in increasing the risk of pregnancy and perinatal complications. Due to the suboptimal level and quality of the current evidence, further well-designed studies are needed.
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Affiliation(s)
- Stefano Palomba
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Roy Homburg
- Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London, UK
| | - Susanna Santagni
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Giovanni Battista La Sala
- Center of Reproductive Medicine and Surgery, Arcispedale Santa Maria Nuova (ASMN)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Viale Risorgimento 80, 42123 Reggio Emilia, Italy
- University of Modena, Reggio Emilia, Italy
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yoder N, Tal R, Martin JR. Abdominal ectopic pregnancy after in vitro fertilization and single embryo transfer: a case report and systematic review. Reprod Biol Endocrinol 2016; 14:69. [PMID: 27760569 PMCID: PMC5070159 DOI: 10.1186/s12958-016-0201-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/06/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5-2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified. RESULTS Patients' ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies. CONCLUSIONS Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks.
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Affiliation(s)
- Nicole Yoder
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Reshef Tal
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - J. Ryan Martin
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
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Muller V, Makhmadalieva M, Kogan I, Fedorova I, Lesik E, Komarova E, Dzhemlikhanova L, Niauri D, Gzgzyan A, Ailamazyan E. Ectopic pregnancy following in vitro fertilization: meta-analysis and single-center experience during 6 years. Gynecol Endocrinol 2016; 32:69-74. [PMID: 27759446 DOI: 10.1080/09513590.2016.1232550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) has been reported to occur in 1.4-5.4% of all clinical pregnancies resulting from in vitro fertilization (IVF) and embryo transfer (ET). Data on factors associated with abnormal embryo implantation following assisted conception are limited. MATERIALS AND METHODS A systematic review and meta-analysis was performed to determine whether there is an association between the day (cleavage-stage, D3, versus blastocyst, D5) or the type (fresh versus frozen/thawed) of ET and EP rate. Risk factors for EP were evaluated in a retrospective study of 1194 women, who achieved pregnancy at our IVF unit between 2010 and 2016. RESULTS Sixteen papers were considered for the meta-analysis. EP rate did not differ between D3 and D5 fresh ET groups (RR = 0.99, 95%CI: 0.76-1.30) and was higher after fresh versus frozen ET (RR = 1.56, 95%CI: 1.25-1.95). At our clinic, 21 (1.76%) pregnancies were documented as ectopic. The risk of EP was associated with tubal pathology (OR = 3.37, 95%CI: 1.39-8.2), previous appendectomy and past chlamydial infection. CONCLUSIONS Present meta-analysis suggests that EP rate is similar following fresh blastocyst and cleavage ETs, but is significantly reduced after frozen compared with fresh ET. Our own findings demonstrate that tubal pathology has the major impact on EP occurrence following assisted conception.
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Affiliation(s)
- V Muller
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - M Makhmadalieva
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - I Kogan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - I Fedorova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - E Lesik
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - E Komarova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
| | - L Dzhemlikhanova
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - D Niauri
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - A Gzgzyan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
| | - E Ailamazyan
- a Department of Assisted Reproduction Technologies , FSBI D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , Saint-Petersburg , Russia and
- b Department of Obstetrics, Gynecology and Reproductology, Faculty of Medicine , Saint-Petersburg State University, Saint-Petersburg , Russia
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50
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Londra L, Moreau C, Strobino D, Bhasin A, Zhao Y. Is the type of gonadotropin-releasing hormone suppression protocol for ovarian hyperstimulation associated with ectopic pregnancy in fresh autologous cycles for in vitro fertilization? Fertil Steril 2016; 106:666-72. [DOI: 10.1016/j.fertnstert.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 01/24/2023]
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