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Gaiday A, Tussupkaliyev A, Nurken A, Gaiday A, Primbetova A, Dossimbetova M, Yeszhanova A, Karimsakova B, Ablakimova N. Successful Management of Cervical and Tubal Stump Double Pregnancy after Assisted Reproductive Technologies Using Multiple High Doses of Methotrexate: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:461-466. [PMID: 39114638 PMCID: PMC11300944 DOI: 10.30476/ijms.2024.102119.3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 08/10/2024]
Abstract
The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. Further research is required to explore optimal treatment strategies for EP, considering patient-specific factors and treatment goals.
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Affiliation(s)
- Andrey Gaiday
- Department of Obstetrics and Gynecology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Akylbek Tussupkaliyev
- Department of Obstetrics and Gynecology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Abay Nurken
- Department of Gynecology, Regional Perinatal Center, Aktobe, Kazakhstan
| | - Assel Gaiday
- Department of Gynecology, Regional Perinatal Center, Aktobe, Kazakhstan
| | - Ainur Primbetova
- Department of Gynecology, Regional Perinatal Center, Aktobe, Kazakhstan
| | - Moldir Dossimbetova
- Department of Obstetrics and Gynecology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | | | - Bibigul Karimsakova
- Department of General Medical Practice, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Nurgul Ablakimova
- Department of Pharmacology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
- Department of Hospital Pharmacy, Regional Perinatal Center, Aktobe, Kazakhstan
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Thanasa A, Thanasa E, Grapsidi V, Antoniou IR, Gerokostas EE, Kamaretsos E, Chasiotis A, Thanasas I. Interstitial Ectopic Pregnancy Associated With Painless and Severe Vaginal Bleeding: A Rare, Atypical Clinical Presentation. Cureus 2024; 16:e53225. [PMID: 38425637 PMCID: PMC10903376 DOI: 10.7759/cureus.53225] [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] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Interstitial ectopic pregnancy is rare (2%-4% of ectopic pregnancies). The atypical clinical presentation of interstitial ectopic pregnancy associated with massive vaginal bleeding is extremely rare and makes early preoperative diagnosis even more difficult. The presentation of our case concerns the early diagnosis and surgical treatment of a patient with an interstitial ectopic pregnancy without rupture, which presented atypically with painless, severe vaginal bleeding. A 27-year-old fourth-term pregnant woman presented with massive painless vaginal bleeding. Secondary amenorrhea was calculated at eight weeks and four days. Transvaginal ultrasound and transvaginal Doppler ultrasound combined with the quantification of beta-chorionic gonadotropin hormone raised the suspicion of interstitial ectopic pregnancy. Intraoperatively, the presence of a large swelling of the right horn of the uterus was established, and a wedge resection was performed with the removal of the corresponding fallopian tube. Three weeks after surgery, the serum beta-chorionic gonadotropin hormone value was zero. In this paper, the rarity of interstitial ectopic pregnancy, the difficulties related to early and correct preoperative diagnosis, and the selection of the appropriate available therapeutic procedures are emphasized, the correct application of which can significantly contribute to reducing the morbidity and mortality of these patients.
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Affiliation(s)
- Anna Thanasa
- Medicine, Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Efthymia Thanasa
- Medicine, Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasiliki Grapsidi
- Obstetrics and Gynecology, General Hospital in Trikala, Trikala, GRC
| | | | | | | | | | - Ioannis Thanasas
- Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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Ottun TA, Adewunmi AA, Jinadu FO, Olumodeji AM, Akinlusi FM, Rabiu KA, Akinola OI, Fabamwo AO. A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria. BMC Pregnancy Childbirth 2023; 23:680. [PMID: 37730568 PMCID: PMC10510187 DOI: 10.1186/s12884-023-05964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The World Health Organization recommends that Assisted Reproductive Technology be complementary to other ethically acceptable solutions to infertility. Whereas fertility centres are increasing in number in urban regions of Africa, published reports of their performance are sparse. We present a 10-year review of assisted reproductive technology performed in a public tertiary centre in Lagos, Nigeria. METHODS This was a hospital-based, retrospective, cross-sectional review of 604 women, over a 10-year period that had in-vitro fertilization or in-vitro fertilization with intra-cytoplasmic sperm injection at the Institute of Fertility Medicine, Lagos State University Teaching Hospital. Data obtained were expressed in descriptive statistics and Pearson correlation was used to determine the strength of linear relationship between two continuous variables at a significance level of p < 0.05. RESULTS The mean age of the women was of 37.7 ± 6.2 years and 89.7% had no previous parous experience. About 27.2% of the male partners had normal seminal fluid parameters while 4.6% had azoospermia. Median serum follicle stimulating hormone of the women was 8.1 IU/L and median serum anti-mullerian hormone was 6.3 pmol/L. There was weak positive correlation between age and serum follicle stimulating hormone (r = 0.306, p < 0.001); weak negative correlation between age and serum anti-mullerian hormone (r = -0.48, p < 0.001) and very weak correlation between body mass index and serum follicle stimulating hormone (r = 0.173, p = 0.011). In-vitro fertilization and intra-cytoplasmic sperm injection was the method of fertilization used in 97.4% of the cases and 81.8% of embryos formed were of good quality. Most women (94.5%) had 2 embryos transferred and 89.9% had day-5 embryo transfer done. About 1 in 4 of the women (143/604, 23.7%) had clinical pregnancy and 49.7% of women who got pregnant had delivery of a live baby at term while 11.9% had preterm delivery of a live baby. CONCLUSION Despite increasing use and success of assisted reproductive technology in south-western Nigeria, there is room for improvement in clinical pregnancy rates and live birth rates post- assisted reproductive technology. Complication rates are desirably low.
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Affiliation(s)
- Tawaqualit Abimbola Ottun
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria.
| | - Adeniyi Abiodun Adewunmi
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | | | - Ayokunle Moses Olumodeji
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Fatimat Motunrayo Akinlusi
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Kabiru Afolarin Rabiu
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Oluwarotimi Ireti Akinola
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Adetokunbo Olusegun Fabamwo
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
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Song L, Bu Z, Sun Y. Endometrial thickness and early pregnancy complications after frozen-thawed embryo transfers. Front Endocrinol (Lausanne) 2023; 14:1066922. [PMID: 37670886 PMCID: PMC10475533 DOI: 10.3389/fendo.2023.1066922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background The relationship between endometrial thickness and pregnancy safety after in vitro fertilization treatment is an important topic that should provoke attention. The aim of this study was to demonstrate the relationship between endometrial thickness on day of embryo transfer and early pregnancy complications, including ectopic pregnancy and early miscarriage, in frozen thawed embryo transfer (FET) cycles. Methods Patients undergoing their first FET cycles were included into this study from January 2010 to December 2021. Patients were divided into three groups according to endometrial thickness on day of embryo transfer: Thin, ≤ 7 mm; Medium, 7-14 mm; Thick, ≥ 14 mm. Ectopic pregnancy and early miscarriage were the two primary outcomes. Endometrial thickness was the main measured variable. The risk factors of these two compilations were determined based on univariate analysis and multivariate logistic regression analysis. Results A total of 11138 clinical pregnancies were included. The overall ectopic pregnancy and early spontaneous miscarriage rates were 2.62% and 13.40%. The ectopic pregnancy and early spontaneous miscarriage rates were significantly higher in patients with thin endometrium as compared with those in the other two groups (ectopic pregnancy rate: 5.06% vs. 2.62% vs. 1.05%; P < 0.001; early spontaneous miscarriage rate: 15.18% vs. 13.45% vs. 11.53%; P < 0.001). In multivariate logistic regression analysis, thin endometrium was an independent factor to predict ectopic pregnancy [adjusted odds ratio (aOR): 5.62; 95% confidence interval (CI): 2.51-12.58, P < 0.001], and to predict early spontaneous miscarriage rate (aOR: 1.57; 95% CI: 1.21-1.74, P < 0.001). Conclusion Thin endometrium on day of embryo transfer in FET cycles is an independent predictor for early pregnancy compilations, including ectopic pregnancy and early spontaneous miscarriage.
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Affiliation(s)
- Lin Song
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Nkwabong E, Atangana Mvodo D, Fouedjio J. Risk factors for ectopic pregnancy in a sub-Saharan African country. Trop Doct 2023:494755231164791. [PMID: 36942405 DOI: 10.1177/00494755231164791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Our case-control study aimed at identifying the risk factors (RFs) for ectopic pregnancy (EP), and was carried out between 1st February and 31st May, 2019. Women who had EP were compared to those without EP. Out of 3421 pregnancies, 93 (2.7%) had EP. Independent RFs were previous EP, past history of infertility, first sexual encounter <15 years, past history of chlamydia infection, ≥ 3 sexual partners, use of levonorgestrel based emergency contraceptive pill, and unemployment. Girls should be counselled concerning these RFs and specifically against early sexual intercourse and multiple sexual partnership.
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Affiliation(s)
- Elie Nkwabong
- Professor, Department of Obstetrics and Gynecology, 260103Faculty of Medicine and Biomedical Sciences & University Teaching Hospital, Yaoundé, Cameroon
| | | | - Jeanne Fouedjio
- Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
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Zhou WJ, Xu BF, Niu ZH. Ectopic pregnancy and failed oocyte retrieval during in vitro fertilization stimulation: Two case reports. World J Clin Cases 2022; 10:10310-10316. [PMID: 36246836 PMCID: PMC9561603 DOI: 10.12998/wjcc.v10.i28.10310] [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: 05/23/2022] [Revised: 07/03/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Due to a slight rise in beta-human chorionic (β-hCG) levels that are undetectable, and vaginal bleeding that is similar to regular menstruation, ectopic pregnancy (EP) that occurs during the expected menstrual cycle prior to ovulation induction as part of in vitro fertilization (IVF) is likely to be undiagnosed. We present two cases of unexpected EP and emphasize the importance of the β-hCG assay when an unexplained increase in progesterone is present prior to the triggering of ovulation during controlled ovarian stimulation (COS).
CASE SUMMARY A 26-year-old woman with primary infertility and a 31-year-old woman with secondary infertility. Both patients sought IVF treatment due to fallopian tube obstruction and underwent COS using the gonadotropin-releasing-hormone (GnRH)-antagonist protocol. In the late stage of COS, progesterone levels in both patients significantly increased, and luteinizing hormone levels decreased, followed by oocyte retrieval failure. A right salpingectomy was performed and tubal ectopic pregnancy was diagnosed by pathology in the first patient, and the second patients was diagnosed with a suspected EP abortion because her β-hCG levels declined to 12.5 mIU/mL. After full recovery for 2 mo, the first patient entered a new IVF treatment cycle with a GnRH-antagonist regimen and successfully achieved eight oocytes and three viable embryos. After 6 mo, the second patient received another COS treatment with a progestin-primed ovarian stimulation protocol and successfully achieved nine oocytes and five viable embryos.
CONCLUSION β-hCG levels in the initial and midterm phases of COS must be considered in patients with unusual hormone dynamics.
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Affiliation(s)
- Wen-Jie Zhou
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Bu-Fang Xu
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhi-Hong Niu
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Anzhel S, Mäkinen S, Tinkanen H, Mikkilä T, Haltia A, Perheentupa A, Tomás C, Martikainen H, Tiitinen A, Tapanainen JS, Veleva Z. Top-quality embryo transfer is associated with lower odds of ectopic pregnancy. Acta Obstet Gynecol Scand 2022; 101:779-786. [PMID: 35546786 DOI: 10.1111/aogs.14375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. MATERIAL AND METHODS An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen-thawed embryo transfer (n = 6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. RESULTS Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p < 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs 11.0%, p < 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56-0.92, p = 0.007). Transfer of two vs one embryo (OR 1.35, 95% CI 1.05-1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68-2.91, p < 0.0001) significantly increased the risk of ectopic pregnancy. CONCLUSIONS Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.
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Affiliation(s)
- Simona Anzhel
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, Medical University Varna, Varna, Bulgaria
| | - Sirpa Mäkinen
- Ovumia Fertinova Infertility Clinics Helsinki, Helsinki, Finland
| | - Helena Tinkanen
- Department of Obstetrics and Gynecology, University of Tampere, Tampere, Finland
| | | | | | - Antti Perheentupa
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Candido Tomás
- Ovumia Fertinova Infertility Clinics Tampere, Tampere, Finland
| | - Hannu Martikainen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Zdravka Veleva
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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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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Naredi N, Tripathy S, Sharma R. Transvaginal ultrasound-guided methotrexate instillation for failed medical management of ectopic pregnancies in subfertile women. J Hum Reprod Sci 2022; 15:90-95. [PMID: 35494196 PMCID: PMC9053346 DOI: 10.4103/jhrs.jhrs_1_22] [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: 01/02/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Ectopic pregnancy (EP) defined as extrauterine implantation of the embryo can be managed medically or surgically. Medical management entails systemic administration of the antineoplastic drug methotrexate (MTX) which, if not successful, surgical management is resorted to. However, we carried out this study wherein the failed medical management cases were given intra-gestational sac MTX instead of surgery. Aim: The aim of this study was to assess the efficacy of intra-gestational MTX administration as a treatment modality for failed medical management of ectopic pregnancies. Study Setting and Design: It was a prospective interventional study carried out at the Reproductive Medicine Centre of a tertiary care hospital. Materials and Methods: It was a prospective interventional study wherein 12 patients of EP with failed medical management (as per established criteria) were administered intra-gestational MTX with follicle aspiration needle under transvaginal sonography guidance. Statistical Analysis Used: Data were collected in Microsoft Excel. Numerical continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as count/percentage. Results: All the patients responded to the local administration of MTX, with none requiring rescue surgery. In addition, no one had any complication of the local instillation. However, one patient required an additional dose of MTX. Conclusion: Intra-gestational MTX administration is a viable non-surgical modality for treatment of ectopic pregnancies even in cases of failed medical management with an added benefit of tubal preservation.
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10
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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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Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment. Chin Med J (Engl) 2021; 133:2054-2060. [PMID: 32810048 PMCID: PMC7478417 DOI: 10.1097/cm9.0000000000001058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Ectopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP. Results The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ2 = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ2 = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ2 = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ2 = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ2 = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706–5.897, P < 0.001). Conclusions In IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.
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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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Fang T, Chen M, Yu W, Ma T, Su Z, Chan DYL, Zhao M, Zheng Q, Wang W. The predictive value of endometrial thickness in 3117 fresh IVF/ICSI cycles for ectopic pregnancy. J Gynecol Obstet Hum Reprod 2021; 50:102072. [PMID: 33508484 DOI: 10.1016/j.jogoh.2021.102072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the predictive value of endometrial thickness (EMT) during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles for ectopic pregnancy (EP). METHODS A total of 3068 patients with 3117 fresh IVF/ICSI cycles between January 2016 and February 2019 from the Reproductive Medicine Center of Sun Yat-Sen Memorial Hospital were included in this retrospective study. The patients were divided into an EP group (n = 92) and an intrauterine pregnancy (IUP) group (n = 3025). Multiple logistic regression analysis was conducted to evaluate the EP risk factors. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the risk factors for EP and calculate the cutoff value of EMT for EP prediction. RESULTS The incidence rate of EP was 2.95 % (92/3117). After adjustment for other factors in the logistic regression model, the incidence of EP decreased by 55 % with an EMT > 10 mm compared with an EMT ≤ 10 mm (odds ratio 0.450, 95 % confidence interval 0.296-0.684, P < 0.001). The EMT in the EP group was significantly thinner than that in the live birth (n = 2540) and spontaneous abortion (n = 485) groups (p < 0.017). The cutoff value of EMT for EP prediction was 10.65 mm, with a sensitivity of 59 % and a specificity of 63 %. CONCLUSION A decreased risk of EP was found among the patients with an EMT > 10 mm prior to embryo transfer. A certain EMT is needed to reduce the incidence of EP.
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Affiliation(s)
- Tingfeng Fang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Manqi Chen
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Wenchang Yu
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Tingting Ma
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - Zheng Su
- Department of Plastic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China
| | - David Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Block E, 1F, Special Block, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Mingpeng Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Block E, 1F, Special Block, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Qiaolan Zheng
- Journal Center of the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou, 510630, PR China
| | - Wenjun Wang
- Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou, 510120, PR China.
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Ectopic Pregnancy Risk with Assisted Reproductive Technology. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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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Bi Y, She Y, Tian Z, Wei Z, Huang Q, Liao S, Ye Y, Qin A, Yang Y. Efficacy and safety of laparoscopy versus local injection with absolute ethanol in the management of tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100032. [PMID: 31403121 PMCID: PMC6687442 DOI: 10.1016/j.eurox.2019.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety between laparoscopy and local injection with absolute ethanol (AE) for treating tubal ectopic pregnancy (EP). STUDY DESIGN Retrospective cohort study of ectopic pregnancies in the fallopian tube from two tertiary hospitals between January 2015 and December 2017. Clinical information such as presenting symptoms, reproductive history, possible risk factors, initial diagnosis, serum beta-human chor-ionic gonadotropin (β-HCG) level, transvaginal ultrasonography findings, methods of treatment and outcomes were reviewed and analyzed. RESULTS A total of 119 patients were identified for this study. The diagnosis was based on clinical manifestations, ultrasonography scan and dynamic serum β-HCG. 71.4% of women (85/119) had at least one risk factor for ectopic pregnancy, with the most common risk factors being a history of induced labor, uterine curettage, spontaneous abortion or tubal pregnancy. 64 patients were managed by laparoscopic surgery (Group A) and 2 subjects were failure and followed by a systemic methotrexate (MTX) prescription. The other 55 patients had local injection with absolute ethanol, of which 9 cases failed, followed by a second local injection and intramuscular MTX. The HCG decrease rate post absolute ethanol injection was a value predictive factor for prognosis. Moreover, the pregnancy rate one-year post treatment in local injection subjects (10/55, 18.2%) was higher than that of surgical subjects (5/64, 7.8%). CONCLUSION Local injection of absolute ethanol and laparoscopic surgery for tubal ectopic pregnancy are both effective and relatively safe, but laparoscopic surgery has better efficacy and shorten hospitalization day. Local injection may be less invasiveness and thus beneficial to fertility preservation.
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Affiliation(s)
- Yin Bi
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yuanping She
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
| | - Zhengping Tian
- Center of Reproductive Medicine, The Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
| | - Zhiyao Wei
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Qiuyan Huang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shengbin Liao
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yuan Ye
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
| | - Aiping Qin
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yihua Yang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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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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Mokhtari Zanjani P, Ahmadnia E, Kharaghani R. Ectopic pregnancy rate in Iranian midwifery clients and infertile patients treated by assisted reproductive technologies. J Evid Based Med 2019; 12:56-62. [PMID: 30426707 DOI: 10.1111/jebm.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 10/14/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There are some studies on the prevalence of ectopic pregnancy (EP) in a different population of Iranian women. This study aimed to estimate the ectopic pregnancy prevalence in obstetrical clients and infertile patients treated by assisted reproductive technologies in Iran. METHODS International and national databases including PubMed, Web of Science, Ovid, Scopus, ScienceDirect, Magiran, Iran doc, and Iran Medex were searched up to January 2016. Also, conference databases were searched. All studies in which, the ectopic pregnancy prevalence in Iranian obstetrical clients and infertile patients treated by assisted reproductive technologies were reported, included and reviewed. Data of studies were extracted into a standard data sheet. Meta-analysis was conducted by a random-effects model with 95% confidence interval. RESULTS Eight studies were included, involving overall 571 826 women of whom 1446 had an ectopic pregnancy. The overall prevalence of ectopic pregnancy in obstetrical units of the hospitals and assisted reproductive technologies patients was 2.9 (95% CI: 2.1, 3.7) and 53 (95% CI: 20.4, 85.6) per 1000 clients, respectively. CONCLUSION There is limited evidence on the ectopic pregnancy prevalence in Iranian obstetrical clients and assisted reproductive technologies patients. Furthermore, a significant heterogeneity existed between the results. So, more population-based studies on national data are needed for the exact estimation of the ectopic pregnancy prevalence in Iran.
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Affiliation(s)
- Pouran Mokhtari Zanjani
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elahe Ahmadnia
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Roghieh Kharaghani
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
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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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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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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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Zhang B, Cui L, Tang R, Ding L, Yan L, Chen ZJ. Reduced Ectopic Pregnancy Rate on Day 5 Embryo Transfer Compared with Day 3: A Meta-Analysis. PLoS One 2017; 12:e0169837. [PMID: 28121989 PMCID: PMC5266274 DOI: 10.1371/journal.pone.0169837] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/22/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To compare the risk of ectopic pregnancy (EP) after embryo transfer on day 3(D3-ET) and day 5(D5-ET). DESIGN Meta-analysis. PATIENTS Women with pregnancy resulting from in vitro undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). RESULT(S) Twenty-two studies were identified through research conducted using the PubMed, Embase, and Cochrane databases and ClinicalTrials.gov. All studies were conducted prior to October 2016. Adding the reproductive data from our center, a total of 143 643 pregnancies were reviewed(D3-ET: n = 62027,D5-ET:n = 81616). A lower EP rate was found in women undergoing D5-ET than in those undergoing D3-ET [relative risk (RR), 0.67;95% confidence interval (CI), 0.54-0.85;143643 pregnancies in 23 studies; I2 = 67%]. These results were validated in subgroups of fresh embryo-transfer (Fre-ET) cycles [RR, 0.78; 95%CI, 0.69-0.88; 91 871 pregnancies in 21 studies; I2 = 29%] and frozen-thawed embryo-transfer (Fro-ET) cycles [RR, 0.43; 95%CI, 0.36-0.51; 51 772 pregnancies in 10 studies; I2 = 33%]. After separating out the randomized controlled trials (RCTs), a significant difference was found in the retrospective studies in both subgroups [both Fre-ET (RR,0.78;95% CI 0.69-0.88);91182 pregnancies in 14 studies; I2 = 45%] and Fro-ET(RR,0.43;95% CI 0.36-0.51; 51751pregnancies in 9 studies;I2 = 33%)], while the RCTs showed no statistical significance for Fre-ET cycles[RR,0.86;95% CI 0.32-2.26); 689 pregnancies in 7 studies; I2 = 0%]. CONCLUSION(S) The present study indicates that D5-ET reduces the risk for EP in cycles that use IVF or ICSI, compared with D3-ET. It suggests that D5-ET may be a better choice for decreasing the EP rate in assisted reproductive technology. Further high-quality randomized controlled trials are anticipated.
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Affiliation(s)
- Bingqian Zhang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Linlin Cui
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Rong Tang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Lingling Ding
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
- * E-mail: (ZC); (LY)
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China
- The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- * E-mail: (ZC); (LY)
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23
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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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Risk factors for ectopic pregnancy in assisted reproductive technology: a 6-year, single-center study. Fertil Steril 2016; 106:90-94. [PMID: 27001382 DOI: 10.1016/j.fertnstert.2016.02.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore factors affecting the incidence of ectopic pregnancy (EP) in assisted reproductive technology (ART). DESIGN A retrospective cohort study on the incidence of EPs in IVF/intracytoplasmic sperm injection (ICSI) and IUI cycles from June 2009 to August 2015. Age of patients, tubal factor infertility, type of cycle (fresh or thawed), embryo being transferred (cleavage embryo or blastocyst), and number of embryos transferred were analyzed to explore their relationship with the incidence of EP. SETTING Teaching hospital. PATIENT(S) A total of 18,432 pregnancies resulting from ART treatment were retrospectively analyzed. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Ectopic pregnancy rate. RESULT(S) For IVF/ICSI cycles, the incidence of EP was different between cycles transferred with cleavage embryo and blastocyst (3.45% vs. 2.47%). In multivariate logistic regression analysis, tubal infertility was associated with EP (adjusted odds ratio 1.716, 95% confidence interval 1.444-2.039). For IUI cycles, EP was significantly higher in stimulated cycles compared with natural cycles (2.62% vs. 0.99%). The EP rate in cycles with sperm from donor and husband was 1.08% and 3.54%, respectively. However, when patients were stratified according to tubal infertility, the EP rate increased with level of peak estrogen. In thawed embryo transfer cycles, the EP rate was lower in blastocyst transfer cycles and in cycles transferred with fewer embryos. CONCLUSION(S) Irrespective of tubal infertility, for fresh IVF/ICSI cycles the rate of EP is positively associated with ovarian stimulation; for thawed IVF/ICSI cycles, blastocyst transfer or transfer with fewer embryos reduces the EP rate. In IUI cycles, EP is associated with sperm source.
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