RISK-FACTORS FOR ECTOPIC PREGNANCY AFTER IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER

Purpose: To find the incidence of ectopic pregnancy (EP) in patients w ho conceived in the IVF-ET program, and risk factors affecting the occ urrence of EP. Methods: We analyzed the effects of the indication for IVF, type of ovarian stimulation (hMG + hCG vs. GnRH + hMG + hCG), typ e of embryo transfer (transcervical intratubal, intrauterine in chest- knee position and intrauterine in lithotomy position) and number of em bryos transferred on the occurrence of EP. EP was treated by laparotom y, prostaglandin E(2) or laparoscopic surgery. Results: In 7991 stimul ated and 92 natural cycles treated in the Ljubljana IVF-ET program bet ween May 1983 and June 1994 we achieved 1059 pregnancies, of which 44 were ectopic (incidence 4.1%), the main risk being tubal factor infert ility. There were 38 (86.3%) tubal, 3 (6.8%) heterotopic, 1 (2.4%) ova rian, and 2 (4.5%) cornual EP. In two patients multiple tubal EP occur red (1 twin, 1 triplet), Forty-two patients (95.4%) had tubal factor i nfertility, 1 (2.3%) unexplained, and 1 (2.3%) patient had male factor . The incidence of EP in patients with tubal infertility was 5.4%, in patients with unexplained infertility 2.0% and in those with male fact or 0.9%. There appealed to be no col relation between the two superovu latory methods, With transcervical intrauterine ET the incidence of EP was 0 of 5 clinical pregnancies (CP); with intrauterine in chest-knee position it was 26 (3.5%) of 738 CP; with intrauterine in lithotomy p osition it was 17 (5.4%) of 316 CP, The difference between the two typ es of intrauterine ET is not statistically significant, The incidence of EP did not cor relate with the number of embryos transferred. The a verage initial values of beta hCG performed 17 days after ET were sign ificantly lower in patients with EP than in those with normal singleto n pregnancy (157 +/- 143 mIU/ml vs. 408 +/- 148 mIU/ml). Conclusions: EP can complicate the IVF procedure. The main risk factor is tubal inf ertility with or without previous tubal surgery, The low initial value of beta hCG has a strong predictive value in the diagnosis of EP.