THE PREDICTION OF ECTOPIC PREGNANCY AFTER IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER

Data from 135 patients who suffered ectopic pregnancies and from 135 p atients who progressed to singleton deliveries after in-vitro fertiliz ation and embryo transfer have been analysed retrospectively. The ecto pic pregnancies represent all such cases observed at Bourn Hall Clinic between 1983 and 1993, The delivered group was randomly selected from the same time period. The ectopic pregnancies included 20 heterotopic , eight ovarian and six bilateral tubal pregnancies; the remainder wer e singleton tubal pregnancies. The aim of this study was to identify t he variables which differed systematically for the two groups of patie nts and to explore whether such variables could be used to predict ect opic pregnancy at an early stage. The mean plasma concentration of hum an chorionic gonadotrophin and progesterone for the ectopic pregnancy group was significantly lower than that for the singleton delivery gro up (P < 0.001). However there was such a degree of overlap that it was impossible to devise a cut-off concentration for either hormone which would offer a clinically useful predictor of ectopic pregnancy. Never theless, using the discriminant function analysis of these data, toget her with the history of pelvic inflammatory disease, we could predict up to 90% of cases of ectopic pregnancy by day 23 after embryo transfe r, long before ultrasound imaging would be useful.