DIAGNOSIS OF ECTOPIC PREGNANCY AFTER IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER

Objective: The combination of transvaginal sonography and serum hCG me asurement is reliable in the diagnosis of ectopic pregnancy (EP) in sp ontaneous pregnancies. In patients who became pregnant through IVF-ET, transfer of multiple embryos after IVF could be responsible for the d ifferent performance of these tests. We evaluated the discriminative c apacity of transvaginal sonography in combination with hCG measurement in the diagnosis of EP after IVF-ET. Design: Prospective cohort study . Setting and Patient(s): Consecutive patients, pregnant through IVF-E T, who presented with clinically suspected EP. Intervention(s): Transv aginal sonography, serum hCG measurement at 6, 9, and 15 days after ET and after a negative transvaginal sonography. Main outcome measure(s) : Ectopic pregnancy confirmed at laparoscopy. Result(s): Between Septe mber 1993 and May 1996, 86 women were included in the study, of whom 2 4 had an EP. Transvaginal sonography identified 46 intrauterine pregna ncies and 5 EPs, but serum hCG could not diagnose EPs in patients in w hom transvaginal sonography did not show a gestational sac. Serum hCG measurement 9 days after ET could identify pregnancy failure with 100% specificity at a cut-off value of 18 IU/L, but it could not identify patients with EP with enough certainty to justify immediate treatment. Conclusion(s): We recommend single serum hCG measurement 9 days after ET to discriminate between viable and nonviable pregnancies. Transvag inal sonography can be postponed until 5 weeks after ET, except for pa tients with abdominal pain and/or vaginal bleeding, or patients with a serum hCG level of <18 IU/L. (C) 1997 by American Society for Reprodu ctive Medicine.