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63 - Ectopic and Heterotopic Pregnancies Following in Vitro Fertilization

from PART III - ASSISTED REPRODUCTION

Published online by Cambridge University Press:  04 August 2010

By
Ziad R. Hubayter  and
Suheil J. Muasher
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Ectopic pregnancy is defined as an abnormal implantation of the conceptus in a location outside the uterine cavity. Heterotopic pregnancy is when there are concomitant intrauterine and extrauterine pregnancies (1). Ectopic pregnancy is a life-threatening condition and is one of the leading causes of maternal mortality. It accounts for 9 percent of all pregnancy-related deaths and is the most common etiology of maternal deaths in the first trimester (2).

Assisted reproductive technologies (ART) are associated with several medical complications. These include ovarian hyperstimulation syndrome, bleeding, infections (ovarian abcess and endometritis), and a higher incidence of ectopic pregnancies. The incidence of ectopic pregnancies is increased in ART due to a higher number of embryos transferred and a higher prevalence of tubal disease in patients undergoing in vitro fertilization (IVF) (3).

Abulcasis was the first to describe an ectopic pregnancy in the tenth century AD. He was an Arabic writer and one of the first to perform and discuss different types of surgical procedures. He discussed a case where he was able to retrieve fetal parts from a draining abdominal wound (4). Riolan, in the early seventeenth century, described a woman who died at four months of gestation. She presented with acute abdominal pain and syncope. Later, a fetus was identified in one of her fallopian tubes (5). In 1708, Duverney described a heterotopic pregnancy on autopsy (4).

Keywords

ectopic pregnanciesheterotopic pregnancieshuman chorionic gonadotropinlaparoscopymifepristonemethotrexatesalpingectomylaparotomyultrasound technology
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 619 - 628
Publisher: Cambridge University Press
Print publication year: 2008

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References

Barbieri, RL, Hornstein, MD. Assisted reproduction. In: Strauss, JF, Barbieri, RL, eds. Yen and Jaffe's Reproductive Endocrinology. Fifth edn. Elsevier Saunders, Philadelphia, 2004: 839–73.Google Scholar
Ectopic pregnancy – United States, 1990-1992. MMWR Morb Mortal Wkly Rep 1995; 44: 46–8.
Rizk, B, Tan, SL, Morcos, S, et al. Heterotopic pregnancies following in-vitro fertilization and embryo transfer. Am J Obstet Gynecol. 1991; 164(1): 161–4.CrossRefGoogle Scholar
Abusheikha, N, Marcus, SF. Ectopic pregnancy following assisted reproductive technology. In: Brinsden, PR, ed. A Textbook of In Vitro Fertilization and Assisted Reproduction. The Bourn Hall Guide to Clinical and Laboratory Practice, second edn. The Parthenon Publishing Group Inc., Pearl River, 1999: 333–42.Google Scholar
Jain, A, Solima, E, Luciano, AA. Ectopic pregnancy. J Am Assoc Gynecol Laparosc 1997; 4: 513–31.CrossRefGoogle ScholarPubMed
Department of Health and Human Services. CDC. 2002 Assisted Reproductive Technology (ART) Report, 2002. (Accessed December 1, 2006, at http://www.cdc.gov/ART/ART02/index.htm).
Rizk, B, Morcos, S, Avery, S, et al. Rare ectopic pregnancies after in-vitro fertilization: one unilateral twin and four bilateral tubal pregnancies. Hum Reprod 1990; 5(8): 1025–28.CrossRefGoogle ScholarPubMed
Rizk, B, Lachelin, GCL, Davies, MC, et al. Ovarian pregnancy following in-vitro fertilization and embryo transfer. Hum Reprod 1990; 5(6): 763–4.CrossRefGoogle ScholarPubMed
Dimitry, ES, Rizk, B. Ectopic pregnancy: epidemiology, advances in diagnosis and management. Brit J Clin Pract 1992; 46(1): 52–4.Google ScholarPubMed
Xiao, HM, Gong, F, Mao, ZH, Zhang, H, Lu, GX. Analysis of 92 ectopic pregnancy patients after in vitro fertilization and embryo transfer. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2006; 31: 584–7.Google ScholarPubMed
Cohen, J, Mayaux, MF, Guihard-Moscato, ML, Schwartz, D. In vitro fertilization and embryo transfer: a collaborative study of 1163 pregnancies on the incidence and risk factors of ectopic pregnancies. Hum Reprod 1986; 1: 255–8.CrossRefGoogle ScholarPubMed
Seeber, BE, Barnhart, KT. Suspected ectopic pregnancy. Obstet Gynecol 2006; 107: 399–413.CrossRefGoogle ScholarPubMed
Tal, J, Haddad, S, Gordon, N, Timor-Tritsch, I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 1996; 66: 1–12.Google ScholarPubMed
Lau, S, Tulandi, T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 1999; 72: 207–15.CrossRefGoogle ScholarPubMed
Bouyer, J, Coste, J, Shojaei, T, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population based study in France. Am J Epidemiol 2003; 157: 185–94.CrossRefGoogle ScholarPubMed
Gemzell, C, Guillome, J, Wang, CF. Ectopic pregnancy following treatment with human chorionic gonadotropins. Am J Obstet Gynecol 1982; 143: 761–5.CrossRefGoogle Scholar
Clayton, HB, Schieve, , Peterson, HB, Jamieson, DJ, Reynolds, MA, Wright, VC. Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol 2006; 107: 595–604.CrossRefGoogle ScholarPubMed
Jun, SH, Milki, AA. Assisted hatching is associated with a higher ectopic pregnancy rate. Fertil Steril 2004; 81: 1701–3.CrossRefGoogle ScholarPubMed
Strandell, A, Thorburn, J, Hamberger, L. Risk factors for ectopic pregnancy in assisted reproduction. Fertil Steril 1999; 71: 282–6.CrossRefGoogle ScholarPubMed
Dumesic, DA, Damario, MA, Session, DR. Interstitial heterotopic pregnancy in a woman conceiving by in vitro fertilization after bilateral salpingectomy. Mayo Clin Proc 2001; 76: 90–2.CrossRefGoogle Scholar
Yovich, JL, Turner, S, Murphy, A. Embryo transfer technique as a cause of ectopic pregnancies in in vitro fertilization. Fertil Steril 1985; 44: 318–21.CrossRefGoogle ScholarPubMed
Knutzen, V, Stratton, CJ, Shee, G, McNamee, PI, Huang, TT, Soto-Albors, C. Mock embryo transfer in early luteal phase, the cycle before in vitro fertilization and embryo transfer: a descriptive study. Fertil Steril 1992; 57: 156–62.CrossRefGoogle ScholarPubMed
Marcus, S, Brinsden, P. Analysis of the incidence and risk factors associated with ectopic pregnancy following in vitro fertilization embryo transfer. Hum Reprod 1995; 10: 199–203.CrossRefGoogle Scholar
Milki, AA, Jun, SH. Ectopic pregnancy rates with day 3 versus day 5 embryo transfer: a retrospective analysis. BMC Pregnancy Childbirth 2003; 3: 7.CrossRefGoogle ScholarPubMed
Dor, J, Seidman, DS, Levran, D, Ben-Rafael, , Ben-Shlomo, I, Mashiach, S. The incidence of combined intrauterine and extrauterine pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1991; 55: 833–4.CrossRefGoogle ScholarPubMed
Rizk, B, Dimitry, ES, Morcos, S, Edwards, RG, et al. A multicenter study on combined intrauterine and extrauterine pregnancy after IVF. 2nd joint meeting of ESHRE and European Sterility Congress Organization, Milan, Italy. August. Reproduction 1990; Abstract No. 377: 113–4.Google Scholar
Rizk, B, Tan, SL, Riddle, A, et al. Heterotopic pregnancy and IVF. British Fertility Society Annual Meeting, The London Hospital, London, England, 1989.Google Scholar
Tang, OS, Ng, EH, So, WW, Ho, PC. Ultrasound-guided embryo transfer: a prospective randomized controlled trial. Hum Reprod 2001; 16: 2310–15.CrossRefGoogle ScholarPubMed
Sallam, HN, Sadek, SS. Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil Steril 2003; 80: 1042–6.CrossRefGoogle ScholarPubMed
Bouyer, J, Coste, J, Fernandez, H, et al. Sites of ectopic pregnancy: a 10 year population based study of 1800 cases. Hum Reprod 2002; 17: 3224–30.CrossRefGoogle ScholarPubMed
Comstock, C, Huston, K, Lee, W. The ultrasonographic appearance of ovarian ectopic pregnancies. Obstet Gynecol 2005; 105: 42–45.CrossRefGoogle ScholarPubMed
Martin, JN Jr., Sessums, JK, Marin, RW, et al. Abdominal pregnancy: current concepts of management. Obstet Gynecol 1988; 71: 549–57.Google ScholarPubMed
Maymon, R, Halperin, R, Mendlovic, S. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 2004; 19: 278–84.CrossRefGoogle ScholarPubMed
Pisarska, MD, Carson, SA, et al. Ectopic pregnancy. Lancet 1998; 351: 1115–20.CrossRefGoogle ScholarPubMed
Job-Spira, N, Fernandez, H, Bouyer, J, et al. Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. Am J Obstet Gynecol 1999; 180: 938–44.CrossRefGoogle ScholarPubMed
Kadar, N, Caldwell, BV, Romero, R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol 1981; 58: 162–6.Google ScholarPubMed
Barnhart, K, Sammel, MD, Rinaudo, PF, Zhou, L, Hummel, AC, Guo, W. Symptomatic patients with an early viable intrauterine pregnancy: hCG curves redefined. Obstet Gynecol 2004; 104: 50–5.CrossRefGoogle ScholarPubMed
Barnhart, K, Sammel, MD, Chung, K, Zhou, L, Hummel, AC, Guo, W. Decline of serum human chorionic gonadotropin and spontaneous complete abortion: defining the normal curve. Obstet Gynecol 2004; 104: 975–81.CrossRefGoogle ScholarPubMed
Glastein, IZ, Hornstein, MD, Kahana, MJ, et al. The predictive value of discriminatory human chorionic gonadotropin levels in the diagnosis of implantation outcome in in vitro fertilization cycles. Fertil Steril 1995; 63: 350–6.Google Scholar
Mol, BW, Veen, VF, Hajenius, JP, et al. Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1997; 68: 1027–32.CrossRefGoogle ScholarPubMed
Chen, CD, Ho, HN, Wu, MY, Chao, KH, Chen, SU, Yang, YS. Paired human chorionic gonadotropin determination for the prediction of pregnancy outcome in assisted reproduction. Hum Reprod 12: 2538–41.CrossRef
Rizk, B, Marcus, S, Fountain, S, et al. The value of transvaginal sonography and hCG in the diagnosis of heterotopic pregnancy. 9th Annual meeting of the ESHRE, Thessaloniki, June. Hum Reprod 1993; Abstract No. 102.Google Scholar
Levi, CS, Lyons, EA, Lindsay, DJ. Ultrasound in the first trimester. Radiol Clin North Am 1990; 28: 19–38.Google ScholarPubMed
Tongsong, T, Pongsatha, S. Transvaginal sonographic features in diagnosis of ectopic pregnancy. Int J Gynaecol Obstet 1993; 43: 277–83.CrossRefGoogle ScholarPubMed
Brown, DL, Doubilet, PM. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 1994; 13: 259–66.CrossRefGoogle ScholarPubMed
Pellerito, JS, Taylor, KJ, Quedens-case, C, et al. Ectopic pregnancy: evaluation with endovaginal color flow imaging. Radiology 1992; 183: 407–11.CrossRefGoogle ScholarPubMed
Kirchler, HC, Seebarcher, S, Alge, AA, Muller-Holzner, E, Fessler, S, Kolle, D. Obstet Gynecol 1993; 82: 561–5.
Condous, G, Okaro, E, Khalid, A, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Fertil Steril 2005; 20: 1404–9.Google Scholar
Fernandez, H, Gervaise, A. Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 2004; 10: 503–13.CrossRefGoogle ScholarPubMed
Bassil, S, Gordts, S, Nisolle, M, Beers, B, Donnez, J. A magnetic resonance imaging approach for the diagnosis of a triplet corneal pregnancy. Fertil Steril 1995; 64(5): 1029–31.CrossRefGoogle Scholar
Ginsburg, ES, Frates, MC, Rein, MS, Fox, JH, Hornstein, MD, Friedman, AJ. Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program. Fertil Steril 1994; 61: 966–9.CrossRefGoogle Scholar
Kataoka, ML, Togashi, K, Kobayashi, H, Inoue, T, Fuji, S, Konishi, J. Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod 1999; 14: 2644–50.CrossRefGoogle ScholarPubMed
Takeuchi, K, Yamada, T, Oomori, S, Ideta, K, Moriyama, T, Maruo, T. Comparison of magnetic resonance imaging and ultrasonography in the early diagnosis of interstitial pregnancy. J Reprod Med 1999; 44: 265–8.Google ScholarPubMed
Izquierdo, , Nicholas, MC. Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound 2003; 31: 484–7.CrossRefGoogle ScholarPubMed
Ioannidis, G, Sacks, G, Reddy, N, et al. Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study. Hum Reprod 2005; 20: 741–6.CrossRefGoogle ScholarPubMed
Mol, BW, Lijmer, JG, Ankum, WM, et al. The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis. Hum Reprod 1998; 13: 3220–7.CrossRefGoogle Scholar
McCord, ML, Muram, D, Buster, JE, et al. Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance. Fertil Steril 1996; 66: 513–16.CrossRefGoogle ScholarPubMed
Daniel, Y, Geva, E, Lerner-Geva, L, et al. Levels of vascular endothelial growth factor are elevated in patients with ectopic pregnancy: is this a novel marker?Fertil Steril 1999; 72: 1013–17.CrossRefGoogle ScholarPubMed
Fasouliotis, SJ, Spandorfer, SD, Witkin, SS, Liu, HC, Roberts, JE, Rosenwaks, Z. Maternal serum vascular endothelial growth factor levels in early ectopic and intrauterine pregnancies after in vitro fertilization treatment. Feril Steril 2004; 82: 309–13.CrossRefGoogle ScholarPubMed
Saha, PK, Gupta, I, Ganguly, NK. Evaluation of serum creatine kinase as a diagnostic marker for tubal pregnancy. Aust NZ J Obstet Gynaecol 1999; 39: 366–7.CrossRefGoogle ScholarPubMed
Lipscomb, GH, Bran, D, McCord, ML, Portera, JC, Ling, FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol 1998; 178: 1354–8.CrossRefGoogle ScholarPubMed
Lipscomb, GH, Givens, VA, Meyer, NL, Bran, D. Previous ectopic pregnancy as a predictor of failure of systemic methotrexate therapy. Fertil Steril 2004; 81: 1221–4.CrossRefGoogle ScholarPubMed
Lipscomb, GH, McCord, ML, Stovall, TG, Huff, G, Portera, G, Ling, FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999; 341: 1974–8.CrossRefGoogle ScholarPubMed
Bixby, S, Tello, R, Kuligowska, E. Presence of yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultrasound Med 2005; 24: 591–8.CrossRefGoogle ScholarPubMed
Sowter, MC, Farquhar, CM, Petrie, KJ, Gudex, G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. Br J Obstet Gynecol 2001; 108: 192–203.Google ScholarPubMed
Sowter, MC, Farquhar, CM, Gudex, G. An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy. Br J Obstet Gynecol 2001; 108: 204–12.Google ScholarPubMed
Medical management of tubal pregnancy. ACOG Practice bulletin #3. American College of Obstetricians and Gynecologists, 1998.
Barnhart, KT, Gosman, G, Ashby, R, Sammel, M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol 2003; 101: 778–84.Google ScholarPubMed
Alleyassin, A, Khademi, A, Aghahosseini, M, Safdarian, L, Badenoosh, B, Hamed, EA. Comparison of success rates in the medical management of ectopic pregnancy with single dose and multiple dose administration of methotrexate: a prospective, randomized clinical trial. Fertil Steril 2006; 85: 1661–6.CrossRefGoogle ScholarPubMed
Lipscomb, GH, Givens, VM, Meyer, NL, Bran, D. Comparison of multidose and single dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol 2005; 192: 1844–7.CrossRefGoogle ScholarPubMed
Lipscomb, GH, Meyer, NL, Flynn, , Peterson, M, Ling, FW. Oral methotrexate for treatment of ectopic pregnancy. Am J Obstet Gynecol 2002; 186: 1192–5.CrossRefGoogle ScholarPubMed
Fernandez, H, Benifla, JL, Lelaidier, C, Baton, C, Frydman, R. Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control. Fertil Steril 1993; 59: 773–7.CrossRefGoogle ScholarPubMed
Fernandez, H, Yves Vincent, SC, Pauthier, S, et al. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility. Hum Reprod 1998; 13: 3239–43.CrossRefGoogle ScholarPubMed
Tzafettas, JM, Stephanatos, A, Loufopoulos, A, et al. Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies. Fertil Steril 1999; 71: 1010–13.CrossRefGoogle ScholarPubMed
Oyawoye, S, Chander, B, Pavlovic, B, Hunter, J, Abdel Gadir, A. Heterotopic pregnancy with aspiration of corneal/interstitial gestational sac and instillation of small dose of methotrexate. Fetal diagn ther 2003; 18: 1–4.CrossRefGoogle ScholarPubMed
Rozenberg, P, Chevret, S, Camus, E, et al. Medical treatment of ectopic pregnancies: a randomized clinical trial comparing methotrexate-mifepristone and methotrexate-placebo. Hum Reprod 2003; 18: 1802–8.CrossRefGoogle ScholarPubMed
Lipscomb, GH, Stovall, TG, Ling, FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med 2000; 343: 1325–9.CrossRefGoogle ScholarPubMed
Murphy, AA, Kettel, LM, Nager, CW, et al. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril 1992; 57: 1180–5.CrossRefGoogle ScholarPubMed
Vermesh, M, Silva, PD, Rosen, GF, et al. Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989; 73: 400–4.Google ScholarPubMed
Hajenius, PJ, Mol, BW, Bossuyt, PM, Ankum, WM, Veen, F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2000; (2):CD000324.CrossRefGoogle ScholarPubMed
Silva, PD, Schaper, AM, Rooney, B. Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy. Obstet Gynecol 1993; 81: 710–15.Google ScholarPubMed
Dubuisson, JB, Morice, P, Chapron, C, Gayffier, A, Mouelhi, T. Salpingectomy—the laparoscopic surgical choice for ectopic pregnancy. Hum Reprod 1996; 11: 1199–203.CrossRefGoogle ScholarPubMed
Mueller, MD. Ectopic pregnancy. In: Lebovic, DI, Gordon, JD, Taylor, RN, Eds. Reproductive Endocrinology and Infertility – Handbook for Clinicians. First edn. Scrub Hill Press, Inc., Arlington, 2005: 113–23.Google Scholar
Tulandi, T. Surgical treatment of ectopic pregnancy and prognosis for subsequent fertility. In: Rose, BD ed. UpToDate. Waltham, MA, 2006.Google Scholar
Trio, D, Stoblet, N, Picciolo, C, et al. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril 1995; 63: 15–19.CrossRefGoogle ScholarPubMed
Shalev, E, Peleg, D, Tsabari, A, et al. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril 1995; 63: 469–72.CrossRefGoogle ScholarPubMed
Lemus, JF. Ectopic pregnancy: an update. Curr Opin Obstet Gynecol 2000; 12: 369–75.CrossRefGoogle ScholarPubMed

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