Tubal ectopic pregnancy after in vitro fertilization and embryo transfer: a role for proximal occlusion or salpingectomy after failed distal tubal surgery?
OBJECTIVE
To assess predisposing factors to tubal pregnancy after in vitro fertilization-embryo transfer (IVF-ET).


METHODS
Retrospective analysis of 891 ET cycles.


METHODS
University-based IVF program.


METHODS
All ET cycles performed in the study period were included; the indication for IVF was tubal factor in 640 (72%) and other (nontubal) factors in 251 (28%) cycles.


METHODS
None.


METHODS
Observing a higher than expected number of tubal pregnancies in our program; we examined subgroups to determine those at highest risk.


RESULTS
Tubal pregnancies comprised 12% of clinical pregnancies in the tubal factor group but only 2.6% in the cycles nontubal factor group (P less than 0.05). Of 640 ET cycles in the tubal factor group, 359 were performed in patients who had prior tubal reconstructive surgery; tubal pregnancies comprised 15.6% of the clinical gestations in this subgroup. In the remainder of the tubal factor group (no prior tubal surgery), 281 ET cycles yielded a tubal pregnancy rate of only 5.5% (P less than 0.05).


CONCLUSIONS
Women with prior reconstructive surgery for distal tubal disease are at highest risk of developing tubal pregnancy after IVF.
Zouves
C
C
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Erenus
M
M
Gomel
V
V
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D004624:Embryo Transfer; D005184:Fallopian Tube Diseases / Q000150:complications / Q000601:surgery*; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D008596:Menotropins / Q000627:therapeutic use; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000209:etiology*; D012189:Retrospective Studies
D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins