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.
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Zouves
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Erenus
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Gomel
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