title: Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer.
abstract: OBJECTIVE
  The combination of transvaginal sonography and serum hCG measurement is reliable in the diagnosis of ectopic pregnancy (EP) in spontaneous pregnancies. In patients who became pregnant through IVF-ET, transfer of multiple embryos after IVF could be responsible for the different performance of these tests. We evaluated the discriminative capacity of transvaginal sonography in combination with hCG measurement in the diagnosis of EP after IVF-ET.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Consecutive patients, pregnant through IVF-ET, who presented with clinically suspected EP.
  
  
  METHODS
  Transvaginal sonography, serum hCG measurement at 6, 9, and 15 days after ET and after a negative transvaginal sonography.
  
  
  METHODS
  Ectopic pregnancy confirmed at laparoscopy.
  
  
  RESULTS
  Between September 1993 and May 1996, 86 women were included in the study, of whom 24 had an EP. Transvaginal sonography identified 46 intrauterine pregnancies and 5 EPs, but serum hCG could not diagnose EPs in patients in whom 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.
  
  
  CONCLUSIONS
  We recommend single serum hCG measurement 9 days after ET to discriminate between viable and nonviable pregnancies. Transvaginal sonography can be postponed until 5 weeks after ET, except for patients with abdominal pain and/or vaginal bleeding, or patients with a serum hCG level of < 18 IU/L.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands. bwmol@knmg.nl
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: P J
authors.initials: PJ
authors.lastname: Hajenius
authors.forename: S
authors.initials: S
authors.lastname: Engelsbel
authors.forename: W M
authors.initials: WM
authors.lastname: Ankum
authors.forename: H V
authors.initials: HV
authors.lastname: Hogerzeil
authors.forename: D J
authors.initials: DJ
authors.lastname: Hemrika
authors.forename: P M
authors.initials: PM
authors.lastname: Bossuyt
mesh_terms: D000328:Adult; D000465:Algorithms; D006063:Chorionic Gonadotropin / Q000097:blood; D003937:Diagnosis, Differential; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014621:Vagina
chemical_list: D006063:Chorionic Gonadotropin