title: Pregnancies of unknown location after in vitro fertilization: minimally invasive management with Karman cannula aspiration.
abstract: OBJECTIVE
  To describe a standardized protocol for the assessment of asymptomatic patients with pregnancies of unknown location (PUL) after IVF.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-based infertility clinic.
  
  
  METHODS
  Women undergoing fresh IVF/intracytoplasmic sperm injection (ICSI) cycles between 2005 and 2011.
  
  
  METHODS
  Endometrial sampling using Karman suction cannula in patients with PUL and abnormal β-hCG trend (increase <53% or decrease <15% in 2 days) and a pelvic ultrasound unremarkable for an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP).
  
  
  METHODS
  Proportion of patients spared methotrexate (MTX) administration.
  
  
  RESULTS
  Endometrial sampling was performed in 45 patients. Of these, 31 (68.9%) were diagnosed with failed IUP by either a sampling after the β-hCG decline (≥15%) and/or the presence of villi on final pathology. No further intervention was required. Fourteen patients (31.1%) were diagnosed with presumed EP by persistent β-hCG level after negative pathology. Ten of these patients (71%) were successfully treated with a single dose of MTX; three required an additional dose, and one required laparoscopy for a ruptured EP.
  
  
  CONCLUSIONS
  In asymptomatic patients with PUL and abnormal β-hCG trends after IVF, the utility of Karman aspiration to confirm an IUP may obviate treatment with MTX in more than two-thirds of patients.
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors: Paula
authors: P
authors: Brady
authors: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani School of Medicine, Tampa, Florida. Electronic address: aimudia@health.usf.edu.
authors: Anthony N
authors: AN
authors: Imudia
authors: Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, Michigan.
authors: Awoniyi O
authors: AO
authors: Awonuga
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors: Diane L
authors: DL
authors: Wright
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors: Aaron K
authors: AK
authors: Styer
authors: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors: Thomas L
authors: TL
authors: Toth
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D013396:Suction / Q000379:methods; D013594:Syringes
keywords: Beta-human chorionic gonadotropin; IVF/ICSI; early pregnancy; ectopic pregnancy; pregnancy of unknown location