title: Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization.
abstract: OBJECTIVE
  To evaluate a prospectively implemented clinical algorithm for early identification of ectopic pregnancy (EP) and heterotopic pregnancy (HP) after assisted reproductive technology (ART).
  
  
  METHODS
  Analysis of prospectively collected data.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  All ART-conceived pregnancies between January 1995 and June 2013.
  
  
  METHODS
  Early pregnancy monitoring via clinical algorithm with all pregnancies screened using human chorionic gonadotropin (hCG) levels and reported symptoms, with subsequent early ultrasound evaluation if hCG levels were abnormal or if the patient reported pain or vaginal bleeding.
  
  
  METHODS
  Algorithmic efficiency for diagnosis of EP and HP and their subsequent clinical outcomes using a binary forward stepwise logistic regression model built to determine predictors of early pregnancy failure.
  
  
  RESULTS
  Of the 3,904 pregnancies included, the incidence of EP and HP was 0.77% and 0.46%, respectively. The algorithm selected 96.7% and 83.3% of pregnancies diagnosed with EP and HP, respectively, for early ultrasound evaluation, leading to earlier treatment and resolution. Logistic regression revealed that first hCG, second hCG, hCG slope, age, pain, and vaginal bleeding were all independent predictors of early pregnancy failure after ART.
  
  
  CONCLUSIONS
  Our clinical algorithm for early pregnancy evaluation after ART is effective for identification and prompt intervention of EP and HP without significant over- or misdiagnosis, and avoids the potential catastrophic morbidity associated with delayed diagnosis.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa. Electronic address: lisa-cookingham@uiowa.edu.
authors.forename: Lisa Marii
authors.initials: LM
authors.lastname: Cookingham
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Goossen
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa.
authors.forename: Amy E T
authors.initials: AET
authors.lastname: Sparks
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa.
authors.forename: Eyup Hakan
authors.initials: EH
authors.lastname: Duran
mesh_terms: D000328:Adult; D000465:Algorithms; D016208:Databases, Factual / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D006801:Humans; D007246:Infertility / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011258:Pregnancy Tests / Q000379:methods; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ART; IVF; algorithm; ectopic; heterotopic