title: Ectopic pregnancy risk factors for ART patients undergoing the GnRH antagonist protocol: a retrospective study.
abstract: BACKGROUND
  In-vitro fertilization is a known risk factor for ectopic pregnancies. We sought to establish the risk factors for ectopic pregnancy in GnRH antagonist cycles examining patient and stimulation parameters with an emphasis on ovulation trigger.
  
  
  METHODS
  We conducted a retrospective, cohort study of 343 patients undergoing 380 assisted reproductive technology (ART) cycles with the GnRH antagonist protocol and achieving a clinical pregnancy from November 2010 through December 2015.
  
  
  RESULTS
  Significant risk factors for ectopic pregnancy in the univariate analysis included prior Cesarean section (CS), endometriosis, mechanical factor infertility, longer stimulation, elevated estradiol and progesterone levels, GnRH agonist trigger, higher number of oocytes aspirated, and insemination technique. Independent risk factors for ectopic pregnancy in the multivariate analysis included GnRH agonist trigger, higher number of oocytes aspirated, insemination technique, and prior Cesarean section.
  
  
  CONCLUSIONS
  Excessive ovarian response, IVF (as opposed to ICSI), prior Cesarean section and GnRH agonist trigger were found to be independent risk factors for ectopic pregnancy. Caution should be exercised before incorporating the GnRH agonist trigger for indications other than preventing OHSS. When excessive ovarian response leads to utilization of GnRH agonist trigger, strategies for preventing ectopic pregnancy, such as a freeze all policy or blastocyst transfer, should be considered. Further studies should elucidate whether adjusting the luteal support can reduce the ectopic pregnancy risk.
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel. amirwe5@gmail.com.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. amirwe5@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Weiss
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Beck-Fruchter
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Golan
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Lavee
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Geslevich
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Shalev
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D004715:Endometriosis / Q000150:complications; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000150:complications; D007315:Insemination, Artificial / Q000009:adverse effects / Q000379:methods; D015999:Multivariate Analysis; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Ectopic pregnancy; GnRH agonist trigger; In-vitro fertilization; Oocyte maturation