Incidence and management of cesarean scar pregnancies after in vitro fertilization-embryo transfer

Abstract

Objective: To explore the incidence, clinical characteristics, management strategies and reproductive outcomes of cesarean scar pregnancies (CSP) after in vitro fertilization-embryo transfer (IVF-ET). Methods: The patients who were diagnosed with CSP followed IVF/ET in the Center for Reproductive Medicine of Peking University Third Hospital between April 1, 2010 and March 31, 2020 were included. The clinical data of each patient were analyzed retrospectively. Results: There were a total of 1 441 patients with secondary infertility complicated with a history of cesarean section and achieved clinical pregnancy after IVF-ET treatments, of which CSP accounted for 1.94% (28/1 441). The average age of CSP patients was (34±3) years old, and 50.0% (14/28) of the patients had a history of artificial abortion. The incidence of CSP in embryo transfers at the cleavage stage had no significantly difference from transfers at the blastocyst stage (1.74% vs 2.20%, χ(2)=0.408, P=0.523), and the incidence of CSP in fresh embryo transfers had no significantly difference from frozen-thawed embryo transfers (1.77% vs 2.23%, χ(2)=0.372, P=0.542). The average gestational age at diagnosis was (47±6) days. According to the classification based on imaging examination during early pregnancy, a case of type Ⅰ CSP received expectant treatment and achieved live birth at third trimester of pregnancy. Two cases of heterotopic cesarean scar pregnancy underwent transvaginal selective reduction of CSP, and intrauterine pregnancies were followed by live births at third trimester of pregnancy. One case of type Ⅲ CSP underwent laparoscopic CSP excision and uterine repair, and 24 patients with type Ⅰ or type Ⅱ CSP underwent hysteroscopic CSP excision with/without uterine artery embolization. After CSP treatment, 5 patients achieved clinical pregnancy through embryo transfer, all of which were normal intrauterine pregnancy followed by term live birth. Conclusions: Color ultrasonography should be performed during early pregnancy to confirm the occurrence of CSP in patients receiving IVF-ET after previous cesarean section. Treatment of CSP should be individualized, and patients with Type Ⅰ CSP who are strictly selected have the opportunity for expectant treatment.