Abstract
To analyze the incidence of ectopic pregnancies (EP’s) after ultrasound-guided IVF-ET, using a specific technique. Retrospective study. A total of 1018 women who underwent IVF procedures from September 2002 through January 2006 were studied with regard to indications for IVF and factors related to the IVF procedure through a retrospective review of medical charts. The incidence of EP and techniques utilized were reviewed. The review consisted of two experienced clinicians, separately performing ultrasound-guided IVF-ETs. During the stimulation phase of the cycle, the distance between the fundus of the uterine cavity and the external cervical os was measured using colpohydrosonography (CHS). At the time of embryo transfer, the catheter was advanced to a distance equivalent to that calculated from the CHS minus 5 mm. Embryo placement was observed via ultrasound. 431 out of 1018 cycles resulted in a positive pregnancy test (pregnancy rate of 42.3%), 4 of which resulted in EP’s (0.4% of all patients and 0.97% of all pregnancies; P< .0001). This data was compared to a review of 9 previous studies, which collectively reveal an EP rate of 4.5% of all pregnancies. Previous studies reviewed 8,604 pregnancies, with dates ranging from 1983 to 2003. Five of the studies (a total of 3,193 pregnancies) attribute tubal factor as the main cause of the increased EP rates. Of the 4 EP’s in our study, 2 of the patients were advanced maternal age (AMA); 1 procedure had an outcome of a heterotopic pregnancy, which subsequently resulted in 1 successful live birth. Tubal factor was not an indication for IVF for any of the 4 patients with ectopic pregnancies. Ultrasound-guided IVF-ET with embryos placed 5mm proximal to the uterine fundus, by experienced clinicians using state of the art equipment, yielded a statistically significant decrease in the EP rates, regardless of IVF indications. AMA may be an independent risk factor for EP.
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