Risk Factors For Ectopic Pregnancy Research Articles

Clinical and Histopathological Findings of Ectopic Pregnancy Cases- A Retrospective Study from a Tertiary Care Hospital, Andhra Pradesh, India

Introduction: Ectopic Pregnancy (EP) is defined as a pregnancy that occurs in ectopic location, that is, outside the cavity of uterus. It is one of the leading causes of mortality in the first trimester of pregnancy and one of indication for emergency laparotomy. Timely diagnosis is extremely crucial as delay in diagnosis can lead to mortality. Diagnosing ectopic pregnancy is quiet challenging as there are many conditions which have similar presentation and may not require surgical management. Histopathology is required for confirmation of ectopic pregnancy by identifying trophoblastic tissue in ectopic location since there are other conditions like haematosalpinx, ruptured hemorrhagic corpus luteum which can have similar presentation clinically. Aim: To analyse the clinicopathological features of cases clinically diagnosed as ectopic pregnancy and estimate the percentage of cases which were confirmed on histopathology and assess the percentage of cases which were negative on histopathology. Materials and Methods: This was a retrospective observational study conducted on three years data collected retrospectively between July 2017 and June 2020. Clinical details like age of the patient, parity, gestational age, previous history of any associated risk factors for ectopic pregnancy, were obtained from patient requisition forms and pathology records. Hematoxylin and Eosin (H & E) stained sections were reviewed. Descriptive analysis was done. Data entry was made in Microsoft (MS) excel sheet. Frequencies and percentages were calculated. Results: Total of 128 cases (mean age 25.8±4.87 years) data was analysed in this study, most women were between 21 to 30 years (97 out of 128 (75.7%), with mean age of 25.8 years and presented in 2nd pregnancy (40 out of 86 cases where details were known (46.5%) and in 6th week of gestation (28 out of 78 cases where details were known) (35.8%)) with mean gestational age of 7.2 weeks. Most common risk factors were previous abortions and previous caesarean section (36 out of 82 cases where details were known (43.9% each)). Fallopian tube was the most common site (112 out of 113 cases, 99.1%). On histopathological examination, trophoblastic tissue was identified in 116 cases out of 128 cases. (90.6%). Twelve cases showed no evidence of trophoblastic tissues (11.7%), of these, three cases (25%) showed ruptured corpus luteum, seven cases (40%) showed hematosalpinx, and two cases (13.3%) showed chronic salpingitis changes. Conclusion: Ectopic pregnancy was most frequent in women between 21 to 30 years, in 2nd pregnancy and in 6th week of gestation. Most common risk factors were previous abortions and previous caesarean section. Fallopian tube was the most common site. Ectopic pregnancy was confirmed on histopathological examination, 90.6% cases. A total of 11.7% cases which showed no evidence of trophoblastic tissues, were cases of Haematosalpinx, ruptured hemorrhagic corpus luteum and chronic salpingitis and they presented clinically as ectopic pregnancy.

Ectopic Pregnancy: A Paradigm Shift

Background: Ectopic pregnancy is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies in day to day practice. The objectives of this present study were to know the incidence of ectopic pregnancy at the tertiary care center, evaluate age group, parity, and risk factors of ectopic pregnancy, and analyse clinical presentation, outcome, management, and associated morbidity and mortality with ectopic pregnancy. Methods: It was a retrospective study done at GSL Medical College and General Hospital, Rajahmundry from 1stAugust 2019 to 31st July 2020. A total of 58 patients with ectopic pregnancy were analysed on clinical presentation, clinicalfindings, investigations, operative findings and outcome. Results: A majority of women were in the age group of 22-32 years and most of them were multigravida. Commonest risk factors were previous history of abortion, tubal ligation and pelvic inflammatory disease. Amenorrhea and pain abdomen were the most common presenting symptoms. Ampulla of the fallopian tube was the commonest site for ectopic pregnancy. There were no maternal deaths and majority were discharged within seven days without serious morbidity. Conclusion: Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. With the use of better diagnostic modalities, ectopic pregnancies can be detected early, and referral in hemodynamically stable condition along with use of minimal access surgery or medical management not only reduces maternal morbidity but also preserves future fertility

Risk Factors for Ectopic Pregnancy: A Case-Control Study in Tertiary Care Hospitals of Jammu and Kashmir

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

Associations between Smoking, Intrauterine Device Uptake, and Ectopic Pregnancy: A Meta Analysis

Background: Ectopic pregnancy is an import­ant cause of maternal morbidity and mortality, estimated to occur in approximately 1-2% of pregnancies worldwide. Smoking and history of using intrauterine devices are risk factors for ectopic pregnancy. This study aims to estimate the magnitude of the relationship between smoking and a history of using intrauterine devices on the incidence of ectopic pregnancy based on a number of previous primary studies. Subjects and Method: This study is a syste­matic review and meta-analysis. The articles used in this study were obtained from several databases, including: PubMed, Google Scholar, and Science Direct which were published from 2000-2020. The inclusion criteria used are full text articles with Case Control design. The keywords used to search for articles were as follows: smoking AND "ectopic pregnancy" AND multivariate; "use of intrauterine device" AND "ectopic pregnancy" AND multivariate; smoking OR cigarette AND “use of intrauterine device” AND “ectopic pregnancy” OR “tubal pregnancy” AND multivariate. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3. Results: A meta-analysis of 7 articles showed that women of reproductive age who smoked had a 2.20 times risk of ectopic pregnancy compared to women of reproductive age who did not smoke (aOR= 2.20; 95% CI= 1.45 to 3.34; p= 0.002). A meta-analysis of 9 articles showed that women of reproductive age with a history of using intrauterine devices had a 2.28 times risk of ectopic pregnancy compared to women of reproductive age who did not use intrauterine devices (aOR= 2.28; 95% CI= 1.74 to 2.98; p<0.001). Conclusion: Smoking and a history of using intrauterine devices increase the risk of ectopic pregnancy.

English

BACKGROUND Ruptured ectopic is a life threatening obstetric emergency. Obstetrician must have a high index of suspicion for ectopic pregnancy and should be aware of importance of early diagnosis and early intervention. The present study was undertaken to evaluate the incidence, clinical presentation, risk factors, treatment and morbidity associated with ectopic pregnancy. METHODS Retrospective analysis of ectopic pregnancy was done in King George Hospital, Visakhapatnam from January 2020 to December 2020 in the department of OBG. The following parameters: Age, risk factors, clinical presentation, site of ectopic, diagnostic methods, mode of treatment were noted. RESULTS A total of 63 cases were reported during this time frame. It is a tertiary care centre getting referrals from nearby districts and other hospitals. Incidence of ectopic pregnancy in the present study is 0.89 %. 41.26 % of patients belonged to age group between 26 to 30 years. Out of 63 cases 49.20 % were multigravida. 28 % of the cases were associated with previous H/O abortions and 23 % of the cases were associated with PID and in 17.4 % of the cases there was no predisposing factors. 96.82 % the patients presented with pain abdomen. Shock in 34.92 % of the cases. Ampulla is the most common site of ectopic. In 76 % of the cases there was hemoperitoneum > 500 ml. Salpingectomy was done in 79.3 % cases. 84 % of cases required blood transfusion > 1 unit. There was no mortality. CONCLUSIONS Ectopic pregnancy is one of the obstetric emergency with significant morbidity and mortality. PID and post abortal sepsis are one of the important risk factors for ectopic pregnancy. As many patients may not have recognizable risk factors, a high index of suspicion is critical for early diagnosis. Early USG diagnosis of ectopic pregnancies reduces mortality and enables us to offer the patient conservative medical and surgical treatment. KEYWORDS Ectopic Pregnancy, TVS, Ampulla, Salpingectomy

A cross-sectional study on knowledge, attitude and practice towards contraception among medical students in a tertiary care center of coastal Karnataka, India

High rates of unplanned pregnancies are due to continued gaps in awareness and access to contraception. An exemplary health care infrastructure would play a major role in resolving this issue. To investigate knowledge, attitude and practice towards contraception among medical students in a tertiary care center of Karnataka. A cross-sectional study was conducted including 100 undergraduate medical students during September 2018 to February 2019 using predesigned questionnaire on contraception and analyzed using percentages. Nearly 93% of students chose condom as best way to prevent sexually transmitted infections and 47% chose emergency contraceptive pills as risk factor for ectopic pregnancy. Failure rates of natural methods was 20-25% according to 33% of the students. Majority of participants believed that both sexes have equal responsibility for contraception and chose intrauterine contraceptive devices as best contraception for nulliparous women. Oral contraceptive pills had least failure rates as per 70% of the subjects compared to diaphragm, condom or natural methods. Irregular bleeding was considered as most common side effect of oral contraceptives by half of participants while 91% thought condoms were best for couples who were not regularly sexually active. Around 84% of undergraduates preferred to consult a doctor for contraceptive advice and were comfortable discussing contraception with partner. Overall, students had reasonably good knowledge on contraception. Similar studies in future would pave the way for upgrading current health curriculum to strengthen knowledge base of future clinicians.

Ectopic pregnancy: a single-center experience over ten years

PurposeThe aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality.MethodsThis was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA).ResultsThe incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10− 5) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04.ConclusionEP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

Clinical profile and risk factors of ectopic pregnancy: A Prospective study from a tertiary care center in Kerala

Clinical profile and risk factors of ectopic pregnancy: A Prospective study from a tertiary care center in Kerala

An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

Ectopic pregnancy at the Gambian Tertiary hospital.

Ectopic pregnancy is a gynaecological emergency with significant burden of maternal mortality and morbidity in the tropics. The incidence reported in the literature range from 1:60 to 1:250 pregnancies. The aim was to determine incidence and risk factors of ectopic pregnancy in the Gambia. A longitudinal study of ectopic pregnancy at Gambian tertiary hospital from January 2016 to April 2018. Data was collected from patients' folders, entered into SPSS version 20 and analysed with descriptive statistics. The test of variation and significance was by ANOVA and Chi-square respectively with error margin set at 0.05 and confidence interval of 95%. A total number of 2562 pregnancies were recorded, 43 were ectopic pregnancies. The estimated incidence was 0.2%. Majority of the patients were between 26 - 35 years (56%), primiparous (32%), heterogeneous marriage (82%) and housewives (86%). Occupation was not associated with ruptured or unruptured ectopic pregnancy (p-0.421). Low parity was associated with more ectopic pregnancy than high parity (p-0.001). The commonest clinical feature was abdominal pain (65.1%), whilst the most prominent risk factors were pelvic inflammatory disease (27.9%) and previous abortion (23.3%). Ectopic pregnancy was seasonal. The incidence rate of 0.2% was in the range reported in the literature. Low parity, previous abortion and pelvic inflammatory disease were the risk factors.

Incidence Rate and Risk Factors of Ectopic Pregnancy at Maternity Wards in Baghdad City’s Hospitals for the Year 2019

Background: Ectopic pregnancy is a condition of immense gynecological importance, particularly in thedeveloping world, because of the high morbidity and mortality associated with it and the enormous threatto life.Objectives:To assess the incidence rate and the risk factors of ectopic pregnancy at Maternity Wards inBaghdad City’s Hospitals for the year 2019.Methods:The study included a non-probability (convenient) sample consisted of (90)pregnant woman whohave ectopic pregnancies. The study subjects are recruited from 10 teachinghospitals in Baghdad,in theirfirsttrimester of gestation age. The studydata is collected from pregnant women’ edical records in the Departmentof Statistics, data are analyzed using descriptive and inferential data analysis process.Results: the results of the current study indicate that the incidence rate of ectopic pregnancy is (2.217)per1000 of population at risk for the year 2019. Smoking is accounted as the most predominant risk factorfor ectopic pregnancy (55.6%),Most of these pregnant women are between the ages of (15-24) years old(40.0%), college graduates (26.7%), government employees (52.2%), and have a monthly income (901.000-1.200.000) ID (32.2%).Conclusion:: Incidence rate of ectopic pregnancy at the maternity wards in Baghdad City’s hospitals is(2.217) per 1000 of population at risk for the year of 2019, The incidence rate of ectopic pregnancy has notbeen affected by the risk factors of infertility, previous ectopic pregnancies, IUCD, assisted reproductivetechniques and smoking of ectopic pregnancy and the incidence rate of ectopic pregnancy has not beenaffected by pregnant demographic characteristics of age, education, occupation and monthly income.

Spontaneous and Simultaneous Bilateral Ruptured Tubal Ectopic Pregnancy: A Case Report

Simultaneous bilateral tubal ectopic pregnancy is a rare entity. The reported incidence ranges between 1 in 725 to 1 in 1580 of all ectopic pregnancies, and it is higher in women undergoing assisted reproductive techniques or ovulation induction. Its spontaneous appearance is almost exceptional. There are no unique features in clinical presentation helping to distinguish it from unilateral ectopic pregnancy. This makes the pre-operative diagnosis difficult, so it’s commonly made during surgery. Whether the ectopic pregnancy is spontaneous or induced, fast management is essential and includes early diagnosis, detailed ultrasound scan, careful contralateral tube control, and also specimen’s histological verification. Thus the treatment will depend on the hemodynamic stability of the patient, the extent of tube damage, as well as the desire for future pregnancies. We report a case of 40 year old patient, gravida 1 without any ectopic pregnancy risk factors, who suffered from abdominal pain and vaginal bleeding at 8 gestation weeks. Endovaginal ultrasound detected adnexal ruptured mass in the right fallopian tube. Urgent laparotomy was performed for suspicious ruptured ectopic pregnancy. A right and left ruptured ectopic pregnancy were found during operation. Bilateral salpingectomy is done and patient is discharged from hospital 3 days later without complications.

Recurrent ectopic pregnancy risk factors and clinical features: a case-control study in Turkey

Recurrent ectopic pregnancy risk factors and clinical features: a case-control study in Turkey

Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion....

Relationship Between Polycystic Ovarian Morphology and Ectopic Pregnancy.

Background:The purpose of the current study was to investigate the presence of polycystic ovarian morphology (PCOM) in patients with ectopic pregnancy (EP) and to find out the value of sonographic appearance of ovaries on the earlier diagnosis of EP.Methods:In the current case-control study, thirty five patients with EP were recruited to evaluate ovarian sonographic morphology whereas 35 gestational age-matched women with healthy intrauterine pregnancy (IUP) were the controls. After ovarian sonography, ultrasound images were analyzed offline for ovarian area, ovarian volume, follicle number per cross section, and follicle distribution pattern. A questionnaire about the presence of hirsutism and menstrual irregularity prepared as well. Student’s t-test or Mann-Whitney U test were used to compare continuous variables between 2 groups and categorical data were evaluated by using Chi-square or Fisher’s exact test, where appropriate. Multiple logistic regression was used to find out the risk factors for EP.Results:Mean gravidity and parity were significantly higher in the EP group compared to IUP group (p<0.05). PCOM was found to be significantly higher in the study group (51.4% vs. 20%, p=0.006). Logistic regression analysis showed that multiparity (OR=8.635; 95% CI, 1.653–45.104) and PCOM image on ultrasound (OR=19.081; 95% CI, 1.139–319.560) were found to be significantly associated with EP.Conclusion:PCOM is more prevalent among women diagnosed with EP. This study demonstrates that PCOM assessed by transvaginal ultrasound may reflect EP in women with EP suspicion and may therefore serve as a clinical marker to assess EP.

Benzodiazepine Use Before Conception and Risk of Ectopic Pregnancy

IntroductionEctopic pregnancy occurs in 1% to 2% of the all recognized pregnancies, yet half of women who have an ectopic pregnancy do not have any known risk factors. A potential but unstudied risk factor for ectopic pregnancy is benzodiazepine use, which could affect muscle contraction in the fallopian tube.&#x0D; Objectives and ApproachWe compared the risk of ectopic pregnancy among women with and women without benzodiazepine prescriptions before conception. using data from United States commercial insurance claims (IBM® MarketScan® Databases). We performed a cohort study of 1,691,366 pregnancies between November 1, 2008 and September 30, 2015, and used unadjusted and inverse probability of treatment (IPT) weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Sub-group analysis was conducted on women who had anxiety and women who had insomnia diagnoses in the year before conception.&#x0D; ResultsOf the 1,691,366 pregnant women, 1.06% filled at least two benzodiazepine prescriptions in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10,000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis.&#x0D; Conclusion / ImplicationsThis study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women and their health care providers make more fully informed decisions about benzodiazepine use in their reproductive years.

P68 Risk factors for ectopic pregnancy among women of reproductive age

P68 Risk factors for ectopic pregnancy among women of reproductive age

VP62.26: An analysis of the related risk factors of ectopic pregnancy during ART

VP62.26: An analysis of the related risk factors of ectopic pregnancy during ART

Knowledge of risk factors for ectopic pregnancy among female undergraduates in Southeastern Nigeria

Objectives: Ectopic pregnancy is a leading cause of maternal death during the first trimester of pregnancy, accounting for approximately one in ten pregnancy-related deaths. Knowledge of potential risk factors can improve early detection and avoid morbidity and complications. This cross-sectional study determined the knowledge level and prevalence of risk factors of ectopic pregnancy among female undergraduates. Material and Methods: Three hundred and ninety female students were randomly selected from the various hostels through multistage sampling. Results: The study found that 234 (60%) respondents were aware of ectopic pregnancy. The majority of the respondents (72.1%) had moderate to a good knowledge level of ectopic pregnancy and the risk factors. There was no significant difference in knowledge level based on marital status of the respondents (P = 0.642). Predominant risk factors for ectopic pregnancy identified among respondents were use of oral contraceptives – 151 (38.8%), frequent alcohol intake – 105 (26.9%), prior pelvic inflammatory disease 94 (24.1%), and induced abortion 52 (13.3%). Initiation of oral contraceptive use was between age 13 and 20 years for about 118 (77.7%) respondents. Conclusion: Health education interventions on the knowledge of symptoms and risk factors of ectopic pregnancy need to be targeted at women of reproductive age to reduce the associated morbidity and mortality.

Ectopic Pregnancy Risk with Assisted Reproductive Technology

To investigate the optimal methods for the reduction of ectopic pregnancy incidence due to assisted reproductive technology (ART). Day five or six blastocyst transfer may decrease ectopic pregnancy rates when compared with day three transfer, similarly, frozen-thawed embryo transfer may lessen the risk of ectopic pregnancy relative to fresh embryo transfer. Single embryo transfers decrease ectopic pregnancy risk and have similar clinical pregnancy outcomes as double embryo transfers. Ectopic pregnancy remains a major cause of maternal morbidity and mortality in the first trimester of pregnancy. Compared with spontaneously conceived pregnancies, pregnancies resulting from in vitro fertilization (IVF) treatments are initially associated with an increased risk of an ectopic implantation. Many risk factors related to ART have been linked to increased ectopic pregnancy risk, though the exact mechanism underlying the link between ectopic pregnancy and ART remains unclear. Tubal factor infertility is the major risk factor for ectopic pregnancy following IVF. Day of transfer, fresh or frozen-thawed cycle single or double transfer are the main controversial factors regarding ectopic pregnancy risk. According to recent data, day 5 blastocyst transfer has decreased ectopic pregnancy risk than day 3, also frozen-thawed cycle has lower risk of ectopic implantation than fresh cycles. Single frozen-thawed blastocyst transfer may thus be the best choice for reducing ectopic pregnancy incidence among IVF patients. Further studies should be done to compare the ectopic pregnancy rates between the single frozen-thawed blastocyst transfer and spontaneous pregnancies.