How do ectopic pregnancies occur in ivf

Several risk factors have been proposed, including abnormalities in the Fallopian tubes an indication for IVF , transfer of multiple embryos, or the treatment technique itself.

This study, performed as an analysis of all , UK treatment cycles reported to the HFEA between and , aimed to discover if the advance in ART techniques in the past few years had affected the incidence of ectopic pregnancy, and what its risk factors in ART might be. The analysis showed that 1. The second significant risk factor was multiple embryos transferred in treatment. Pelvic inflammatory disease PID is often caused by sexually transmitted infections like chlamydia or gonorrhoea. The bad news?

It can affect the fallopian tubes. PID makes the tiny hairs on the lining of your tubes less able to transport the egg to your uterus for implantation. PID can also cause scarring of your tubes — this is bad for egg transportation too.

Endometriosis causes the endometrial tissue and cells of the womb to grow in other areas of the pelvis. This renegade tissue has a monthly bleed too, which results in scarring and adhesions. The fallopian tubes are commonly affected by endometriosis. Scarring can cause them to become damaged, twisted or stuck to other organs. All this make it harder for a fertilised egg to pass through.

Cue: a possible ectopic. Two forms of contraceptive are linked to higher ectopic risks: the IUD or coil and the progesterone-only birth-control pill. The latter is sometimes called the mini pill. But bear in mind that the chances of getting pregnant while using an IUD are low anyway. ASRM advises that women wanting to get pregnant after having had an ectopic pregnancy should seek the care of a fertility specialist.

HCG levels will need to be checked on a recurring basis until reaching zero. This process applies to women who did not have their entire fallopian tube removed. If the hCG level stays high, this can indicate that there is still ectopic tissue present.

When this occurs surgery or an injection of methotrexate is required. Ectopic pregnancy at a glance Ectopic pregnancy occurs when an embryo implants somewhere other than the uterine lining. Ectopic pregnancies most commonly take place inside of the fallopian tubes, which is referred to as a tubal pregnancy.

Underlying conditions and lifestyle factors like history of pelvic infection, endometriosis, and previous abdominal surgery increase the risk of this kind of pregnancy. Devoted to you, dedicated to your success Contact Dallas IVF today to set up an appointment to discuss your fertility options. Request an appointment. Risk factors There are some underlying conditions and lifestyle factors that can increase the chances of having this type of pregnancy.

These include: Previous abdominal or pelvic surgery. Scarring from pelvic surgery. Age 35 or older. Previous ectopic pregnancies. Pelvic inflammatory disease PID. Multiple induced abortions. Smoking cigarettes.

Have had or currently have an STD — especially chlamydia or gonorrhea. A total of 28 cases were identified. Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers.

These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks. Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted reproductive technology ART , occurring in approximately 1.

The majority of ectopic pregnancies from either IVF or spontaneous pregnancy occur within the fallopian tubes, but implantation may occur in other locations such as the cervix, ovary, or abdomen [ 3 ]. Abdominal ectopic pregnancies are a very rare form of ectopic pregnancy, yet are clinically significant due to their potential for high morbidity and often atypical presentation [ 4 ].

Recent studies have attempted to identify risk factors for ectopic pregnancy after IVF. Suggested risk factors include infertility due to tubal factor, endometriosis, transfer at blastocyst stage, higher number of embryos transferred, decreased endometrial thickness, variation in culture media, and fresh embryo transfer [ 5 — 9 ].

However, very little data exists regarding risk factors for abdominal ectopic pregnancy after IVF. In this case study, we report an abdominal ectopic pregnancy after IVF with fresh single embryo transfer. We also performed a systematic review of the literature for known cases of abdominal ectopic pregnancy after IVF and provide detailed characterization of these patients and risk factors for this rare complication.

The patient was a year-old G2P who presented to our fertility center seeking fertility treatment. She had a medical history of polycystic ovarian syndrome PCOS and her partner had a diagnosis of male factor infertility. She had no prior surgical history, no known allergies, and medications included prenatal vitamins.

She denied any history of sexually transmitted infections and had a normal hysterosalpingogram and saline sonohysterogram. Her first IVF cycle with an elective single embryo transfer resulted in a negative pregnancy test.

Twenty-two oocytes were retrieved. On day five a single fresh blastocyst was transferred using a pass through technique under ultrasound guidance. A stiff outer sheath was introduced through the cervix and past the internal os. A soft tipped catheter containing the embryo was advanced through the outer sheath and the embryo was expelled into the uterine cavity approximately 1.

Beta hCG was positive on post-transfer day 9 and serial beta hCG values were monitored and continued to rise appropriately Table 1. On day 28 after embryo transfer, the patient underwent a transvaginal ultrasound TVUS in the office that did not identify an intrauterine pregnancy IUP or any abnormal adnexal structures.

She was asymptomatic with no vaginal bleeding or abdominal pain. The patient was sent for a more comprehensive ultrasound evaluation at the associated Maternal Fetal Medicine unit and another beta hCG value was obtained. Repeat scan similarly failed to identify an IUP or visualize an ectopic pregnancy.

Given the high beta hCG value in the absence of an IUP, the patient was counseled and advised to take methotrexate treatment for presumed ectopic pregnancy of unknown location.

The decision was made to proceed with diagnostic laparoscopy for treatment of ectopic pregnancy after failure of methotrexate therapy. The patient continued to be asymptomatic with no vaginal bleeding or abdominal pain. Diagnostic laparoscopy was performed on day 34 post-embryo transfer. The products of conception were removed using graspers without difficulty and hemostasis was obtained with electrocautery and surgicel. All other pelvic organs including uterus and bilateral ovaries and tubes appeared grossly normal in appearance.

Diagnostic laparoscopy demonstrating hemoperitoneum top image and products of conception implanted in the posterior cul-de-sac bottom image. A systematic literature review was performed with the aim of identifying all other case reports of abdominal ectopic pregnancies after IVF. To the best of our knowledge, all reported cases and available data are summarized in Table 2.

A total of 28 cases of abdominal ectopic pregnancy after IVF were identified. Notable cases include 5 retroperitoneal ectopic pregnancies, an abdominal fetal demise at 28 weeks, and 4 cases of viable abdominal pregnancies at 30 weeks, 32 weeks two cases , and 34 weeks gestation.

For this reason, early recognition and treatment is crucial in the setting of abdominal ectopic pregnancy. This atypical presentation of an ectopic pregnancy highlights the need to consider abdominal ectopic pregnancy in the differential of any pregnancy of unknown location after IVF, especially in the setting of non-diagnostic transvaginal ultrasound.

There appears to be an increased rate of ectopic pregnancies after ART when compared to rates in spontaneous pregnancy [ 11 ]. As the number of IVF procedures performed continues to rise, the incidence of ectopic and abdominal ectopic pregnancy will likely also rise.

While there are still relatively few reported cases of abdominal ectopic pregnancies after IVF, our systematic review demonstrates several trends among reported cases.

In a larger, more recent study of , ART cycles in the US, among all infertility diagnoses, TFI was the only one significantly associated with increased risk for ectopic pregnancy adjusted relative risk RR 1. A retrospective study that measured the risk of EP following IVF in women with a previous ectopic demonstrated a fold higher risk of recurrence when compared with women with other causes of infertility.

The authors reported that the prevalence of EP was 8. Odds ratio for developing EP was 8. Interestingly, bilateral salpingectomy was the most common tubal surgery reported in our case review. While the exact mechanism of abdominal ectopic after bilateral salpingectomy remains unclear, many authors have proposed that it may be due to the development of a micro-fistulous tract after salpingectomy.