The Correlation Analysis Of Increased Risk Of Ectopic Pregnancy And In Vitro Fertilization And Embryo Transfer

ObjectiveCompare the treatment process and clinical outcomes of infertile women acquiring ectopic pregnancy and intrauterine pregnancy after IVF cycles,and explore the correlation between increased risk of ectopic pregnancy and IVF-ET.MethodsA retrospective analysis from January 2014 to December 2017 at the Infertility Unit of QiLu Hospital at Shandong University was conducted.86 patients diagnosed with ectopic pregnancy(including heterotopic pregnancy)after IVF-ET and 2606 patients diagnosed with intrauterine pregnancy at the same time period were considered for our retrospective study entry.1026 pregnancy cycles resulting from fresh embryo transfers and 1666 pregnancy cycles resulting from frozen-thawed embryo transfers were divided into ectopic pregnancy group and intrauterine pregnancy group respectively.A total of 2692 pregnancy cycles resulting from fresh and frozen-thawed embryo transfers were divided into four groups,fresh cleavage embryo transfer,fresh blastocyst transfer,frozen cleavage embryo transfer and frozen blastocyst transfer in our study.1666 pregnancy cycles from frozen-thawed embryo transfers were divided into three groups,nature cycle,hormone replacement cycle and stimulating ovulation cycle.To observe trends of the incidence of ectopic pregnancy during four years,we calculate the morbidity of EP each year.Calculate the proportion of pregnancy cycles from fresh and frozen embryo transfers respectively,and analyse the variations during four years.So also does the proportion of pregnancy cycles from cleavage embryo and blastocyst.The patients'age,BMI,antral follicle count,previous abortion history,previous uterine curettage history,previous ectopic pregnancy,previous pelvic surgery history,basic serum estrogen levels and FSH levels,the total dose and days of gonadotropin,fertilization methods,the estrogen and progesterone levels on the day of HCG administration,the number of embryos transferred,the endometrium thickness on the day of embryo transfer and the distance from the top of the transplant tube to the bottom of the uterine cavity were compared between the EP groups and IUP groups.The basic characteristics mentioned above and the incidence of ectopic pregnancy were evaluated among the four groups and the three groups respectively in our study.Data analysis was performed using SPSS 19.0 statistical software(SPSS Inc,Chicago,IL,USA).All values are presented as the means±SD.Normally distributed data were compared using variance(ANOVA)tests and independent t-tests.Comparison of rates were using Continuity Correction and Fisher's Exact test.In searching for variables associated with the outcome,we considered as statistically significant a p value below 0.05.Results1.Of the 2692 pregnancy cycles after IVF-ET from January 2014 to December 2017 at the Infertility Unit of QiLu Hospital at Shandong University,there are 86 cases of EP,(3.19%,86/2692).The incidence of EP varies from 3.91%(19/486)to 4.41%(25/567)to 2.80%(21/750)to 2.36%(21/889),and decrease as a whole.2.No statistically significant differences were found in basic characteristics of patients and IVF outcomes of the groups in the retrospective study,except the previous abortion history,previous uterine curettage history,previous ectopic pregnancy,previous pelvic surgery history,the total dose of gonadotropin,the estrogen levels on the day of HCG administration.3.Compared to IUP group,the number of patients with two embryos transferred is significantly higher in EP group,and the number of patients with blastocyst embryo transferred is significantly lower in EP group(P<0.05).4.The ectopic pregnancy rate of frozen blastocyst transfer 1.17%(13/1113)is lowest compared with three other groups,(P<0.05).The EP rate of cleavage embryo transfer is significantly higher than blastocyst transfer,(P<0.05).The EP rate of fresh blastocyst transfer is significantly higher than frozen blastocyst transfer,(P<0.05).5.The incidence of ectopic pregnancy was 1.12%(8/713)in nature cycles,and 2.71%(22/813)in hormone replacement cycle,3.57%(5/140)in stimulating ovulation cycle.Compared with the other two endometrial preparation groups,EP rate in the natural cycle was the smallest with statistically significance.Conclusions1.The incidence of ectopic pregnancy increases with the number of artificial abortion and uterine curettage and pelvic surgery.2.The developmental stage of the embryo,the number of embryos transferred and the high estrogen level on the day of embryo transfer are risk factors for ectopic pregnancy after IVF-ET.3.Relative to fresh embryo transfer and cleavage embryo transfer,thawed embryo transfer and blastocyst embryo transfer were associated with significantly reduced incidence of ectopic pregnancy.The lowest risk of ectopic pregnancy was associated with the transfer of a single frozen blastocyst.