Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles

Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles Mingxia Gao, Xianghua Dong, Haifei Liu, Xinyue Zhou, Jiajia Liu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4102047/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Research Question: To study the outcome of heterotopic pregnancy (HP) and related influencing factors after in vitro fertilization-embryo transfer (IVF-ET), and to provide clinical experience for the treatment of heterotopic pregnancy. Design: Observational study. Results Our data revealed a HP incidence of 1.27‰. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). ​Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P < 0.05). Conclusion Laparoscopic surgery is an effective method for the treatment of HP, and laparoscopic ectopic resection of ectopic pregnancy lesion does not seem to affect the continuous pregnancy and live birth of the intrauterine gestational sac. The mean diameter of the intrauterine gestational sac on the day of surgery, the development of the intrauterine gestational sac, and the duration of surgery can affect the patient's pregnancy outcome. Health sciences/Medical research/Epidemiology Health sciences/Medical research/Outcomes research Health sciences/Medical research/Study design Biological sciences/Developmental biology/Intrauterine growth Health sciences/Risk factors Health sciences/Diseases/Reproductive disorders/Infertility Health sciences/Health care/Prognosis In vitro fertilization-embryo transfer Heterotopic pregnancy Laparoscopy Pregnancy outcome Figures Figure 1 Introduction As reproductive medicine continues to evolve, IVF-ET has emerged as a critical and efficacious modality for the management of infertility. Despite the remarkable successes attributed to this technique, its proliferation has brought to light several attendant complications and risks. A notable complication is Heterotopic Pregnancy (HP) 1 , a rare form of ectopic pregnancy characterized by the concurrent presence of both intrauterine and extra-uterine pregnancies. In the context of natural conception, the incidence of HP is relatively low, ranging between 1 in 7,963 to 1 in 30,000 pregnancies 2 , 3 . However, a concerning trend has been observed with the utilization of IVF-ET 4 , 5 , where the incidence of HP escalates to approximately 1–3% 6,7 . This augmented incidence in the IVF-ET population presents diagnostic and management challenges for clinicians, chiefly due to the existence of a concomitant intrauterine pregnancy 8 . The ramifications of undetected or inadequately managed HP are severe, with potential complications including ectopic pregnancy rupture and hemorrhage, which can jeopardize both the life and future fertility of the patients 9 , 10 . Therefore, it is essential for the early recognition and timely intervention of this disease. However, there are relatively few research on HP, and the clinical experience of diagnosis and treatment is still limited. Given these high stakes, the early identification and prompt intervention of HP are paramount. Nonetheless, the paucity of research dedicated to HP, coupled with limited clinical experience in its diagnosis and management 11 , underscores a critical knowledge gap. Aiming to address this gap, our study undertakes a retrospective analysis of patients diagnosed with HP following IVF-ET at our institution over the past decade. Through the identification of risk factors and examination of pregnancy outcomes associated with HP post-IVF-ET, we aspire to furnish a valuable reference for clinicians managing HP in the IVF setting. By doing so, we intend to contribute to the enhancement of patient quality of life and fertility outcomes and investigate avenues for the reduction of HP incidence subsequent to IVF-ET. Our study, therefore, seeks to enrich both the research corpus and clinical practice in this domain, with the ultimate goal of bolstering the safety and effectiveness of IVF-ET treatments. Materials and Methods 1. Study Participants This study conducted a retrospective analysis of 66 patients who developed HP following IVF-ET treatment at the First Hospital of Lanzhou University, spanning from January 2012 to December 2022.​ All participants underwent preoperative transvaginal ultrasound (TVS), with subsequent pathological examinations confirming the presence of intrauterine pregnancies and adnexal masses. This study received approval from the Ethics Committee of the First Hospital of Lanzhou University, with the approval number LDYLL2023-323. 2. Data collection Data were meticulously collected on various parameters including age, duration of infertility, type and cause of infertility, history of pelvic and abdominal surgeries, history of abnormal pregnancies and other adverse pregnancy outcomes, ovulation induction methods, fertilization techniques, the number of embryos transferred, ultrasound findings, treatment modalities, and pregnancy outcomes, etc. 3. Treatment Modalities Out of the 66 patients diagnosed with HP, 5 patients underwent conservative management, while 61 patients opted for surgical intervention, either through laparoscopic salpingectomy or laparoscopic cornual resection. 4. Statistical Analysis Statistical analysis was conducted utilizing SPSS version 25.0. Continuous variables were represented as mean ± standard deviation, while categorical data were depicted as percentages. Binary logistic regression analysis was employed to investigate the risk factors influencing the outcomes of pregnancies in patients with HP. A P-value of less than 0.05 was deemed to represent statistical significance. All methods were performed in accordance with the relevant guidelines and regulations. Results 1. Patient Demographics and Treatment Outcomes: The study encompassed a total of 66 participants, all diagnosed with HP. Among these, five patients elected for conservative management. Of these five patients, a single case resulted in a successful full-term live birth. Early pregnancy losses were documented in two cases, occurring at 8 + and 9 + weeks of gestation, respectively. Furthermore, one spontaneous abortion was recorded at 15 + weeks of gestation, while another case necessitated induced labor at 19 + weeks of gestation due to fetal demise. The remaining cohort of 61 patients underwent surgical intervention via laparoscopy. Table 1 illustrates the demographic data of the 61 HP patients who underwent laparoscopic surgery. The age range of this subgroup spanned from 24 to 39 years, with a mean age of 31.43 ± 3.83 years. Within this subgroup, 37 patients underwent frozen embryo transfer (FET) cycles while 24 patients were part of fresh cycles. The average duration of infertility among these 61 patients was 3.35 ± 2.33 years. One notable case within this cohort involved a patient who experienced fetal brain abnormality attributable to medication, which consequently led to labor induction. Post this event, the patient opted for contraceptive measures and later sought assisted reproductive technologies due to male factor infertility. The maximum duration of infertility observed in this subgroup was 10 years (Table 1 ). Table 1 General Information of Patients Undergoing Laparoscopic Surgery General information ( \(\stackrel{-}{x}\) ±s), ཎ༈%༉ Age/years 31.43 ± 3.83 Duration of infertility/years 3.35 ± 2.33 Type of infertility Primary infertility Secondary infertility 36(59.02%) 25(40.98%) Cause of infertility Tubal factors Male factors Other factors 47(77.05%) 9(14.75%) 5(8.20%) History of pelvic surgeries 30(49.18%) History of fallopian tube surgery 23(37.70%) History of ovarian drilling technique 1(1.64%) History of uterine myomectomy 1(1.64%) History of oophorocystectomy 1(1.64%) History of cesarean section 3(4.92%) History of pelvic adhesiolysis 1(1.64%) None 31(50.82%) History of abdominal surgeries 7(11.48%) History of ileus surgery 1(1.64%) History of cholecystectomy 2(3.28%) History of laparoscopic surgery (specific unknown) 3(4.92%) History of laparoscopic combination of laparoscopic surgery (specific unknown) 1(1.64%) History of ectopic pregnancy None Once Twice 45(73.77%) 14(22.95%) 3(4.92%) Other adverse pregnancy history None 1 2 3 45(73.77%) 10(16.39%) 5(8.20%) 2(3.28%) Type Fresh cycles FET cycles 24(39.34%) 37(60.66%) Embryo fertilization method IVF ICSI RICSI IVF, ICSI 41(67.21%) 17(27.87%) 2(3.28%) 1(1.64%) Number of embryos transferred 2 3 52(85.25%) 9(14.75%) Endometrial thickness on the day of transplantation/mm 10.13 ± 2.21 Note: "x̅" denotes the sample mean, "s" denotes the sample standard deviation, "n" denotes the sample size. These results offer a comprehensive overview of the patient demographics, treatment modalities, and outcomes for individuals diagnosed with HP, thereby providing critical insights into the management and prognosis of this condition. 2. Pregnancy Outcomes of Intrauterine Pregnancies: In our cohort, the 61 HP patients who underwent laparoscopic surgery were categorized into two groups based on pregnancy outcomes: Intrauterine Live Birth Group and Non-Live Birth Group. In the Intrauterine Live Birth Group, comprising 47 patients (77.05% of the surgical cohort), 43 individuals (91.49%) achieved successful full-term live births with no neonatal abnormalities reported. Notably, in one instance, both twins of an intrauterine twin pregnancy were born healthy. Furthermore, 4 cases (8.51%) were classified as preterm births, with two occurring at 36 + weeks of gestation and two at 34 + weeks of gestation. No adverse outcomes were reported among these preterm neonates (Table 2 ). Table 2 Pregnancy Outcomes of Intrauterine Pregnancy in the Laparoscopic Surgery Group Item n(%) Group Intrauterine live birth group 47(77.05%) Non-live birth group 14(22.95%) Intrauterine live birth group Full-term live birth 43(91.49%) Preterm birth 4(8.51%) Non-live birth group Early abortion 11(78.57%) Induction of labor 2(14.29%) Abortion time unknown 1(7.14%) Conversely, the Non-Live Birth Group consisted of 14 patients (22.95% of the surgical cohort). Within this group, 11 patients experienced early pregnancy loss (78.57%), while two patients underwent induced labor (14.29%) due to fetal Down syndrome and gestational hypertension diagnoses, respectively. Additionally, the exact timing of pregnancy termination remained unknown for one patient (7.14%). During laparoscopic surgery, 49 cases exhibited a visible germ within the intrauterine gestational sac. Among these, 38 cases (77.55%) resulted in live births. This subset included a twin intrauterine pregnancy with healthy neonatal outcomes, two instances of preterm birth at 36 + weeks of gestation, and one preterm birth at 34 + weeks. Additionally, two patients underwent induced labor: one due to gestational hypertension at 27 weeks and the other due to Down syndrome at 21 weeks. Six early pregnancy terminations were documented. Of the 12 cases with no visible germ in the intrauterine gestational sac, five resulted in live births with favorable neonatal outcomes, while five were classified as early pregnancy terminations. The gestational duration of pregnancy termination was unknown for one patient. Of the 41 cases presenting with a visible fetal heartbeat within the intrauterine gestational sac, 33 (80.49%) resulted in live births. This included one twin intrauterine pregnancy, one preterm birth at 36 + weeks, and one preterm birth at 34 + weeks. Three early pregnancy terminations were due to fetal demise, and two cases involved induced labor. Additionally, 20 cases with no visible fetal heartbeat were observed, half of which achieved successful full-term live births. One patient underwent cesarean delivery at 34 + weeks due to gestational hypertension, with no adverse neonatal outcomes reported. A total of 53 cases of ectopic pregnancy were localized in the fallopian tube, comprising 86.89% of the total number of cases. Among these, 28 cases (52.83%) were situated in the ampullary section of the fallopian tube, with 21 cases (75.00%) resulting in successful full-term live births and two cases (7.14%) leading to premature births at 36 + weeks, with all newborns being healthy; four cases (14.29%) ended in early miscarriages. Additionally, one case (3.57%) resulted in intrauterine death due to gestational hypertension, necessitating labor induction at 27 + weeks. Moreover, four cases (7.55%) of ectopic pregnancy were located in the isthmus of the fallopian tube, among which two cases (50.00%) led to successful full-term live births, and the remaining two cases (50.00%) resulted in early miscarriages. There were two cases (3.77%) located in the interstitial part of the fallopian tube, of which one (50.00%) culminated in a successful full-term live birth, and the other case underwent labor induction due to Down's syndrome. In nineteen cases (35.85%), the exact location of the ectopic pregnancy within the fallopian tube was unknown; of these, fourteen cases (73.68%) resulted in successful full-term live births, one case (5.26%) was a premature birth at 36 + weeks, and three cases (15.79%) experienced early miscarriages. There were four cases (6.56%) of cornual pregnancy, with only one case (25.00%) resulting in a successful full-term live birth, one case (25.00%) was a 36 + weeks premature birth, and the remaining two cases (50.00%) ended in early miscarriages. Additionally, four patients (6.56%) had an ovarian pregnancy, all of which resulted in successful full-term live births (Table 3 ). Table 3 Pregnancy Outcomes for 61 Patients in the Laparoscopic Surgery Group [n (%)] n Full-term live birth Preterm birth Early abortion Induction of labor Abortion time unknown Visible germ within the IG sac Yes 49 38(77.55%) 3(6.12%) 6(12.24%) 2(4.08%) - No 12 5(41.67%) 1(8.33%) 5(41.67%) - 1(8.33%) Visible fetal heartbeat within the IG sac Yes 41 33(80.49%) 2(4.88%) 3(7.32%) 2(4.88%) - No 20 10(50.00%) 1(5.00%) 8(40.00%) - 1(5.00%) Ectopic pregnancy site Ampulla of fallopian tube 28 21(75.00%) 2(7.14%) 4(14.29%) 1(3.57%) - Isthmus of fallopian tube 4 2(50.00%) - 2(50.00%) - - Interstitial part of fallopian tube 2 1(50.00%) - - 1(50.00%) - The exact location of the fallopian tube is unknown 19 14(73.68%) 1(5.26%) 3(15.79%) - 1(5.26%) Ovary 4 4(100.00%) - - - - Cornu 4 1(25.00%) 1(25.00%) 2(50.00%) - - Note: IG stands for Intrauterine Gestational. 3. Logistic Regression Analysis of Factors Influencing Postoperative Pregnancy Outcomes: In an effort to investigate the determinants influencing the outcomes of pregnancies following surgery, this study employed logistic regression analysis. Specifically, it scrutinized various factors such as the average diameter of the intrauterine gestational (IG) sac, the visibility of embryonic structures and fetal heartbeat, the duration of laparoscopic surgery, and the levels of human chorionic gonadotropin (HCG) and progesterone at the time of pregnancy diagnosis. The findings revealed that the average diameter of the gestational sac, the visibility of the embryonic structures and fetal heartbeat during laparoscopic surgery, as well as the duration of the surgery itself, were significant factors affecting the pregnancy outcomes (P < 0.05) (Table 4 ). Table 4 Logistic regression analysis of factors influencing postoperative pregnancy outcomes Item B SE OR CI Z P Average diameter of the IG sac 0.125 0.054 1.133 1.019–1.261 2.702 .021 Presence of fetal germ within the IG sac 1.634 0.695 5.125 1.313–20.003 2.466 .019 Presence of fetal heartbeat within the IG sac 2.225 0.694 9.257 2.375–36.081 3.441 .001 Duration of operation -0.029 0.011 0.972 0.951–0.993 2.782 .010 HCG on pregnancy test day 0.000 0.000 1.000 0.999-1.000 1.64 .672 Progesterone on the pregnancy test day 0.020 0.020 1.020 0.981–1.061 1.34 .317 Taking the non-live birth group as a reference. Note "B" denotes the regression coefficient, "SE" denotes the standard error, "OR" denotes the odds ratio, "CI" denotes the confidence interval, "Z" denotes the test statistic, and "P" denotes the p-value. 4. Analysis results of continuous variable ROC curve (Fig. 1 ): Valuable continuous variables were analyzed using ROC curves, with detailed findings depicted in Fig. 1 and Table 5 . The AUC values for the duration of operation, the average diameter of the IG sac, progesterone levels on the day of the pregnancy test, and hCG levels on the pregnancy test day are 0.764, 0.745, 0.628, and 0.579, respectively. These values and their corresponding optimal cutoffs are detailed in Table 5 . An AUC greater than 0.7 is indicative of a strong predictive capability. Particularly, the AUCs for the duration of operation and the average diameter of the IG sac stand at 0.764 and 0.745, respectively, reflecting a robust predictive strength for these factors. The Youden's index values for these parameters are 0.421 and 0.564, further underscoring their significance. These findings suggest that both the duration of operation and the average diameter of the IG sac are influential in predicting pregnancy outcomes during surgical procedures. Furthermore, these two risk factors have demonstrated statistical significance in affecting pregnancy outcomes (P < 0.05), thereby affirming their utility as reliable predictive indicators for the pregnancy outcomes of patients. These results are quantitatively supported by the AUC values (0.764 and 0.745) and the statistical significance (P < 0.05). Table 5 Analysis results of continuous variable ROC curve variable AUC Best cutoff value Youdens index Sensitivity Specificity Duration of operation 0.764 75min 0.421 83.72% 58.33% Average diameter of the IG sac 0.745 12.25 0.564 89.74% 66.67% Progesterone on the pregnancy test day 0.628 25.61 0.289 53.65% 75.00% HCG on pregnancy test day 0.579 649.75 0.192 69.23% 50.00% Note: "AUC" denotes the area under the ROC curve. 5. Impact of the Number of Days Between Transplantation and Surgery on Postoperative Pregnancy Outcomes: The cohort was stratified according to the number of days between embryo transplantation and laparoscopic surgery (17–23 days as Group A, 24–30 days as Group B, 31–35 days as Group C, and > 35 days as Group D), to evaluate the impact of this duration on postoperative pregnancy outcomes (refer to Table 6 ). Table 6 Pregnancy Outcomes at Different Transplantation Times on the Day of Laparoscopic Surgery [n (%)] n Term delivery Premature birth Early abortion Induction of labor Abortion time unknown Group A(17–23 days) 11 7(63.64%) 1(9.09%) 3(27.27%) - - Group B(24–30 days) 29 20(68.97%) 3(10.34%) 4(13.79%) 1(3.45%) 1(3.45%) Group C(31–35 days) 11 8(72.70%) - 2(18.18%) 1(9.09%) - Group D(>35 days) 10 8(80.00%) - 2(20.00%) - - In Group A, comprising eleven patients with HP, seven patients (63.64%) had successful full-term live births, while three patients experienced early miscarriages. Group B included twenty-nine HP patients. Of these, twenty (68.97%) had successful full-term live births, four experienced early miscarriages (the timing of the miscarriage was unknown for one patient), and one patient underwent induced labor at 27 weeks due to gestational hypertension. Moreover, one patient in this group had a full-term twin live birth, while others included one case of preterm birth at 34 + weeks and two cases of preterm birth at 36 + weeks. Group C consisted of eleven HP patients, among which eight (72.70%) had full-term twin live births. One patient in this group underwent labor induction at 21 weeks due to a diagnosis of Down syndrome. Group D contained ten HP patients, with eight (80.00%) achieving full-term live births, and two cases experiencing early miscarriages. Discussion Single blastocyst transfer represents the most effective strategy for preventing HP during IVF-ET cycles 12 – 14 . Nonetheless, the pursuit of elevating the success rate of IVF leads numerous centers to perform double blastocyst transfers, contributing to a substantial rise in the incidence of HP with the proliferation of IVF technology 15 . This study observed an HP incidence of 0.95‰ during fresh embryo transfer cycles in IVF, and 1.63‰ during frozen embryo transfer (FET) cycles. When compared to cases of isolated ectopic pregnancy, the clinical challenges in managing HP are markedly acute. Timely intervention to terminate the ectopic pregnancy, while ensuring the preservation and normal progression of the intrauterine embryo, is imperative. Consequently, enhancing post-IVF-ET pregnancy outcomes in HP patients is an urgent and complex challenge. The literature reveals that HP cases commonly exhibit a elevated abortion rate 16 – 18 . However, this study found that the live birth rate in the surgical therapy group was an encouraging 77.05%. Laparoscopic surgery has emerged as a more favorable treatment option compared to conservative therapy 19 , 20 , owing to its superior pelvic visualization, reduced hospitalization time, minimized postoperative pain, and diminished interference with intrauterine pregnancy 21 , The prompt removal of ectopic gestational sacs via laparoscopy has been associated with improved pregnancy outcomes. Notably, laparoscopic surgery does not appear to elevate the risk of abortion in ongoing intrauterine pregnancies compared to laparotomy 22 , 23 . Thus, we advocate laparoscopic intervention for HP patients, with meticulous timing and expeditious surgical execution to mitigate the potential adverse effects on embryonic development. An auxiliary study focusing on the impact of the number of days of embryo transfer on postoperative pregnancy outcomes revealed no significant correlation. Further logistic regression analysis demonstrated that the average diameter of the intrauterine gestational sac, along with the visibility of the embryo and fetal heart, are critical determinants of pregnancy outcomes in HP cases. Larger diameters, visible embryos, and fetal heartbeats were associated with improved outcomes, characterized by higher full-term live birth rates and lower risks of miscarriage and medically induced labor. These factors signify the normal development of the intrauterine embryo, which, when concomitant with laparoscopic removal of ectopic gestational sacs, emerges as a vital determinant of favorable pregnancy outcomes. Notwithstanding, the duration of laparoscopic surgery has been identified as a risk factor influencing pregnancy outcomes, perhaps due to prolonged surgical intervention exacerbating uterine stimulation. Hence, it is paramount to expedite the surgical procedure as much as feasible to curtail uterine stimulation. In contrast to abdominal ultrasound, TVS demonstrates heightened sensitivity and precision in early HP detection 24 , identifying approximately 70% of HP cases between the 5th and 8th weeks of pregnancy 25 . For IVF-ET cycles where two or more embryos are transferred, particularly for patients with increased HP risk factors, we recommend vigilant monitoring to ascertain the location of the gestational sac, thereby reducing the likelihood of diagnostic oversight. For patients diagnosed with HP, it has been observed that opting for laparoscopic surgery does not adversely affect the pregnancy outcomes. In fact, laparoscopic surgery can potentially lead to more favorable pregnancy outcomes if performed at an opportune time. In scenarios where the patient is stable, it may be prudent to defer surgery until the gestational sac's fetal germ and heartbeat are visible through intrauterine monitoring. Additionally, minimizing the duration of surgery could be beneficial in reducing uterine stimulation, which in turn may contribute to better pregnancy outcomes. In summary, HP is more prevalent among women undergoing IVF-ET compared to natural conception and is susceptible to misdiagnosis, posing significant risks to both maternal and fetal health. The presence of an intrauterine gestational sac does not preclude ectopic pregnancy. Clinicians must exercise diligence in taking patient history, performing examinations, and employing early TVS for HP screening to facilitate prompt detection and diagnosis. The judicious selection of surgical intervention at the opportune moment is essential to terminate ectopic pregnancies while minimizing harm to the intrauterine pregnancies, thereby optimizing pregnancy outcomes. Given the low incidence of HP, large-scale clinical trials are not feasible to ascertain the optimal timing for surgical intervention. Hence, further research is indispensable for refining treatment modalities and bolstering the reproductive health outcomes of HP patients. Declarations Author contributions statement: Mingxia Gao and Xianghua Dong were involved in conceptualization, data curation, formal analysis, and writing of the original draft as well as reviewing and editing the manuscript. Haifei Liu, Xinyue Zhou, Jiajia Liu, and Hongwei Li contributed to data curation and reviewing the manuscript. Xuehong Zhang contributed to reviewing and polishing the manuscript. Additional information: Competing interests: The authors declare no competing interests. Ethical Approval: The requirement for informed consent was waived by the Ethics Committee of LZU No.1 Hospital as this is a retrospective study, with the approval number LDYLL2023-323. Consent to Participate: This is not applicable. Consent for Publication: This is not applicable. Conflict of Interest: The author declares no competing interests. Funding: The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received. Acknowledgment None. Data Availability: The data that support the findings of this study are available from Reproductive Medicine Center of The First Hospital of Lanzhou University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Reproductive Medicine Center of The First Hospital of Lanzhou University. If someone is interested in the data from this study, please contact the corresponding author of this paper. References Maleki, A., Khalid, N., Rajesh Patel, C. & El-Mahdi, E. 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Ultrasound Obstet Gynecol 41, 563–569, doi: 10.1002/uog.12341 (2013). Kalra, A., Kumar, P. & Parwan, D. Live birth after laparoscopic management of a ruptured myomectomy site pregnancy and unruptured tubal gestation in a double ectopic heterotopic gestation. Minerva Obstet Gynecol 73, 268–271, doi: 10.23736/s2724-606x.21.04772-9 (2021). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4102047","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":292207500,"identity":"8510f66c-6058-4fc3-9595-e35bee42a962","order_by":0,"name":"Mingxia Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYNACg39ybOztB0jRUnHAmI/nTAIpWs4cSJwn4WBAnGJ598NHN/O23Ulvk2BIYPhRsY2wFsMzaWk3Z7Y9y22TbjzA2HPmNhFaGnLMbnxsY85tkzmQwMzYRoyW/jdmNxLbmNPZJBIMiNMiLwG05cOZwwnEazGQeJZ2c0ZFmmEbMJAPEuUX+f7kY7d5DGzk5dvbDz74UUGMLQeQOAdwKEKzpYEoZaNgFIyCUTCiAQCiJ0CbC1b1wgAAAABJRU5ErkJggg==","orcid":"","institution":"The First Hospital of Lanzhou University","correspondingAuthor":true,"prefix":"","firstName":"Mingxia","middleName":"","lastName":"Gao","suffix":""},{"id":292207501,"identity":"cda42847-eac3-40a2-a486-7da4d8f5e6b9","order_by":1,"name":"Xianghua Dong","email":"","orcid":"","institution":"The First Clinical Medical College of Lanzhou University, Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xianghua","middleName":"","lastName":"Dong","suffix":""},{"id":292207502,"identity":"ee6bb4f9-efd8-45d3-8c1e-c188235a224f","order_by":2,"name":"Haifei Liu","email":"","orcid":"","institution":"The First Clinical Medical College of Lanzhou University, Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Haifei","middleName":"","lastName":"Liu","suffix":""},{"id":292207503,"identity":"8f4b83e6-eb75-42f1-9a91-d93f0c1c1b57","order_by":3,"name":"Xinyue Zhou","email":"","orcid":"","institution":"The First Clinical Medical College of Lanzhou University, Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xinyue","middleName":"","lastName":"Zhou","suffix":""},{"id":292207504,"identity":"355b817b-3d62-42ef-81b5-f1e3e5aa0145","order_by":4,"name":"Jiajia Liu","email":"","orcid":"","institution":"The First Clinical Medical College of Lanzhou University, Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Jiajia","middleName":"","lastName":"Liu","suffix":""},{"id":292207505,"identity":"92bc6a24-e6da-4188-80ca-9e33b2f1f3d3","order_by":5,"name":"Hongwei Li","email":"","orcid":"","institution":"The First Clinical Medical College of Lanzhou University, Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Li","suffix":""},{"id":292207506,"identity":"1b2b91c1-332f-4918-b6ea-2ff7429272f9","order_by":6,"name":"Xuehong Zhang","email":"","orcid":"","institution":"The First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Xuehong","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-03-14 15:28:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4102047/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4102047/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55061951,"identity":"2fff61c6-9380-4f07-ba8d-b6db928adb0e","added_by":"auto","created_at":"2024-04-22 02:53:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27623,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis results of continuous variable ROC curve\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4102047/v1/82ccf0b9b52fb004fb9a42c3.png"},{"id":71525685,"identity":"6befbd7f-978a-4edc-b567-72c0beb94f3c","added_by":"auto","created_at":"2024-12-16 12:24:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":578254,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4102047/v1/4a94c461-c676-41b8-bf5b-dcb5c504c402.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs reproductive medicine continues to evolve, IVF-ET has emerged as a critical and efficacious modality for the management of infertility. Despite the remarkable successes attributed to this technique, its proliferation has brought to light several attendant complications and risks. A notable complication is Heterotopic Pregnancy (HP) \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, a rare form of ectopic pregnancy characterized by the concurrent presence of both intrauterine and extra-uterine pregnancies. In the context of natural conception, the incidence of HP is relatively low, ranging between 1 in 7,963 to 1 in 30,000 pregnancies \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. However, a concerning trend has been observed with the utilization of IVF-ET\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, where the incidence of HP escalates to approximately 1\u0026ndash;3% \u003csup\u003e6,7\u003c/sup\u003e. This augmented incidence in the IVF-ET population presents diagnostic and management challenges for clinicians, chiefly due to the existence of a concomitant intrauterine pregnancy \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe ramifications of undetected or inadequately managed HP are severe, with potential complications including ectopic pregnancy rupture and hemorrhage, which can jeopardize both the life and future fertility of the patients \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Therefore, it is essential for the early recognition and timely intervention of this disease. However, there are relatively few research on HP, and the clinical experience of diagnosis and treatment is still limited. Given these high stakes, the early identification and prompt intervention of HP are paramount. Nonetheless, the paucity of research dedicated to HP, coupled with limited clinical experience in its diagnosis and management \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, underscores a critical knowledge gap.\u003c/p\u003e \u003cp\u003eAiming to address this gap, our study undertakes a retrospective analysis of patients diagnosed with HP following IVF-ET at our institution over the past decade. Through the identification of risk factors and examination of pregnancy outcomes associated with HP post-IVF-ET, we aspire to furnish a valuable reference for clinicians managing HP in the IVF setting. By doing so, we intend to contribute to the enhancement of patient quality of life and fertility outcomes and investigate avenues for the reduction of HP incidence subsequent to IVF-ET. Our study, therefore, seeks to enrich both the research corpus and clinical practice in this domain, with the ultimate goal of bolstering the safety and effectiveness of IVF-ET treatments.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e1. Study Participants\u003c/p\u003e \u003cp\u003eThis study conducted a retrospective analysis of 66 patients who developed HP following IVF-ET treatment at the First Hospital of Lanzhou University, spanning from January 2012 to December 2022.​ All participants underwent preoperative transvaginal ultrasound (TVS), with subsequent pathological examinations confirming the presence of intrauterine pregnancies and adnexal masses. This study received approval from the Ethics Committee of the First Hospital of Lanzhou University, with the approval number LDYLL2023-323.\u003c/p\u003e \u003cp\u003e2. Data collection\u003c/p\u003e \u003cp\u003eData were meticulously collected on various parameters including age, duration of infertility, type and cause of infertility, history of pelvic and abdominal surgeries, history of abnormal pregnancies and other adverse pregnancy outcomes, ovulation induction methods, fertilization techniques, the number of embryos transferred, ultrasound findings, treatment modalities, and pregnancy outcomes, etc.\u003c/p\u003e \u003cp\u003e3. Treatment Modalities\u003c/p\u003e \u003cp\u003eOut of the 66 patients diagnosed with HP, 5 patients underwent conservative management, while 61 patients opted for surgical intervention, either through laparoscopic salpingectomy or laparoscopic cornual resection.\u003c/p\u003e \u003cp\u003e4. Statistical Analysis\u003c/p\u003e \u003cp\u003eStatistical analysis was conducted utilizing SPSS version 25.0. Continuous variables were represented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while categorical data were depicted as percentages. Binary logistic regression analysis was employed to investigate the risk factors influencing the outcomes of pregnancies in patients with HP. A P-value of less than 0.05 was deemed to represent statistical significance. All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Patient Demographics and Treatment Outcomes:\u003c/p\u003e \u003cp\u003eThe study encompassed a total of 66 participants, all diagnosed with HP. Among these, five patients elected for conservative management. Of these five patients, a single case resulted in a successful full-term live birth. Early pregnancy losses were documented in two cases, occurring at 8\u0026thinsp;+\u0026thinsp;and 9\u0026thinsp;+\u0026thinsp;weeks of gestation, respectively. Furthermore, one spontaneous abortion was recorded at 15\u0026thinsp;+\u0026thinsp;weeks of gestation, while another case necessitated induced labor at 19\u0026thinsp;+\u0026thinsp;weeks of gestation due to fetal demise. The remaining cohort of 61 patients underwent surgical intervention via laparoscopy.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the demographic data of the 61 HP patients who underwent laparoscopic surgery. The age range of this subgroup spanned from 24 to 39 years, with a mean age of 31.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83 years. Within this subgroup, 37 patients underwent frozen embryo transfer (FET) cycles while 24 patients were part of fresh cycles. The average duration of infertility among these 61 patients was 3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33 years. One notable case within this cohort involved a patient who experienced fetal brain abnormality attributable to medication, which consequently led to labor induction. Post this event, the patient opted for contraceptive measures and later sought assisted reproductive technologies due to male factor infertility. The maximum duration of infertility observed in this subgroup was 10 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Information of Patients Undergoing Laparoscopic Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s), ཎ༈%༉\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge/years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of infertility/years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of infertility\u003c/p\u003e \u003cp\u003ePrimary infertility\u003c/p\u003e \u003cp\u003eSecondary infertility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(59.02%)\u003c/p\u003e \u003cp\u003e25(40.98%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause of infertility\u003c/p\u003e \u003cp\u003eTubal factors\u003c/p\u003e \u003cp\u003eMale factors\u003c/p\u003e \u003cp\u003eOther factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47(77.05%)\u003c/p\u003e \u003cp\u003e9(14.75%)\u003c/p\u003e \u003cp\u003e5(8.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of pelvic surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(49.18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of fallopian tube surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(37.70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ovarian drilling technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of uterine myomectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of oophorocystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(4.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of pelvic adhesiolysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(50.82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of abdominal surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(11.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ileus surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of cholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of laparoscopic surgery (specific unknown)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(4.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of laparoscopic combination of laparoscopic surgery (specific unknown)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ectopic pregnancy\u003c/p\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003eOnce\u003c/p\u003e \u003cp\u003eTwice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(73.77%)\u003c/p\u003e \u003cp\u003e14(22.95%)\u003c/p\u003e \u003cp\u003e3(4.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther adverse pregnancy history\u003c/p\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(73.77%)\u003c/p\u003e \u003cp\u003e10(16.39%)\u003c/p\u003e \u003cp\u003e5(8.20%)\u003c/p\u003e \u003cp\u003e2(3.28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType\u003c/p\u003e \u003cp\u003eFresh cycles\u003c/p\u003e \u003cp\u003eFET cycles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(39.34%)\u003c/p\u003e \u003cp\u003e37(60.66%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmbryo fertilization method\u003c/p\u003e \u003cp\u003eIVF\u003c/p\u003e \u003cp\u003eICSI\u003c/p\u003e \u003cp\u003eRICSI\u003c/p\u003e \u003cp\u003eIVF, ICSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(67.21%)\u003c/p\u003e \u003cp\u003e17(27.87%)\u003c/p\u003e \u003cp\u003e2(3.28%)\u003c/p\u003e \u003cp\u003e1(1.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of embryos transferred\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(85.25%)\u003c/p\u003e \u003cp\u003e9(14.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness on the day of transplantation/mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eNote: \"x̅\" denotes the sample mean, \"s\" denotes the sample standard deviation, \"n\" denotes the sample size.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese results offer a comprehensive overview of the patient demographics, treatment modalities, and outcomes for individuals diagnosed with HP, thereby providing critical insights into the management and prognosis of this condition.\u003c/p\u003e \u003cp\u003e2. Pregnancy Outcomes of Intrauterine Pregnancies:\u003c/p\u003e \u003cp\u003eIn our cohort, the 61 HP patients who underwent laparoscopic surgery were categorized into two groups based on pregnancy outcomes: Intrauterine Live Birth Group and Non-Live Birth Group. In the Intrauterine Live Birth Group, comprising 47 patients (77.05% of the surgical cohort), 43 individuals (91.49%) achieved successful full-term live births with no neonatal abnormalities reported. Notably, in one instance, both twins of an intrauterine twin pregnancy were born healthy. Furthermore, 4 cases (8.51%) were classified as preterm births, with two occurring at 36\u0026thinsp;+\u0026thinsp;weeks of gestation and two at 34\u0026thinsp;+\u0026thinsp;weeks of gestation. No adverse outcomes were reported among these preterm neonates (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePregnancy Outcomes of Intrauterine Pregnancy in the Laparoscopic Surgery Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine live birth group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47(77.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-live birth group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(22.95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine live birth group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-term live birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43(91.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(8.51%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-live birth group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(78.57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInduction of labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(14.29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion time unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(7.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eConversely, the Non-Live Birth Group consisted of 14 patients (22.95% of the surgical cohort). Within this group, 11 patients experienced early pregnancy loss (78.57%), while two patients underwent induced labor (14.29%) due to fetal Down syndrome and gestational hypertension diagnoses, respectively. Additionally, the exact timing of pregnancy termination remained unknown for one patient (7.14%).\u003c/p\u003e \u003cp\u003eDuring laparoscopic surgery, 49 cases exhibited a visible germ within the intrauterine gestational sac. Among these, 38 cases (77.55%) resulted in live births. This subset included a twin intrauterine pregnancy with healthy neonatal outcomes, two instances of preterm birth at 36\u0026thinsp;+\u0026thinsp;weeks of gestation, and one preterm birth at 34\u0026thinsp;+\u0026thinsp;weeks. Additionally, two patients underwent induced labor: one due to gestational hypertension at 27 weeks and the other due to Down syndrome at 21 weeks. Six early pregnancy terminations were documented. Of the 12 cases with no visible germ in the intrauterine gestational sac, five resulted in live births with favorable neonatal outcomes, while five were classified as early pregnancy terminations. The gestational duration of pregnancy termination was unknown for one patient.\u003c/p\u003e \u003cp\u003eOf the 41 cases presenting with a visible fetal heartbeat within the intrauterine gestational sac, 33 (80.49%) resulted in live births. This included one twin intrauterine pregnancy, one preterm birth at 36\u0026thinsp;+\u0026thinsp;weeks, and one preterm birth at 34\u0026thinsp;+\u0026thinsp;weeks. Three early pregnancy terminations were due to fetal demise, and two cases involved induced labor. Additionally, 20 cases with no visible fetal heartbeat were observed, half of which achieved successful full-term live births. One patient underwent cesarean delivery at 34\u0026thinsp;+\u0026thinsp;weeks due to gestational hypertension, with no adverse neonatal outcomes reported.\u003c/p\u003e \u003cp\u003eA total of 53 cases of ectopic pregnancy were localized in the fallopian tube, comprising 86.89% of the total number of cases. Among these, 28 cases (52.83%) were situated in the ampullary section of the fallopian tube, with 21 cases (75.00%) resulting in successful full-term live births and two cases (7.14%) leading to premature births at 36\u0026thinsp;+\u0026thinsp;weeks, with all newborns being healthy; four cases (14.29%) ended in early miscarriages. Additionally, one case (3.57%) resulted in intrauterine death due to gestational hypertension, necessitating labor induction at 27\u0026thinsp;+\u0026thinsp;weeks. Moreover, four cases (7.55%) of ectopic pregnancy were located in the isthmus of the fallopian tube, among which two cases (50.00%) led to successful full-term live births, and the remaining two cases (50.00%) resulted in early miscarriages. There were two cases (3.77%) located in the interstitial part of the fallopian tube, of which one (50.00%) culminated in a successful full-term live birth, and the other case underwent labor induction due to Down's syndrome. In nineteen cases (35.85%), the exact location of the ectopic pregnancy within the fallopian tube was unknown; of these, fourteen cases (73.68%) resulted in successful full-term live births, one case (5.26%) was a premature birth at 36\u0026thinsp;+\u0026thinsp;weeks, and three cases (15.79%) experienced early miscarriages. There were four cases (6.56%) of cornual pregnancy, with only one case (25.00%) resulting in a successful full-term live birth, one case (25.00%) was a 36\u0026thinsp;+\u0026thinsp;weeks premature birth, and the remaining two cases (50.00%) ended in early miscarriages. Additionally, four patients (6.56%) had an ovarian pregnancy, all of which resulted in successful full-term live births (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePregnancy Outcomes for 61 Patients in the Laparoscopic Surgery Group [n (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFull-term live birth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEarly abortion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInduction of labor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAbortion time unknown\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisible germ within the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(77.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(6.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(12.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(4.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(41.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(41.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(8.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisible fetal heartbeat within the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(80.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(4.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(7.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(4.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(5.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(40.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(5.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpulla of fallopian tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(75.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(14.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsthmus of fallopian tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterstitial part of fallopian tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe exact location of the fallopian tube is unknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(73.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(5.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(15.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(5.26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(100.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCornu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: IG stands for Intrauterine Gestational.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3. Logistic Regression Analysis of Factors Influencing Postoperative Pregnancy Outcomes:\u003c/p\u003e \u003cp\u003eIn an effort to investigate the determinants influencing the outcomes of pregnancies following surgery, this study employed logistic regression analysis. Specifically, it scrutinized various factors such as the average diameter of the intrauterine gestational (IG) sac, the visibility of embryonic structures and fetal heartbeat, the duration of laparoscopic surgery, and the levels of human chorionic gonadotropin (HCG) and progesterone at the time of pregnancy diagnosis. The findings revealed that the average diameter of the gestational sac, the visibility of the embryonic structures and fetal heartbeat during laparoscopic surgery, as well as the duration of the surgery itself, were significant factors affecting the pregnancy outcomes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis of factors influencing postoperative pregnancy outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage diameter of the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.019\u0026ndash;1.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of fetal germ within the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.313\u0026ndash;20.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of fetal heartbeat within the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.375\u0026ndash;36.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.951\u0026ndash;0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCG on pregnancy test day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.999-1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgesterone on the pregnancy test day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.981\u0026ndash;1.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTaking the non-live birth group as a reference.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003e\"B\" denotes the regression coefficient, \"SE\" denotes the standard error, \"OR\" denotes the odds ratio, \"CI\" denotes the confidence interval, \"Z\" denotes the test statistic, and \"P\" denotes the p-value.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e4. Analysis results of continuous variable ROC curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cp\u003eValuable continuous variables were analyzed using ROC curves, with detailed findings depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The AUC values for the duration of operation, the average diameter of the IG sac, progesterone levels on the day of the pregnancy test, and hCG levels on the pregnancy test day are 0.764, 0.745, 0.628, and 0.579, respectively. These values and their corresponding optimal cutoffs are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. An AUC greater than 0.7 is indicative of a strong predictive capability. Particularly, the AUCs for the duration of operation and the average diameter of the IG sac stand at 0.764 and 0.745, respectively, reflecting a robust predictive strength for these factors. The Youden's index values for these parameters are 0.421 and 0.564, further underscoring their significance. These findings suggest that both the duration of operation and the average diameter of the IG sac are influential in predicting pregnancy outcomes during surgical procedures. Furthermore, these two risk factors have demonstrated statistical significance in affecting pregnancy outcomes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), thereby affirming their utility as reliable predictive indicators for the pregnancy outcomes of patients. These results are quantitatively supported by the AUC values (0.764 and 0.745) and the statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis results of continuous variable ROC curve\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBest cutoff value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYoudens index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e83.72%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage diameter of the IG sac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgesterone on the pregnancy test day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53.65%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCG on pregnancy test day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e649.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: \"AUC\" denotes the area under the ROC curve.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e5. Impact of the Number of Days Between Transplantation and Surgery on Postoperative Pregnancy Outcomes:\u003c/p\u003e \u003cp\u003eThe cohort was stratified according to the number of days between embryo transplantation and laparoscopic surgery (17\u0026ndash;23 days as Group A, 24\u0026ndash;30 days as Group B, 31\u0026ndash;35 days as Group C, and \u0026gt;\u0026thinsp;35 days as Group D), to evaluate the impact of this duration on postoperative pregnancy outcomes (refer to Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePregnancy Outcomes at Different Transplantation Times on the Day of Laparoscopic Surgery [n (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTerm delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePremature birth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEarly abortion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInduction of labor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAbortion time unknown\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup A(17\u0026ndash;23 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(63.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3(27.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup B(24\u0026ndash;30 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(68.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(10.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4(13.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(3.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(3.45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup C(31\u0026ndash;35 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(72.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2(18.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup D(\u0026gt;35 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(80.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2(20.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Group A, comprising eleven patients with HP, seven patients (63.64%) had successful full-term live births, while three patients experienced early miscarriages.\u003c/p\u003e \u003cp\u003eGroup B included twenty-nine HP patients. Of these, twenty (68.97%) had successful full-term live births, four experienced early miscarriages (the timing of the miscarriage was unknown for one patient), and one patient underwent induced labor at 27 weeks due to gestational hypertension. Moreover, one patient in this group had a full-term twin live birth, while others included one case of preterm birth at 34\u0026thinsp;+\u0026thinsp;weeks and two cases of preterm birth at 36\u0026thinsp;+\u0026thinsp;weeks.\u003c/p\u003e \u003cp\u003eGroup C consisted of eleven HP patients, among which eight (72.70%) had full-term twin live births. One patient in this group underwent labor induction at 21 weeks due to a diagnosis of Down syndrome.\u003c/p\u003e \u003cp\u003eGroup D contained ten HP patients, with eight (80.00%) achieving full-term live births, and two cases experiencing early miscarriages.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSingle blastocyst transfer represents the most effective strategy for preventing HP during IVF-ET cycles \u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Nonetheless, the pursuit of elevating the success rate of IVF leads numerous centers to perform double blastocyst transfers, contributing to a substantial rise in the incidence of HP with the proliferation of IVF technology \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. This study observed an HP incidence of 0.95\u0026permil; during fresh embryo transfer cycles in IVF, and 1.63\u0026permil; during frozen embryo transfer (FET) cycles. When compared to cases of isolated ectopic pregnancy, the clinical challenges in managing HP are markedly acute. Timely intervention to terminate the ectopic pregnancy, while ensuring the preservation and normal progression of the intrauterine embryo, is imperative. Consequently, enhancing post-IVF-ET pregnancy outcomes in HP patients is an urgent and complex challenge.\u003c/p\u003e \u003cp\u003eThe literature reveals that HP cases commonly exhibit a elevated abortion rate \u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. However, this study found that the live birth rate in the surgical therapy group was an encouraging 77.05%. Laparoscopic surgery has emerged as a more favorable treatment option compared to conservative therapy \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, owing to its superior pelvic visualization, reduced hospitalization time, minimized postoperative pain, and diminished interference with intrauterine pregnancy \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, The prompt removal of ectopic gestational sacs via laparoscopy has been associated with improved pregnancy outcomes. Notably, laparoscopic surgery does not appear to elevate the risk of abortion in ongoing intrauterine pregnancies compared to laparotomy\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Thus, we advocate laparoscopic intervention for HP patients, with meticulous timing and expeditious surgical execution to mitigate the potential adverse effects on embryonic development.\u003c/p\u003e \u003cp\u003eAn auxiliary study focusing on the impact of the number of days of embryo transfer on postoperative pregnancy outcomes revealed no significant correlation. Further logistic regression analysis demonstrated that the average diameter of the intrauterine gestational sac, along with the visibility of the embryo and fetal heart, are critical determinants of pregnancy outcomes in HP cases. Larger diameters, visible embryos, and fetal heartbeats were associated with improved outcomes, characterized by higher full-term live birth rates and lower risks of miscarriage and medically induced labor. These factors signify the normal development of the intrauterine embryo, which, when concomitant with laparoscopic removal of ectopic gestational sacs, emerges as a vital determinant of favorable pregnancy outcomes. Notwithstanding, the duration of laparoscopic surgery has been identified as a risk factor influencing pregnancy outcomes, perhaps due to prolonged surgical intervention exacerbating uterine stimulation. Hence, it is paramount to expedite the surgical procedure as much as feasible to curtail uterine stimulation.\u003c/p\u003e \u003cp\u003eIn contrast to abdominal ultrasound, TVS demonstrates heightened sensitivity and precision in early HP detection \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, identifying approximately 70% of HP cases between the 5th and 8th weeks of pregnancy \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. For IVF-ET cycles where two or more embryos are transferred, particularly for patients with increased HP risk factors, we recommend vigilant monitoring to ascertain the location of the gestational sac, thereby reducing the likelihood of diagnostic oversight.\u003c/p\u003e \u003cp\u003eFor patients diagnosed with HP, it has been observed that opting for laparoscopic surgery does not adversely affect the pregnancy outcomes. In fact, laparoscopic surgery can potentially lead to more favorable pregnancy outcomes if performed at an opportune time. In scenarios where the patient is stable, it may be prudent to defer surgery until the gestational sac's fetal germ and heartbeat are visible through intrauterine monitoring. Additionally, minimizing the duration of surgery could be beneficial in reducing uterine stimulation, which in turn may contribute to better pregnancy outcomes.\u003c/p\u003e \u003cp\u003eIn summary, HP is more prevalent among women undergoing IVF-ET compared to natural conception and is susceptible to misdiagnosis, posing significant risks to both maternal and fetal health. The presence of an intrauterine gestational sac does not preclude ectopic pregnancy. Clinicians must exercise diligence in taking patient history, performing examinations, and employing early TVS for HP screening to facilitate prompt detection and diagnosis. The judicious selection of surgical intervention at the opportune moment is essential to terminate ectopic pregnancies while minimizing harm to the intrauterine pregnancies, thereby optimizing pregnancy outcomes. Given the low incidence of HP, large-scale clinical trials are not feasible to ascertain the optimal timing for surgical intervention. Hence, further research is indispensable for refining treatment modalities and bolstering the reproductive health outcomes of HP patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMingxia Gao and Xianghua Dong were involved in conceptualization, data curation, formal analysis, and writing of the original draft as well as reviewing and editing the manuscript. Haifei Liu, Xinyue Zhou, Jiajia Liu, and Hongwei Li contributed to data curation and reviewing the manuscript. Xuehong Zhang contributed to reviewing and polishing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eEthical Approval: The requirement for informed consent was waived by the Ethics Committee of LZU No.1 Hospital as this is a retrospective study, with the approval number LDYLL2023-323.\u003c/p\u003e\n\u003cp\u003eConsent to Participate: This is not applicable.\u003c/p\u003e\n\u003cp\u003eConsent for Publication: This is not applicable.\u003c/p\u003e\n\u003cp\u003eConflict of Interest: The author declares no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003eNo funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003eAcknowledgment None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from Reproductive Medicine Center of The First Hospital of Lanzhou University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Reproductive Medicine Center of The First Hospital of Lanzhou University. If someone is interested in the data from this study, please contact the corresponding author of this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaleki, A., Khalid, N., Rajesh Patel, C. \u0026amp; El-Mahdi, E. The rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization. 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Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer. Ultrasound Obstet Gynecol 41, 563\u0026ndash;569, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/uog.12341\u003c/span\u003e\u003cspan address=\"10.1002/uog.12341\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalra, A., Kumar, P. \u0026amp; Parwan, D. Live birth after laparoscopic management of a ruptured myomectomy site pregnancy and unruptured tubal gestation in a double ectopic heterotopic gestation. Minerva Obstet Gynecol 73, 268\u0026ndash;271, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23736/s2724-606x.21.04772-9\u003c/span\u003e\u003cspan address=\"10.23736/s2724-606x.21.04772-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"In vitro fertilization-embryo transfer, Heterotopic pregnancy, Laparoscopy, Pregnancy outcome","lastPublishedDoi":"10.21203/rs.3.rs-4102047/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4102047/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eResearch Question:\u003c/h2\u003e \u003cp\u003eTo study the outcome of heterotopic pregnancy (HP) and related influencing factors after in vitro fertilization-embryo transfer (IVF-ET), and to provide clinical experience for the treatment of heterotopic pregnancy.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e \u003cp\u003eObservational study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur data revealed a HP incidence of 1.27\u0026permil;. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). ​Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLaparoscopic surgery is an effective method for the treatment of HP, and laparoscopic ectopic resection of ectopic pregnancy lesion does not seem to affect the continuous pregnancy and live birth of the intrauterine gestational sac. The mean diameter of the intrauterine gestational sac on the day of surgery, the development of the intrauterine gestational sac, and the duration of surgery can affect the patient's pregnancy outcome.\u003c/p\u003e","manuscriptTitle":"Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-22 02:53:24","doi":"10.21203/rs.3.rs-4102047/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35ac1896-006e-4203-98ab-63ab646efbeb","owner":[],"postedDate":"April 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30782935,"name":"Health sciences/Medical research/Epidemiology"},{"id":30782936,"name":"Health sciences/Medical research/Outcomes research"},{"id":30782937,"name":"Health sciences/Medical research/Study design"},{"id":30782938,"name":"Biological sciences/Developmental biology/Intrauterine growth"},{"id":30782939,"name":"Health sciences/Risk factors"},{"id":30782940,"name":"Health sciences/Diseases/Reproductive disorders/Infertility"},{"id":30782941,"name":"Health sciences/Health care/Prognosis"}],"tags":[],"updatedAt":"2024-12-16T12:23:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-22 02:53:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4102047","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4102047","identity":"rs-4102047","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}