Ectopic pregnancy risk with assisted reproductive technology procedures

Heather B Clayton, Clayton HB, Laura A. Schieve, Schieve LA, Herbert B. Peterson, Peterson HB, Denise J. Jamieson, Meredith A Reynolds, Reynolds MA, Victoria C Wright, Wright VC
Obstetrics and gynecology · 2006 · doi:10.1097/01.AOG.0000196503.78126.62 · PMID:16507930
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Analysis of 94,118 ART pregnancies reveals that ectopic pregnancy risk varies by procedure type and patient factors, including a significantly increased risk for women with endometriosis.

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This study analyzed population-based data from U.S. assisted reproductive technology clinics between 1999 and 2001 to determine ectopic pregnancy risks associated with various treatment procedures. The researchers found that the overall ectopic rate was 2.1%, with significant variations observed based on the specific ART method used, such as higher rates for zygote intrafallopian transfer and lower rates for donor oocyte cycles. Multivariable analysis indicated that women with endometriosis had a significantly increased risk of ectopic pregnancy compared to those undergoing ART for male factor infertility. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

OBJECTIVE: To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS: The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. RESULTS: Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. CONCLUSION: Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2.
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Objective

To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures.

Methods

The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999–2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression.

Results

Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient’s oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7–2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0–1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2–1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5–0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5–0.9), but not when 3 or more embryos were transferred.

Conclusion

Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2

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Condition tags

endometriosisinfertility

MeSH descriptors

Pregnancy, Ectopic Reproductive Techniques, Assisted Female Humans Logistic Models Pregnancy Pregnancy, Ectopic Pregnancy, Ectopic Reproductive Techniques, Assisted Risk Factors United States United States

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