Research question

What are the main risk factors associated with ectopic pregnancy and what is the true incidence of ectopic pregnancies in an IVF programme?

Design

Retrospective single-centre study of 12,429 blastocyst transfers (8182 fresh and 4247 frozen embryo transfers) conducted between January 2010 and December 2017. IVF outcome was analysed, and ectopic pregnancy risk evaluated according to patient's characteristics and assisted reproductive technology treatment factors.

Results

Of 5061 patients reporting a positive pregnancy test, 43 were diagnosed with ectopic pregnancy (0.85%). Neither female age (36.7 versus 35.8 years), body mass index, quality of transfer nor stimulation protocol affected the ectopic pregnancy rate, but history of previous ectopic pregnancy (OR 3.26; P = 0.0080), tubal surgery, or both (OR 6.20; P < 0.0001) did. The incidence of ectopic pregnancy was increased in women with uterine malformations (OR 3.85; P = 0.0052), uterine pathologies (OR 5.35; P = 0.0001), uterine surgeries (OR 2.29; P = 0.0154) or sub-optimal endometrial build-up (OR 4.46 to 5.31; P < 0.0001). Transfer of slow-developing blastocysts (expressed by expansion) significantly increased the risk of ectopic pregnancy (OR 2.59; P = 0.0102).

Conclusions

Unfavourable uterine environment, including uterine pathologies, uterine or tubal surgery and suboptimal endometrial build-up were related to ectopic pregnancy. Low expansion grade of blastocysts was identified as an additional putative risk factor for ectopic pregnancy, indicating the importance of proper embryonal–maternal synchronization. The overall ectopic pregnancy rate after blastocyst transfer was low, comparable with reported ectopic pregnancy rates in spontaneous conceptions. Proper evaluation of tubal and uterine pathologies, optimizing endometrial preparation and the transfer of expanded blastocysts in a frozen embryo transfer cycle, might be beneficial.

中文翻译：

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子宫内膜-胚胎同步不良是辅助生殖技术中异位妊娠的危险因素。

研究问题

与异位妊娠相关的主要危险因素是什么？试管婴儿计划中异位妊娠的真实发生率是多少？

设计

在2010年1月至2017年12月之间进行了12429例胚泡移植（8182例新鲜胚胎和4247例冷冻胚胎的移植）的回顾性单中心研究。分析了IVF结局，并根据患者的特征和辅助生殖技术治疗因素评估了异位妊娠的风险。

结果

在5061名报告妊娠试验阳性的患者中，有43名被诊断为异位妊娠（0.85％）。女性年龄（36.7岁对35.8岁），体重指数，转移质量或刺激方案均未影响异位妊娠率，但既往异位妊娠史（OR 3.26；P  = 0.0080），输卵管手术或两者（OR 6.20；P <0.0001）。子宫畸形（OR 3.85；P  = 0.0052），子宫病变（OR 5.35；P  = 0.0001），子宫手术（OR 2.29；P  = 0.0154）或子宫内膜欠佳的妇女异位妊娠的发生率增加（或4.46至5.31；P<0.0001）。发育缓慢的胚泡的转移（通过扩张表示）显着增加了异位妊娠的风险（OR 2.59；P  = 0.0102）。

结论

子宫环境不利，包括子宫病理，子宫或输卵管手术以及子宫内膜增生欠佳均与异位妊娠有关。胚泡的低膨胀等级被认为是异位妊娠的另一个假定的危险因素，表明正确的胚胎-母亲同步是很重要的。胚泡转移后异位妊娠的总体发生率较低，与自发性妊娠报道的异位妊娠率相当。适当评估输卵管和子宫的病理，优化子宫内膜的准备以及在冷冻胚胎转移周期中转移扩张的胚泡可能是有益的。