Correlation between Ovarian Reserve and Incidence of Ectopic Pregnancy after  In Vitro  Fertilization and Embryo Transfer

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Abstract

Purpose

To elucidate the correlation between ovarian reserve and the incidence of ectopic pregnancy (EP) following in vitro fertilization and embryo transfer (IVF/ET) cycles.

Materials and Methods

In this observational study, 430 fresh IVF/ET cycles were examined from patient data of two university hospital infertility clinics. All included patients were positive for β-human chorionic gonadotropin (hCG) at 2 weeks after oocyte retrieval via controlled ovarian stimulation. For each cycle, information on age, duration of infertility, basal follicle stimulating hormone (FSH), anti-Müllerian hormone (AMH), days of ovarian stimulation, numbers of retrieved oocytes and transferred embryos, and pregnancy outcomes was collected. Patients with AMH lower than 1.0 ng/dL or basal FSH higher than 10 mIU/mL were classified into the decreased ovarian reserve (DOR) group, and the remaining patients were classified into the normal ovarian reserve (NOR) group.

Results

In total, 355 cycles showed NOR, and 75 cycles DOR. There were no significant differences between the DOR and NOR groups regarding intrauterine (74.7% vs. 83.4%, respectively) or chemical (14.7% vs. 14.1%, respectively) pregnancies. The DOR group had a higher EP than that of NOR group [10.7% (8/75) vs. 2.5% (9/355), p=0.004]. In both univariate [odds ratio (OR) 5.6, 95% confidence interval (CI) 1.4–9.6, p=0.011] and multivariate (adjusted OR 5.1, 95 % CI 1.1–18.7, p=0.012) analysis, DOR was associated with a higher risk of EP.

Conclusion

DOR may be associated with a higher risk of EP in IVF/ET cycles with controlled ovarian stimulation. More careful monitoring may be necessary for pregnant women with DOR.

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Most cited references 37

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Ectopic pregnancy risk with assisted reproductive technology procedures.

Laurence B. Peterson, Teri Reynolds, Catherine Clayton … (2006)

To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. 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. 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. 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. II-2.

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Risk factors for ectopic pregnancy: a multi-center case-control study

Cheng-Cheng Li, Wei-Hong Zhao, Qian Zhu … (2015)

Background Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy. A better understanding of EP risk can help prevent its occurrence. We carried out a multi-center, large-sample, case-control study to evaluate the risk factors for EP in Shanghai, China. Methods Women who were diagnosed with EP (n = 2411) and women with intrauterine pregnancies (n = 2416) were recruited from five hospitals in Shanghai, China. Information regarding the sociodemographic characteristics; reproductive, gynecological and surgical history; and previous and current use of contraceptives was collected from all participants. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated and adjusted for potential confounding factors via multivariate logistic regression analysis. Results The study revealed that the risk of EP was associated with the traditional risk factors including previous EP (Adjusted odds ratio [AOR] = 2.72, 95 % CI: 1.83–4.05), previous Chlamydia trachomatis infection (Adjusted OR = 3.18, 95 % CI: 2.64, 3.84), previous infertility (AOR = 2.18, 95 % CI: 1.66–2.88), previous adnexal surgery (AOR = 2.09, 95 % CI: 1.49–2.93), previous appendectomy (AOR = 1.64, 95 % CI: 1.13–2.37), and previous use of intrauterine devices (IUDs) (AOR = 1.72, 95 % CI: 1.39–2.13). Additionally, EP risk was increased following the failure of most contraceptives used in the current cycle including IUDs (AOR = 16.43, 95 % CI: 10.42–25.89), oral contraceptive pills (AOR = 3.02, 95 % CI: 1.16–7.86), levonorgestrel emergency contraception (AOR = 4.75, 95 % CI: 3.79–5.96), and female sterilization (AOR = 4 .73, 95 % CI: 1.04–21.52). Stratified analysis showed that in vitro fertilization and embryo transfer (IVF-ET) was the main risk factor for EP in women with tubal infertility (AOR = 8.99, 95 % CI: 1.98–40.84), although IVF-ET showed no association with EP in women with non-tubal infertility (AOR = 2.52, 95 % CI: 0.14–44.67). Conclusion In addition to the traditional risk factors, IVF-ET and current IUD use play dominant roles in the occurrence of EP. Attention should be given to women with tubal infertility who have undergone IVE-ET treatment.

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Pregnancy-related mortality surveillance--United States, 1991--1999.

Jeani Chang, Laurie Elam-Evans, Cynthia Berg … (2003)

The risk of death from complications of pregnancy has decreased approximately 99% during the twentieth century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982. However, since 1982, no further decrease has occurred in maternal mortality in the United States. In addition, racial disparity in pregnancy-related mortality ratios persists; since 1940, mortality ratios among blacks have been at least three to four times higher than those for whites. The Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; substantial improvements are needed to meet the same objective for Healthy People 2010. This report summarizes surveillance data for pregnancy-related deaths in the United States for 1991-1999. The Pregnancy Mortality Surveillance System was initiated in 1987 by CDC in collaboration with state health departments and the American College of Obstetricians and Gynecologists Maternal Mortality Study Group. Health departments in the 50 states, the District of Columbia, and New York City provide CDC with copies of death certificates and available linked outcome records (i.e., birth certificates or fetal death certificates) of all deaths occurring during or within 1 year of pregnancy. State maternal mortality review committees, the media, and individual providers report a limited number of deaths not otherwise identified. Death certificates and relevant birth or fetal death certificates are reviewed by clinically experienced epidemiologists at CDC to determine whether they are pregnancy-related. During 1991-1999, a total of 4,200 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 11.8 deaths per 100,000 live births and ranged from 10.3 in 1991 to 13.2 in 1999. The pregnancy-related mortality ratio for black women was consistently higher than that for white women for every characteristic examined. Older women, particularly women aged >/= 35 years and women who received no prenatal care, were at increased risk for pregnancy-related death. The distribution of the causes of death differed by pregnancy outcome. Among women who died after a live birth (i.e., 60% of the deaths), the leading causes of death were embolism and pregnancy-induced hypertension. The reported pregnancy-related mortality ratio has substantially increased during 1991-1999, probably because of improved ascertainment of pregnancy-related deaths. Black women continued to have a 3-4 times higher pregnancy-related mortality ratio than white women. In addition, pregnancy-related mortality has the largest racial disparity among the maternal and child health indicators. Reasons for this difference could not be determined from the available data. Continued surveillance and additional studies should be conducted to monitor the magnitude of pregnancy-related mortality, to identify factors that contribute to the continuing racial disparity in pregnancy-related mortality, and to develop effective strategies to prevent pregnancy-related mortality for all women. In addition, CDC is working with state health departments, researchers, health-care providers, and other stakeholders to improve the ascertainment and classification of pregnancy-related deaths.

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Author and article information

Journal

Journal ID (nlm-ta): Yonsei Med J

Journal ID (iso-abbrev): Yonsei Med. J

Journal ID (publisher-id): YMJ

Title: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

ISSN (Print): 0513-5796

ISSN (Electronic): 1976-2437

Publication date (Print): 01 March 2019

Publication date (Electronic): 18 February 2019

Volume: 60

Issue: 3

Pages: 285-290

Affiliations

[1 ]Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

[2 ]Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.

Author notes

Corresponding author: Seung-Yup Ku, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-1971, Fax: 82-2-762-3599, jyhsyk@ 123456snu.ac.kr

^*Sung Woo Kim and Yong Jin Kim contributed equally to this work.

Author information

Sung Woo Kim https://orcid.org/0000-0003-4689-1323

Yong Jin Kim https://orcid.org/0000-0001-8684-2126

Jung Ho Shin https://orcid.org/0000-0001-7559-5457

Hoon Kim https://orcid.org/0000-0002-5623-6368

Seung-Yup Ku https://orcid.org/0000-0002-6423-854X

Chang Suk Suh https://orcid.org/0000-0003-1835-7350

Seok Hyun Kim https://orcid.org/0000-0003-0649-3224

Young Min Choi https://orcid.org/0000-0003-1245-0378

Article

DOI: 10.3349/ymj.2019.60.3.285

PMC ID: 6391525

PubMed ID: 30799591

SO-VID: ea1d1686-6992-49db-819c-6360505d79e1

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 20 June 2018

Date revision received : 27 September 2018

Date accepted : 19 November 2018

Funding

Funded by: Ministry of Science, ICT and Future Planning, CrossRef https://doi.org/10.13039/501100003621;

Correlation between Ovarian Reserve and Incidence of Ectopic Pregnancy after In Vitro Fertilization and Embryo Transfer

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Abstract

Purpose

Materials and Methods

Results

Conclusion

Related collections

HLA-G and immune tolerance in pregnancy

Most cited references 37

Ectopic pregnancy risk with assisted reproductive technology procedures.

Risk factors for ectopic pregnancy: a multi-center case-control study

Pregnancy-related mortality surveillance--United States, 1991--1999.

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