Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

Cirillo, Federico; Paladino, Ilaria; Ronchetti, Camilla; Busnelli, Andrea; Morenghi, Emanuela; Grilli, Leonora; Patrizio, Pasquale; Zannoni, Elena; Levi-Setti, Paolo Emanuele

doi:10.1038/s41598-022-24649-w

Cited by 12 publications

(8 citation statements)

References 60 publications

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“…Apart from the counselling regarding the risks of pregnancy complications with the transfer of more than one embryo, and resulting multiple gestations, patients for whom DET is considered should be aware that the risk of ectopic pregnancy increases along with the number of embryos transferred, up to about 20-fold ( Li et al , 2015 ; Perkins et al , 2015 ; Bu et al , 2016 ; Santos-Ribeiro et al , 2016 ; Pi et al , 2020 ; Anzhel et al , 2022 ; Cirillo et al , 2022 ). The risk of extrauterine pregnancy is elevated after the transfer of two versus one embryo, regardless of development stage or freezing status ( Santos-Ribeiro et al , 2016 ; Anzhel et al , 2022 ).…”

Section: Discussionmentioning

confidence: 99%

ESHRE guideline: number of embryos to transfer during IVF/ICSI

Alteri,

Arroyo,

Baccino

et al. 2024

Human Reproduction

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STUDY QUESTION Which clinical and embryological factors should be considered to apply double embryo transfer (DET) instead of elective single embryo transfer (eSET)? SUMMARY ANSWER No clinical or embryological factor per se justifies a recommendation of DET instead of eSET in IVF/ICSI. WHAT IS KNOWN ALREADY DET is correlated with a higher rate of multiple pregnancy, leading to a subsequent increase in complications for both mother and babies. These complications include preterm birth, low birthweight, and other perinatal adverse outcomes. To mitigate the risks associated with multiple pregnancy, eSET is recommended by international and national professional organizations as the preferred approach in ART. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development and update of ESHRE guidelines. Literature searches were performed in PUBMED/MEDLINE and Cochrane databases, and relevant papers published up to May 2023, written in English, were included. Live birth rate, cumulative live birth rate, and multiple pregnancy rate were considered as critical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were discussed until a consensus was reached within the Guideline Development Group (GDG). A stakeholder review was organized after the guideline draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 35 recommendations on the medical and non-medical risks associated with multiple pregnancies and on the clinical and embryological factors to be considered when deciding on the number of embryos to transfer. These recommendations include 25 evidence-based recommendations, of which 24 were formulated as strong recommendations and one as conditional, and 10 good practice points. Of the evidence-based recommendations, seven (28%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (three recommendations; 12%), or very low-quality evidence (15 recommendations; 60%). Owing to the lack of evidence-based research, the guideline also clearly mentions recommendations for future studies. LIMITATIONS, REASONS FOR CAUTION The guideline assessed different factors one by one based on existing evidence. However, in real life, clinicians’ decisions are based on several prognostic factors related to each patient’s case. Furthermore, the evidence from randomized controlled trials is too scarce to formulate high-quality evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides health professionals with clear advice on best practice in the decision-making process during IVF/ICSI, based on the best evidence currently available, and recommendations on relevant information that should be communicated to patients. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, the literature searches, and the dissemination of the guideline. The guideline group members did not receive payment. DPB declared receiving honoraria for lectures from Merck, Ferring, and Gedeon Richter. She is a member of ESHRE EXCO, and the Mediterranean Society for reproductive medicine and the president of the Croatian Society for Gynaecological Endocrinology and Reproductive Medicine. CDG is the past Chair of the ESHRE EIM Consortium and a paid deputy member of the Editorial board of Human Reproduction. IR declared receiving reimbursement from ESHRE and EDCD for attending meetings. She holds an unpaid leadership role in OBBCSSR, ECDC Sohonet, and AER. KAR-W declared receiving grants for clinical researchers and funding provision to the institution from the Swedish Cancer Society (200170F), the Senior Clinical Investigator Award, Radiumhemmets Forskningsfonder (Dnr: 201313), Stockholm County Council FoU (FoUI-953912) and Karolinska Institutet (Dnr 2020-01963), NovoNordisk, Merck and Ferring Pharmaceuticals. She received consulting fees from the Swedish Ministry of Health and Welfare. She received honoraria from Roche, Pfizer, and Organon for chairmanship and lectures. She received support from Organon for attending meetings. She participated in advisory boards for Merck, Nordic countries, and Ferring. She declared receiving time-lapse equipment and grants with payment to institution for pre-clinical research from Merck pharmaceuticals and from Ferring. SS-R received research funding from Roche Diagnostics, Organon/MSD, Theramex, and Gedeo-Richter. He received consulting fees from Organon/MSD, Ferring Pharmaceuticals, and Merck Serono. He declared receiving honoraria for lectures from Ferring Pharmaceuticals, Besins, Organon/MSD, Theramex, and Gedeon Richter. He received support for attending Gedeon Richter meetings and participated in the Data Safety Monitoring Board of the T-TRANSPORT trial. He is the Deputy of ESHRE SQART special interest group. He holds stock options in IVI Lisboa and received equipment and other services from Roche Diagnostics and Ferring Pharmaceuticals. KT declared receiving payment for honoraria for giving lectures from Merck Serono and Organon. She is member of the safety advisory board of EDQM. She holds a leadership role in the ICCBBA board of directors. ZV received reimbursement from ESHRE for attending meetings. She also received research grants from ESHRE and Juhani Aaltonen Foundation. She is the coordinator of EHSRE SQART special interest group. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (full disclaimer available at https://www.eshre.eu/Guidelines-and-Legal).

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Section: Discussionmentioning

confidence: 99%

ESHRE guideline: number of embryos to transfer during IVF/ICSI

Alteri,

Arroyo,

Baccino

et al. 2024

Human Reproduction

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“…Adhesions are commonly associated with tubal ectopic pregnancies and represent a significant risk factor for ectopic pregnancies (aOR 2.24 95% CI 1.50-3.37, p<0.001). 7 We managed our case surgically because of worsening haemodynamic status of the patient within 6 hours of admission. Moreover, the size of the ovarian ectopic and high levels of βHCG supported the decision of surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Tubo-Ovarian ectopic pregnancy: a rare twin ectopic pregnancy

Khan,

Farooq,

Khan

2024

J Pak Med Assoc

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The most common twin ectopic pregnancy is heterotopic (1/7000). We are reporting a rare case of twin tubo-ovarian ectopic pregnancy, which was presented in the emergency department of Ayub Teaching Hospital Abbottabad. A 30-year-old female arrived with worsening lower Abdominal pain persisting for three weeks. She also had per-vaginal bleeding with passage of clots 1week ago. Clinical examination revealed a tense abdomen with tenderness in the left iliac fossa. Per-vaginally, there was cervical motion tenderness and fullness in the posterior fornix. Beta HCG level revealed a sub-optimal rise whereas Transabdominal ultrasound showed an echogenic shadow in the left ovary. The uterus appeared normal. On exploratory laparotomy a large left ovarian mass was seen with ruptured chronic right tubal pregnancy with adhesions. On cut-section of the ovary, a small foetus was evident. ---Continue

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“…9 The incidence of ectopic pregnancy accounts for 2.1-9.4% of all clinical pregnancies after IVF. 10 The most common implantation site outside the endometrial cavity is the fallopian tube, accounting for more than 90%. 11 Other implantation sites include ovaries, cervix, abdominal cavity, cesarean section scar, or stroma.…”

Section: Discussionmentioning

confidence: 99%

Rare Unilateral Twin Ectopic Pregnancy After Frozen Embryo Transfer: A Case Report and Literature Review

Zhang,

Lu,

Wang

et al. 2023

IMCRJ

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Background: Unilateral twin ectopic pregnancy is extremely rare in natural pregnancy, with an incidence rate of only 1 in 200,000-2,500,000, represents a major health risk for reproductive-aged women, leading to even life-threatening complications. There is a lack of data on the prevalence of this rare disease after in-vitro fertilization-embryo transfer (IVF-ET) cycles. Case Report: We present a case of a 51-year-old woman with rare unilateral twin ectopic pregnancy after frozen embryo transfer treated with bilateral salpingectomy, followed by a review of the literature. Conclusion: Twin ectopic pregnancy is a very rare type of pregnancy that requires a high index of suspicion to diagnose and treat early to prevent complications and maternal death.

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Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

Cited by 12 publications

References 60 publications

ESHRE guideline: number of embryos to transfer during IVF/ICSI

ESHRE guideline: number of embryos to transfer during IVF/ICSI

Tubo-Ovarian ectopic pregnancy: a rare twin ectopic pregnancy

Rare Unilateral Twin Ectopic Pregnancy After Frozen Embryo Transfer: A Case Report and Literature Review

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