Advertisement

Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization

      Objective

      To evaluate a prospectively implemented clinical algorithm for early identification of ectopic pregnancy (EP) and heterotopic pregnancy (HP) after assisted reproductive technology (ART).

      Design

      Analysis of prospectively collected data.

      Setting

      Academic medical center.

      Patient(s)

      All ART-conceived pregnancies between January 1995 and June 2013.

      Intervention(s)

      Early pregnancy monitoring via clinical algorithm with all pregnancies screened using human chorionic gonadotropin (hCG) levels and reported symptoms, with subsequent early ultrasound evaluation if hCG levels were abnormal or if the patient reported pain or vaginal bleeding.

      Main Outcome Measure(s)

      Algorithmic efficiency for diagnosis of EP and HP and their subsequent clinical outcomes using a binary forward stepwise logistic regression model built to determine predictors of early pregnancy failure.

      Result(s)

      Of the 3,904 pregnancies included, the incidence of EP and HP was 0.77% and 0.46%, respectively. The algorithm selected 96.7% and 83.3% of pregnancies diagnosed with EP and HP, respectively, for early ultrasound evaluation, leading to earlier treatment and resolution. Logistic regression revealed that first hCG, second hCG, hCG slope, age, pain, and vaginal bleeding were all independent predictors of early pregnancy failure after ART.

      Conclusion(s)

      Our clinical algorithm for early pregnancy evaluation after ART is effective for identification and prompt intervention of EP and HP without significant over- or misdiagnosis, and avoids the potential catastrophic morbidity associated with delayed diagnosis.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Confino E.
        • Demir R.H.
        • Friberg J.
        • Gleicher N.
        The predictive value of hCG β subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: an international collaborative study.
        Fertil Steril. 1986; 45: 526-531
        • Korhonen J.
        • Tiitinen A.
        • Alfthan H.
        • Ylöstalo P.
        • Stenman U.H.
        Ectopic pregnancy after in-vitro fertilization is characterized by delayed implantation but a normal increase of serum human chorionic gonadotrophin and its subunits.
        Hum Reprod. 1996; 11: 2750-2757
        • Bjercke S.
        • Tanbo T.
        • Dale P.O.
        • Mørkrid L.
        • Abyholm T.
        Human chorionic gonadotrophin concentrations in early pregnancy after in-vitro fertilization.
        Hum Reprod. 1999; 14: 1642-1646
        • Urbancsek J.
        • Hauzman E.
        • Fedorcsák P.
        • Halmos A.
        • Dévényi N.
        • Papp Z.
        Serum human chorionic gonadotropin measurements may predict pregnancy outcome and multiple gestation after in vitro fertilization.
        Fertil Steril. 2002; 78: 540-542
        • Kadar N.
        • Caldwell B.V.
        • Romero R.
        A method of screening for ectopic pregnancy and its indications.
        Obstet Gynecol. 1981; 58: 162-166
        • Glatstein I.Z.
        • Hornstein M.D.
        • Kahana M.J.
        • Jackson K.V.
        • Friedman A.J.
        The predictive value of discriminatory human chorionic gonadotropin levels in the diagnosis of implantation outcome in in vitro fertilization cycles.
        Fertil Steril. 1995; 63: 350-356
        • Poikkeus P.
        • Hiilesmaa V.
        • Tiitinen A.
        Serum HCG 12 days after embryo transfer in predicting pregnancy outcome.
        Hum Reprod. 2002; 17: 1901-1905
        • Seeber B.E.
        What serial hCG can tell you, and cannot tell you, about an early pregnancy.
        Fertil Steril. 2012; 98: 1074-1077
        • Perkins K.M.
        • Boulet S.L.
        • Kissin D.M.
        • Jamieson D.J.
        Risk of ectopic pregnancy associated with assisted reproductive technology (ART), United States, 2001–2011.
        Fertil Steril. 2014; 102: e38-e39
        • Fernandez H.
        • Gervaise A.
        Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy.
        Hum Reprod Update. 2004; 10: 503-513