Risk factors and pregnancy outcomes of intrauterine pregnancy with tubal pregnancy after IVF/ICSI
Objective To investigate the risk factors,pregnancy outcomes of intrauterine pregnancy with tubal pregnancy after in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Methods The study was a retrospective case-control study that collected clinical data of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI for infertility at Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital from January 2009 to December 2021.The study group consisted of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI and treated with surgery(n=91).The control group consisted of patients diagnosed with early intrauterine pregnancy after IVF/ICSI in a 1∶4 ratio during the same period(n=364).General information,assisted reproduction and pregnancy-related data of the two groups were analyzed,and risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI were determined through univariate and logistic analyses.Furthermore,the study group was divided into two subgroups according to different pregnancy outcomes,miscarriage and live birth,and risk factors that may affect pregnancy outcomes of patients with intrauterine combined with tubal pregnancy were analyzed between the two subgroups.Results There were no significant differences in age,body mass index,gestational times,basal hormone levels,endometrial thickness before transplantation and human chorionic gonadotropin level after transplantation between the study group and control group(all P>0.05).The live birth rate of the two groups was similar(P>0.05).A history of ectopic pregnancy(OR=2.605,95%CI:1.352-5.016,P=0.004)and hydrosalpinx(OR=26.012,95%CI:2.942-229.974,P=0.003)were risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI.Patients with intrauterine combined with tubal pregnancy were divided into live birth subgroup and abortion subgroup.There were no significant differences in the proportion of abdominal pain,uterine hemoperitoneum and other symptoms between the two subgroups(all P>0.05),and there were no statistical differences in operation time,gestational age and intraperitoneal hemorrhage between the two subgroups(all P>0.05).Vaginal bleeding after transplantation(OR=3.128,95%CI:1.067-9.172,P=0.038)in the abortion subgroup may be a risk factor for miscarriage in intrauterine combined with tubal pregnancy.Conclusion Live birth rate in intrauterine pregnancy combined with tubal pregnancy patients after surgery was similar with patients with normal intrauterine pregnancy.Ectopic pregnancy history and hydrosalpinx may be risk factors for patients with intrauterine pregnancy combined with tubal pregnancy after IVF/ICSI,and vaginal bleeding after transplantation may be a high risk factor for abortion in those patients.
Fertilization in vitroEmbryo transferPregnancy,heterotopicLive birthHydrosalpinx
NETL
NSTL
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