Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: implications for preventive management.

OBJECTIVE

To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF).

DESIGN

A retrospective study of IVF pregnancies was performed between November 1983 and December 1989.

SETTING

This study was conducted in a tertiary care center, the Port-Royal University Hospital.

PATIENTS

Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF.

INTERVENTIONS

Forty-six salpingectomies were performed for EP after IVF.

MAIN OUTCOME MEASURE

We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred.

RESULTS

Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies.

CONCLUSIONS

Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.