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Suboptimal endometrial-embryonal synchronization is a risk factor for ectopic pregnancy in assisted reproduction
Maximilian Murtinger1, Barbara Wirleitner1, Maximilian Schuff1
1NEXTCLINIC IVF Zentren Prof. Zech - Bregenz, Roemerstrasse 2, Bregenz 6900, Austria.
Reproductive Biomedicine Online
|June 17, 2020
Summary
Ectopic pregnancy risk is linked to uterine conditions and suboptimal endometrial lining. Transferring expanded blastocysts improves outcomes in IVF, with overall rates comparable to natural conception.
Area of Science:
- Reproductive Medicine
- In Vitro Fertilization (IVF)
- Obstetrics and Gynecology
Background:
- Ectopic pregnancy is a significant concern in assisted reproductive technology (ART).
- Understanding risk factors is crucial for improving IVF safety and success rates.
- Previous studies have identified various risk factors, but specific associations with blastocyst transfer need further clarification.
Purpose of the Study:
- To determine the incidence of ectopic pregnancy following blastocyst transfer in an IVF program.
- To identify key patient characteristics and treatment factors associated with an increased risk of ectopic pregnancy.
Main Methods:
- A retrospective single-centre study analyzed 12,429 blastocyst transfers (fresh and frozen) from 2010-2017.
- Ectopic pregnancy risk was evaluated based on patient demographics, medical history, and specific IVF treatment parameters.
- Statistical analysis, including odds ratios (OR), was used to assess risk factor significance.
Main Results:
- The incidence of ectopic pregnancy after blastocyst transfer was 0.85% (43 out of 5061 positive tests).
- Increased risk was associated with a history of ectopic pregnancy (OR 3.26), tubal surgery (OR 6.20), uterine malformations (OR 3.85), uterine pathologies (OR 5.35), uterine surgeries (OR 2.29), and suboptimal endometrial build-up (OR 4.46-5.31).
- Transfer of slow-developing blastocysts (low expansion grade) also significantly increased ectopic pregnancy risk (OR 2.59).
Conclusions:
- An unfavorable uterine environment (pathologies, surgeries, poor endometrial lining) is a significant risk factor for ectopic pregnancy.
- Low blastocyst expansion grade is an additional risk factor, highlighting the need for embryonal-maternal synchronization.
- The overall ectopic pregnancy rate after blastocyst transfer is low and comparable to spontaneous conception; optimizing uterine and tubal evaluation, endometrial preparation, and blastocyst selection is recommended.
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