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Transferring more embryos increases risk of heterotopic pregnancy
I S Tummon1, N A Whitmore, S A Daniel
1Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada.
Objectives:
To analyze symptoms and signs that may distinguish heterotopic pregnancy from solely ectopic pregnancy (EP) after IVF. To determine if the number of embryos transferred is a risk factor for heterotopic compared with solely EP.
Design:
Retrospective cohort of 587 IVF pregnancies, 328 with distorted tubal anatomy.
Setting:
University Hospital, London, a referral center for Ontario provincial government-supported assisted reproductive technologies.
Participants:
Couples undergoing IVF.
Intervention:
None.
Main Outcome Measures:
Heterotopic pregnancy, solely EP, intrauterine pregnancy, and distorted pelvic anatomy.
Results:
Of 587 pregnancies, 7 were heterotopic pregnancies and 24 were solely EP, all in the subset of 328 women with distorted tubal anatomy. Symptoms, signs and time of diagnosis were not different between heterotopic and solely ectopic gestations. Compared with solely EP, heterotopic pregnancies were associated with transfer of more embryos. With four or more embryos transferred, the odds ratio for development of heterotopic versus solely ectopic gestation was 10.0.
Conclusion:
Heterotopic pregnancy occurred in 2% of gestations after IVF, all in women with distorted tubal anatomy. Transfer of four or more embryos was a risk factor for heterotopic pregnancy.