Heterotopic pregnancies after in vitro fertilization and embryo transfer

Article Abstract:

A greater proportion of pregnancies achieved through in vitro fertilization (IVF; in which fertilization takes place under laboratory conditions with subsequent transfer of the embryo to the uterus) than naturally occurring pregnancies implant in a site other than the uterus (known as heterotopic, or ectopic, pregnancies). This can be difficult to diagnose, since blood levels of beta-human chorionic gonadotropin (beta-hCG, measured in pregnancy tests and normally lower in heterotopic than normal pregnancies) may not be suspiciously reduced if a combined pregnancy has taken place (one heterotopic and one or more normal implantations). To learn more about the outcome and management of combined pregnancy after IVF-embryo transfer, 17 cases (among 1,648 IVF-induced pregnancies) were studied. Two medical facilities in Britain participated in the study: in one, patients underwent transabdominal and transvaginal ultrasonography evaluation (two techniques for visualizing the pelvic organs); in the other, patients underwent transabdominal ultrasonography only. Five patients had a history of tubal surgery and two had previous extrauterine pregnancies. The symptoms of the heterotopic pregnancies were variable; nine women had abdominal pain and vaginal bleeding, five patients had no symptoms, and three had acute surgical emergencies. Diagnosis based on findings from abdominal ultrasonography was accurate in only five out of 10 cases, while all patients who had both types of ultrasonography were correctly diagnosed. When the diagnosis of the heterotopic pregnancy was made, seven patients had viable singleton intrauterine pregnancies, and three others had twin intrauterine pregnancies. All of these but one delivered successfully. The heterotopic pregnancies were terminated by several different means, but most patients (14) underwent surgery to remove the extrauterine pregnancies. IVF patients' risk for a heterotopic pregnancy may be elevated because of the medical conditions that led them to seek fertility assistance; in addition, the process of embryo replacement itself could move the embryo to an abnormal location. Thus patients undergoing IVF-embryo transfer should be carefully monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Cervical pregnancy after in vitro fertilization and embryo transfer

Article Abstract:

In vitro fertilization is the process by which an egg fertilized outside the body, in a laboratory, is reintroduced to the uterus for implantation. An implantation outside of the uterus is considered an ectopic pregnancy and must be removed. Implantation of a fertilized ovum on the cervix was reported after in vitro fertilization for a 38-year-old woman. Painless bleeding from the vagina was present from the onset of the pregnancy. Ultrasonography, the use of high frequency sound waves to visualize internal structures, revealed that the fetus was located on the cervix and not in the uterus. The patient was confined to bedrest and the pregnancy remained in control until the 26th week of gestation when labor began. The male fetus was removed surgically; the woman subsequently suffered a rapid loss of blood and a hysterectomy was performed. The newborn died six hours later. The implantation of a fetus on the cervix is rare (one in 2,400). The placement of the embryos in the cervical canal, during embryo transfer, may have been the cause of the unusual implantation site.

Pregnancy, Complications of, Pregnancy complications, Ovum implantation

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The obstetric outcome of in vitro fertilization and embryo transfer in women with congenital uterine malformation

Article Abstract:

Women with congenital uterine malformations appear to achieve comparable pregnancy rates with in vitro fertilization, but they may be at higher risk for premature birth, and cesarean delivery. Researchers analyzed data from 24 women with either a one-horned or two-horned uterus, a divided uterus, or a doubled uterus, cervix, and vagina. Seventeen women achieved pregnancy with one or more embryos. Four had miscarriages. Six women gave birth prematurely and 10 had cesarean sections. Half of the women with multiple pregnancies gave birth prematurely compared to one-quarter with singleton pregnancies.

Usage, Abnormalities, Premature birth, Uterus, Cesarean section

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