Advertisement

The impact of a previous tubal ectopic pregnancy on live birth and perinatal outcomes in vitrified-warmed cycles

  • Author Footnotes
    # These authors contributed equally to this work.
    Mengjie Wei
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
    Guangen Feng
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Department of Biochemistry and Molecular Biology, School of Basic Medicine, Shanxi Medical University, Shanxi, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
    Xiaoyan Mao
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Ling Wu
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Weiran Chai
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Jie Zhang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.

      Abstract

      Research question

      Does a previous history of naturally conceived tubal ectopic pregnancy (TEP) affect subsequent pregnancy and perinatal outcomes when a freeze-all policy is applied?

      Design

      A large retrospective study was performed involving women who had undergone their first frozen-thawed embryo transfer (FET) cycles, using vitrified-warmed embryos, from January 2013 to April 2018 at a tertiary care centre. Participants were divided into two groups: a study group consisting of women with a history of TEP preceding IVF, and a control group consisting of women without an initial TEP. The live birth rate (LBR) and perinatal outcomes were evaluated via a propensity score matching method.

      Results

      A total of 23,270 women were included for potential analysis and finally 2168 pairs of women were generated for comparison after propensity score matching. The LBR in the study group was similar to that in the control group (45.7% versus 44.0%, P = 0.259). No differences were noted regarding rates of ectopic pregnancy (5.4% versus 4.1%, P = 0.122), miscarriage (11.5% versus 13.5%, P = 0.158) or intrauterine implantation (35.8% versus 35.8%, P = 0.974) between the groups. Regarding birth outcomes, the mean gestational age and birthweight and the incidences of preterm birth and low birthweight were comparable between the groups for both singletons and twins.

      Conclusions

      The present study demonstrated that a prior history of TEP was not associated with adverse reproductive and perinatal outcomes in subsequent FET cycles. With the increasing utilization of FET globally, these results are important as they can help guide physicians during patient counselling.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Reproductive BioMedicine Online
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Acharya K.S.
        • Acharya C.R.
        • Provost M.P.
        • Yeh J.S.
        • Steward R.G.
        • Eaton J.L.
        • Muasher S.J.
        Ectopic pregnancy rate increases with the number of retrieved oocytes in autologous in vitro fertilization with non-tubal infertility but not donor/recipient cycles: an analysis of 109,140 clinical pregnancies from the Society for Assisted Reproductive Technology registry.
        Fertil. Steril. 2015; 104: 873-878
        • Acharya K.S.
        • Acharya C.R.
        • Bishop K.
        • Harris B.
        • Raburn D.
        • Muasher S.J.
        Freezing of all embryos in in vitro fertilization is beneficial in high responders, but not intermediate and low responders: an analysis of 82,935 cycles from the Society for Assisted Reproductive Technology registry.
        Fertil. Steril. 2018; 110: 880-887
        • Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology
        The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting.
        Hum. Reprod. 2011; 26: 1270-1283
        • Austin P.C.
        Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples.
        Stat. Med. 2011; 30: 1292-1301
        • Barnhart K.T.
        Introduction: are we ready to eliminate the transfer of fresh embryos in in vitro fertilization?.
        Fertil. Steril. 2014; 102: 1-2
        • Bhattacharya S.
        • McLernon D.J.
        • Lee A.J.
        • Bhattacharya S.
        Reproductive outcomes following ectopic pregnancy: register-based retrospective cohort study.
        PLoS Med. 2012; 9e1001243
        • Buunen M.
        • Gholghesaei M.
        • Veldkamp R.
        • Meijer D.W.
        • Bonjer H.J.
        • Bouvy N.D.
        Stress response to laparoscopic surgery: a review.
        Surg. Endosc. 2004; 18: 1022-1028
        • Bu Z.
        • Xiong Y.
        • Wang K.
        • Sun Y.
        Risk factors for ectopic pregnancy in assisted reproductive technology: a 6-year, single-center study.
        Fertil. Steril. 2016; 106: 90-94
        • Cai H.
        • Mol B.W.
        • Li P.
        • Liu X.
        • Watrelot A.
        • Shi J.
        Tubal factor infertility with prior ectopic pregnancy: a double whammy? A retrospective cohort study of 2,892 women.
        Fertil. Steril. 2020; 113: 1032-1038
        • Chang H.J.
        • Suh C.S.
        Ectopic pregnancy after assisted reproductive technology: what are the risk factors?.
        Curr. Opin. Obstet. Gynecol. 2010; 22: 202-207
        • Chen Z.J.
        • Shi Y.
        • Sun Y.
        • Zhang B.
        • Liang X.
        • Cao Y.
        • Yang J.
        • Liu J.
        • Wei D.
        • Weng N.
        • Tian L.
        • Hao C.
        • Yang D.
        • Zhou F.
        • Shi J.
        • Xu Y.
        • Li J.
        • Yan J.
        • Qin Y.
        • Zhao H.
        • Zhang H.
        • Legro R.S.
        Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome.
        N. Engl. J. Med. 2016; 375: 523-533
        • Chouinard M.
        • Mayrand M.H.
        • Ayoub A.
        • Healy-Profitós J.
        • Auger N.
        Ectopic pregnancy and outcomes of future intrauterine pregnancy.
        Fertil. Steril. 2019; 112: 112-119
        • Clayton H.B.
        • Schieve L.A.
        • Peterson H.B.
        • Jamieson D.J.
        • Reynolds M.A.
        • Wright V.C.
        Ectopic pregnancy risk with assisted reproductive technology procedures.
        Obstet. Gynecol. 2006; 107: 595-604
        • Coroleu B.
        • Barri P.N.
        • Carreras O.
        • Martínez F.
        • Parriego M.
        • Hereter L.
        • Parera N.
        • Veiga A.
        • Balasch J.
        The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study.
        Hum. Reprod. 2002; 17: 341-346
        • Decleer W.
        • Osmanagaoglu K.
        • Meganck G.
        • Devroey P.
        Slightly lower incidence of ectopic pregnancies in frozen embryo transfer cycles versus fresh in vitro fertilization-embryo transfer cycles: a retrospective cohort study.
        Fertil. Steril. 2014; 101: 162-165
        • Du T.
        • Wang Y.
        • Fan Y.
        • Zhang S.
        • Yan Z.
        • Yu W.
        • Xi Q.
        • Chen Q.
        • Mol B.W.
        • Lyu Q.
        • Kuang Y.
        Fertility and neonatal outcomes of embryos achieving blastulation on Day 7: are they of clinical value?.
        Hum. Reprod. 2018; 33: 1038-1051
        • Fang C.
        • Huang R.
        • Wei L.N.
        • Jia L.
        Frozen-thawed day 5 blastocyst transfer is associated with a lower risk of ectopic pregnancy than day 3 transfer and fresh transfer.
        Fertil. Steril. 2015; 103: 655-661
        • Farquhar C.M.
        Ectopic pregnancy.
        Lancet. 2005; 366: 583-591
        • Gardner D.K.
        • Schoolcraft W.B.
        Culture and transfer of human blastocysts.
        Curr. Opin. Obstet. Gynecol. 1999; 11: 307-311
        • Gu F.
        • Li S.
        • Zheng L.
        • Gu J.
        • Li T.
        • Du H.
        • Gao C.
        • Ding C.
        • Quan S.
        • Zhou C.
        • Li P.
        • Xu Y.
        Perinatal outcomes of singletons following vitrification versus slow-freezing of embryos: a multicenter cohort study using propensity score analysis.
        Hum. Reprod. 2019; 34: 1788-1798
        • Hjordt Hansen M.V.
        • Dalsgaard T.
        • Hartwell D.
        • Skovlund C.W.
        • Lidegaard O.
        Reproductive prognosis in endometriosis. A national cohort study.
        Acta Obstet. Gynecol. Scand. 2014; 93: 483-489
        • Irani M.
        • Robles A.
        • Gunnala V.
        • Spandorfer S.D.
        Unilateral Salpingectomy and Methotrexate Are Associated With a Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing In Vitro Fertilization.
        J. Minim. Invasive Gynecol. 2017; 24: 777-782
        • Jun S.H.
        • Milki A.A.
        Assisted hatching is associated with a higher ectopic pregnancy rate.
        Fertil. Steril. 2004; 81: 1701-1703
        • Jwa S.C.
        • Seto S.
        • Takamura M.
        • Kuwahara A.
        • Kajihara T.
        • Ishihara O.
        Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry.
        Fertil. Steril. 2020; 114: 1198-1206
        • Kolte A.M.
        • Westergaard D.
        • Lidegaard Ø.
        • Brunak S.
        • Nielsen H.S.
        Chance of live birth: a nationwide, registry-based cohort study.
        Hum. Reprod. 2021; 36: 1065-1073
        • Kuang Y.
        • Chen Q.
        • Fu Y.
        • Wang Y.
        • Hong Q.
        • Lyu Q.
        • Ai A.
        • Shoham Z.
        Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization.
        Fertil. Steril. 2015; 104: 62-70
        • Kuang Y.
        • Chen Q.
        • Hong Q.
        • Lyu Q.
        • Ai A.
        • Fu Y.
        • Shoham Z.
        Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol).
        Reprod. Biomed. Online. 2014; 29: 684-691
        • Kuwayama M.
        • Vajta G.
        • Kato O.
        • Leibo S.P.
        Highly efficient vitrification method for cryopreservation of human oocytes.
        Reprod. Biomed. Online. 2005; 11: 300-308
        • Lin S.
        • Li R.
        • Zheng X.
        • Chi H.
        • Ren X.
        • Yang R.
        • Liu P.
        • Qiao J.
        Influence of embryo culture medium on incidence of ectopic pregnancy in in vitro fertilization.
        Fertil. Steril. 2015; 104: 1442-1445
        • Liu H.
        • Zhang J.
        • Wang B.
        • Kuang Y.
        Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles.
        Fertil. Steril. 2020; 113: 131-139
        • Londra L.
        • Moreau C.
        • Strobino D.
        • Garcia J.
        • Zacur H.
        • Zhao Y.
        Ectopic pregnancy after in vitro fertilization: differences between fresh and frozen-thawed cycles.
        Fertil. Steril. 2015; 104: 110-118
        • Londra L.
        • Moreau C.
        • Strobino D.
        • Bhasin A.
        • Zhao Y.
        Is the type of gonadotropin-releasing hormone suppression protocol for ovarian hyperstimulation associated with ectopic pregnancy in fresh autologous cycles for in vitro fertilization?.
        Fertil. Steril. 2016; 106: 666-672
        • Lund Kårhus L.
        • Egerup P.
        • Wessel Skovlund C.
        • Lidegaard Ø.
        Long-term reproductive outcomes in women whose first pregnancy is ectopic: a national controlled follow-up study.
        Hum. Reprod. 2013; 28: 241-246
        • Mak W.
        • Kondapalli L.A.
        • Celia G.
        • Gordon J.
        • DiMattina M.
        • Payson M.
        Natural cycle IVF reduces the risk of low birthweight infants compared with conventional stimulated IVF.
        Hum. Reprod. 2016; 31: 789-794
        • Mol F.
        • van Mello N.M.
        • Strandell A.
        • Jurkovic D.
        • Ross J.A.
        • Yalcinkaya T.M.
        • Barnhart K.T.
        • Verhoeve H.R.
        • Graziosi G.C.
        • Koks C.A.
        • Mol B.W.
        • Ankum W.M.
        • van der Veen F.
        • Hajenius P.J.
        • van Wely M.
        Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).
        Hum. Reprod. 2015; 30: 2038-2047
        • Pereira N.
        • Elias R.T.
        • Christos P.J.
        • Petrini A.C.
        • Hancock K.
        • Lekovich J.P.
        • Rosenwaks Z.
        Supraphysiologic estradiol is an independent predictor of low birth weight in full-term singletons born after fresh embryo transfer.
        Hum. Reprod. 2017; 32: 1410-1417
        • Perkins K.M.
        • Boulet S.L.
        • Kissin D.M.
        • Jamieson D.J.
        Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011.
        Obstet. Gynecol. 2015; 125: 70-78
        • Premru-Srsen T.
        • Bokal Vrtačnik E.
        • Bizjak T.
        • Verdenik I.
        • Korošec S.
        • Ban Frangež H.
        Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF/ICSI.
        Hum. Reprod. 2021; 36: 1630-1639
        • Refaat B.
        • Dalton E.
        • Ledger W.L.
        Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies.
        Reprod. Biol. Endocrinol. 2015; 13: 30
        • Rombauts L.
        • McMaster R.
        • Motteram C.
        • Fernando S.
        Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of 8120 assisted reproduction technology cycles.
        Hum. Reprod. 2015; 30: 2846-2852
        • Steptoe P.C.
        • Edwards R.G.
        Reimplantation of a human embryo with subsequent tubal pregnancy.
        Lancet. 1976; 1: 880-882
        • Vitale S.G.
        • Riemma G.
        • Cianci A.
        Unraveling the "double whammy" dilemma: do concomitant tubal infertility and previous ectopic pregnancy shrink the possibility of live birth?.
        Fertil. Steril. 2020; 113: 934-935
        • Vuong L.N.
        • Dang V.Q.
        • Ho T.M.
        • Huynh B.G.
        • Ha D.T.
        • Pham T.D.
        • Nguyen L.K.
        • Norman R.J.
        • Mol B.W.
        IVF transfer of fresh or frozen embryos in women without polycystic ovaries.
        N. Engl. J. Med. 2018; 378: 137-147
        • Wang J.
        • Wei Y.
        • Diao F.
        • Cui Y.
        • Mao Y.
        • Wang W.
        • Liu J.
        The association between polycystic ovary syndrome and ectopic pregnancy after in vitro fertilization and embryo transfer.
        Am. J. Obstet. Gynecol. 2013; 209 (139.e1-9)
        • Weigert M.
        • Gruber D.
        • Pernicka E.
        • Bauer P.
        • Feichtinger W.
        Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in in vitro fertilization-embryo transfer patients.
        J. Assist. Reprod. Genet. 2009; 26: 13-17
        • Xu Z.
        • Yan L.
        • Liu W.
        • Xu X.
        • Li M.
        • Ding L.
        • Ma J.
        • Chen Z.J.
        Effect of treatment of a previous ectopic pregnancy on in vitro fertilization-intracytoplasmic sperm injection outcomes: a retrospective cohort study.
        Fertil. Steril. 2015; 104: 1446-1451
        • Zaat T.
        • Zagers M.
        • Mol F.
        • Goddijn M.
        • van Wely M.
        • Mastenbroek S.
        Fresh versus frozen embryo transfers in assisted reproduction (Review).
        Cochrane Database of Systematic Reviews. 2021;
        • Zegers-Hochschild F.
        • Adamson G.D.
        • Dyer S.
        • Racowsky C.
        • de Mouzon J.
        • Sokol R.
        • Rienzi L.
        • Sunde A.
        • Schmidt L.
        • Cooke I.D.
        • Simpson J.L.
        • van der Poel S.
        The International Glossary on Infertility and Fertility Care, 2017.
        Hum. Reprod. 2017; 32: 1786-1801
        • Zhang J.
        • Liu H.
        • Mao X.
        • Chen Q.
        • Fan Y.
        • Xiao Y.
        • Wang Y.
        • Kuang Y.
        Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China.
        BMC Med. 2019; 17: 114

      Biography

      Mengjie Wei completed her Master's degree at the School of Medicine, Shanghai Jiao Tong University, China. Her current research interests include ectopic pregnancy and assisted reproductive technology.
      Key Message
      A previous history of ectopic pregnancy did not affect subsequent live birth and perinatal outcomes following vitrified-warmed embryo transfer. These findings are important as they can help physicians to counsel women with a prior ectopic pregnancy, both at the time of treatment and later when they look for antenatal care.