Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer

Ben W.J. Mol*, Willem M. Ankum, Fulco Van Der Veen, Hendricus V. Hogerzeil, Petra J. Hajenius, Douwe J. Hemrika, Simone Engelsbel, Patrick M.M. Bossuyt

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: The combination of transvaginal sonography and serum hCG measurement is reliable in the diagnosis of ectopic pregnancy (EP) in spontaneous pregnancies. In patients who became pregnant through IVF-ET, transfer of multiple embryos after IVF could be responsible for the different performance of these tests. We evaluated the discriminative capacity of transvaginal sonography in combination with hCG measurement in the diagnosis of EP after IVF-ET. Design: Prospective cohort study. Setting and Patient(s): Consecutive patients, pregnant through IVF-ET, who presented with clinically suspected EP. Intervention(s): Transvaginal sonography, serum hCO measurement at 6, 9, and 15 days after ET and after a negative transvaginal sonography. Main outcome measure(s): Ectopic pregnancy confirmed at laparoscopy. Result(s): Between September 1993 and May 1996, 86 women were included in the study, of whom 24 had an EP. Transvaginal sonography identified 46 intrauterine pregnancies and 5 EPs, but serum hCG could not diagnose EPs in patients in whom transvaginal sonography did not show a gestational sac. Serum hCG measurement 9 days after ET could identify pregnancy failure with 100% specificity at a cut-off value of 18 IU/L, but it could not identify patients with EP with enough certainty to justify immediate treatment. Conclusion(s): We recommend single serum hCG measurement 9 days after ET to discriminate between viable and nonviable pregnancies. Transvaginal sonography can be postponed until 5 weeks after ET, except for patients with abdominal pain and/or vaginal bleeding, or patients with a serum hCG level of < 18 IU/L.

Original languageEnglish
Pages (from-to)1027-1032
Number of pages6
JournalFertility and Sterility
Volume68
Issue number6
DOIs
Publication statusPublished - 1 Dec 1997

Keywords

  • Diagnosis
  • Ectopic pregnancy
  • hCG
  • IVF-ET
  • Transvaginal sonography

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    Mol, B. W. J., Ankum, W. M., Van Der Veen, F., Hogerzeil, H. V., Hajenius, P. J., Hemrika, D. J., Engelsbel, S., & Bossuyt, P. M. M. (1997). Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer. Fertility and Sterility, 68(6), 1027-1032. https://doi.org/10.1016/S0015-0282(97)00401-9