Transcervical embryo transfer as a risk factor for ectopic pregnancy

Objective: To evaluate the ease and timing of transcervical ET as risk factors for ectopic pregnancy (EP) after IVF. Design: Retrospective study. Setting: University-based IVF program in the United Kingdom. Patient(s): Eighteen consecutively seen patients with an EP after IVF and 314 patients with an intrauterine pregnancy after transcervical ET performed during the same period. Intervention(s): Additional manipulation with a transfer catheter or the use of other instruments to assist transfer. Embryo transfer on day 2 or 3 after oocyte retrieval. Main Outcome Measure(s): Risk factors for EP (day 2 ET, difficult transfer overall and on days 2 and 3, history of tubal subfertility, and previous EP) presented as odds ratios with 95% confidence intervals. Result(s): The risk of EP was 2.26 (0.64-8.01) after day 2 ET, 3.91 (1.49-10.23) after difficult ET, 3.88 (1.34-11.24) after difficult ET on day 2, 2.7 (0.20-13.99) after difficult ET on day 3, 5.73 (1.99-16.62) when there was a history of tubal subfertility, and 5.41 (1.96-14.91) when there was a previous EP. Conclusion(s): A difficult ET significantly increases the risk of an EP. The risk is particularly high when the patient has a history of tubal damage or previous EP. The timing of ET is important only if the ET is difficult. (C) 1999 by American Society for Reproductive Medicine.