University of Oulu

Anzhel, S., Mäkinen, S., Tinkanen, H., Mikkilä, T., Haltia, A., Perheentupa, A., Tomás, C., Martikainen, H., Tiitinen, A., Tapanainen, J. S., & Veleva, Z. (2022). Top‐quality embryo transfer is associated with lower odds of ectopic pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 101(7), 779–786.

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

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Author: Anzhel, Simona1,2; Mäkinen, Sirpa3; Tinkanen, Helena4;
Organizations: 1Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
2Department of Obstetrics and Gynecology, Medical University Varna, Varna, Bulgaria
3Ovumia Fertinova Infertility Clinics Helsinki, Helsinki, Finland
4Department of Obstetrics and Gynecology, University of Tampere, Tampere, Finland
5Fimlab Laboratory Tampere, Tampere, Finland
6Felicitas Mehiläinen Turku, Turku, Finland
7Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
8Ovumia Fertinova Infertility Clinics Tampere, Tampere, Finland
9Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-11-24


Introduction: The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy.

Material and Methods: An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6–8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen–thawed embryo transfer (n = 6054). Treatments were performed during 2000–2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation.

Results: Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p < 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs 11.0%, p < 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56–0.92, p = 0.007). Transfer of two vs one embryo (OR 1.35, 95% CI 1.05–1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68–2.91, p < 0.0001) significantly increased the risk of ectopic pregnancy.

Conclusions: Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.

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Series: Acta obstetricia et gynecologica Scandinavica
ISSN: 0001-6349
ISSN-E: 1600-0412
ISSN-L: 0001-6349
Volume: 101
Issue: 7
Pages: 779 - 786
DOI: 10.1111/aogs.14375
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by grants from the Academy of Finland, the Sigrid Jusélius Foundation, the Helsinki University Hospital Research Fund (to J.S.T.) and the Finnish Medical Foundation (to Z.V.). The funding organizations had no involvement in the study design, in the collection, analysis and interpretation of data,writing the report or in the decision to submit the manuscript.
Copyright information: © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.