Analysis Of Related Factors Of Ectopic Pregnancy In In Vitro Fertilization And Embryo Transfer

Objective:To analyze the related factors that may lead to ectopic pregna ncy in the process of in vitro fertilization and embryo transfer,to find out the high risk factors of EP after IVF-ET and to avoid them as much as possible,so as to reduce the incidence of EP after IVF-ET.Methods:The clinical data of 2950 cases of IVF-ET assisted pregnancy in the Department of Reproductive Medicine of the fourth Hospital of Hebei Medical University from 2016 to 2020 were analyzed retrospectively.There were 960 cases of fresh cycle,942 cases of intrauterine pregnancy and 18cases of ectopic pregnancy.There were 1990 cases of freeze-thaw cycle,1960cases of intrauterine pregnancy and 30 cases of ectopic pregnancy.The general characteristics of age,years of infertility,type of infertility,body mass index,history of ectopic pregn ancy,history of pelvic and abdominal surgery,endometriosis,basic follicle stimulating hormone,basic estradiol and estrogen and progesterone on the day of injection of human chorionic gonadotropin level,total amount of gonadotropin,type and number of transferred embryos,thickness of endometrium on transfer day,distance between embryo and uterine floor,cycle type and other factors related to IVF-ET assisted pregn ancy.The high risk factors causing EP were studied,and then multivariate analysis was carried out.Results:1.The incidence of ectopic pregnancy:from July 2015 to June 2020,the incidence of EP after IVF-ET was 1.63%,the incidence of ectopic pregnancy in fresh cycle was 1.88%,and the incidence of ectopic pregnancy in freeze-thawed embryo transfer cycle was 1.51%.2.Analysis of related factors of fresh cycle EP.2.1 Single factor analysis.1)The proportion of abortion history,EP history and pelvic and abdominal operation history in the ectopic pregnancy group was higher than that in the intrauterine pregnancy group,and the difference was statistically significant（P<0.05）.There was no significant difference in age,years of infertility,type of infertility,BMI,endometriosis,basal FSH and basal E₂.2)The levels of E₂ and P on hCG day in ectopic pregnancy group were higher than those in intrauterine pregnancy group,and the difference was statistically significant（P<0.05）.The endometrial thickness on the day of transplantation in the ectopic pregnancy group was significantly lower than that in the intrauterine pregnancy group（P<0.05）.There was no significant difference in the total amount of Gn,the distance between the transplantation tube and the uterine floor,the difficulty of operation and the filling of bladder between the two groups（P>0.05）.3)There was no significant difference in the type of transferred embryos,the number of embryos（P>0.05）.2.2 Multi-factor analysis.Logistic regression showed that history of ectopic pregnancy,history of pelvic and abdominal surgery,E₂ level on hCG day and P level were independent risk factors for ectopic pregnancy after IVF-ET（P<0.05,OR>1）.The thickness of endometrium on the day of transplantation was a protective factor for ectopic pregnancy after IVF-ET（P<0.05,OR<1）.3.Analysis of related factors of frozen embryo transfer cycle EP.3.1 Single factor analysis.1)The history of ectopic pregnancy and pelvic and abdominal operation in the ectopic pregnancy group was higher than that in the intrauterine pregnancy group,and the difference was statistically significant（P<0.05）.There was no significant difference in age,years of infertility,type of infertility,BMI,endometriosis,basal FSH and basal E₂levels（P>0.05）.2)There was significant difference in endometrial thickness on the day of frozen-thawed embryo transfer between the two groups（P<0.05）.There was no significant difference in endometrial preparation scheme,distance between transplantation tube and uterine floor,bladder filling,difficulty of operation and so on（P>0.05）.3)There was significant difference in the number of embryos transferred in frozen-thawed embryo cycle between the two groups（P<0.05）,but there was no significant difference in embryo type between the two groups（P>0.05）.3.2 Multi-factor analysis.Logistic regression analysis showed that the history of ectopic pregnancy,the history of pelvic and abdominal surgery and the number of embryos trans ferred were independent risk factors for ectopic pregnancy after IVF-ET（P<0.05,OR>1）.The thickness of endometrium on the day of transp lantation is the protective factor after IVF-ET（P<0.05,OR<1）.4.Comparison between fresh cycle and Frozen embryo cycle.There was no significant difference in the incidence of ectopic pregnancy between fresh cycle cleavage stage embryo transfer and freeze-thaw cycle cleavage stage embryo transfer（P>0.05）.There was no significant difference between fresh cycle blastocyst stage embryo transfer and freeze-thaw cycle blastocyst stage embryo transfer（P>0.05）.Conclusions:1.The history of previous abortion,ectopic pregnancy and pelvic and abdominal surgery all increase the risk of ectopic pregnancy.2.The high E₂and P levels of hCG in ectopic pregnancy group are the high risk factors of EP after IVF-ET.3.The thickness of endometrium on the day of transplantation is a protective factor of ectopic pregnancy.4.The increase in the number of embryos transferred in the freeze-thaw cycle will also increase the risk of ectopic pregnancy.