Subject(s)
Fertility Agents, Female/therapeutic use , Infertility, Female/therapy , Ovary/drug effects , Ovulation Induction/methods , Ovulation/drug effects , Adult , Female , Fertility Agents, Female/adverse effects , Humans , Infertility, Female/diagnosis , Infertility, Female/physiopathology , Maternal Age , Ovarian Reserve/drug effects , Ovary/physiopathology , Ovulation Induction/adverse effects , Patient Selection , Pregnancy , Risk Assessment , Risk Factors , Treatment FailureABSTRACT
PURPOSE: The incidence of ectopic pregnancy (EP) in the general population is 2%, whereas the EP rate following assisted reproductive technologies (ART) is between 2.1 and 11%. EP is also an adverse effect of tubal surgery with incidences up to 40% depending on the type, location, and severity of tubal disease and the surgical procedure. METHODS: This paper looks at the incidence of EP following tubal reconstructive microsurgery, analyzes risk factors for EP following own 1,295 ART cycles and looks on the incidence of EP in 128,314 pregnancies following ART according to the presence or absence of tubal infertility using data from the German IVF Registry (DIR). RESULTS: In our clinic, the EP rate following resterilization was 6.7%. In the presence of acquired tubal disease, the EP rate following adhesiolysis, salpingostomy, salpingoneostomy, fimbrioplasty, and anastomosis was 7.9%. The EP rate following ART in our clinic was 5.6%. Previous abdominal surgeries, microsurgical procedures, hydro-/sactosalpinges, salpingitis, salpingitis isthmica nodosa, and periadnexal adhesions showed a significant positive correlation with EP as outcome. Data of DIR demonstrate a significantly increased incidence of EP in the presence of tubal pathology. The highest EP rate related to all clinical pregnancies was 4.5% (95% CI 3.0-6.0) in smoking women <30 years with tubal pathology following IVF. CONCLUSIONS: In the presence of tubal infertility, the incidence of EP following ART and tubal microsurgery are approximately comparable with each other and higher than in women without tubal infertility. The success of infertility surgery depends on a careful selection of appropriate patients.
Subject(s)
Fallopian Tube Diseases/surgery , Fallopian Tubes/surgery , Microsurgery , Pregnancy, Ectopic/etiology , Reproductive Techniques, Assisted/adverse effects , Sterilization Reversal/adverse effects , Adult , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Incidence , Infertility, Female/surgery , Pregnancy , Pregnancy, Ectopic/epidemiology , Retrospective Studies , Risk , Smoking/adverse effects , Young AdultABSTRACT
To our knowledge, this is the first analysis in which male and female weights have been combined. The registry dataset covering a 12-year period was analysed for all treatment cycles where an embryo transfer was reported. In all, 706,360 cycles were analysed. Treatments include IVF, ICSI, IVF/ICSI and CPE. The highest success rate in IVF cycles was found in couples, with an obese male partner. In the group of obese women, the pregnancy rate decreased to 27.2%. Similar to IVF treatment, the highest success rate in ICSI cycles was found in couples, where either the male or the female partner was obese. The highest success rate in cycles with a cryopreserved embryo transfer was observed in couples where both partner were obese. The lowest success rate was seen where the female partner was obese. Our data analysis suggests that the combination of an obese male and a normal-weight female is positively related to better implantation rates in IVF as well as ICSI-cycles. This combination is more likely to be found in couples with a higher social status. Therefore, the increased pregnancy rate in this group might as well be related to other lifestyle factors associated with higher social status.
