Tubal factor, cleavage stage and more than one embryo transferred were risk factors associated with ectopic pregnancy after assisted reproductive treatment.

OBJECTIVE: Ectopic pregnancy is a well-known complication following in vitro fertilization with embryo transfer; studies have questioned, however, whether there are risk factors that could be identified before the procedure. The objective of this study was to investigate the possible risk factors involved in ectopic pregnancy following in vitro fertilization. METHODS: Retrospective case-control study performed at an assisted reproduction clinic in Brazil. To select the control group, we used a 1:4 ratio. The study included 499 patients submitted to in vitro fertilization with clinical pregnancy. We collected the data from electronic records, between 2000-2019 and divided into: Group 1, ectopic pregnancy (n=90) and Group 2, intrauterine pregnancies (n=409). RESULTS: When comparing groups, the results observed were: Tubal factor infertility (35.6% vs. 21.1%, p=.005) (OR 2.0 [1.2-3.4], p=.004); Previous miscarriage history (15.1% vs. 7.1%, p<.05) (OR 2.0 [1.02-4.29], p=.044); Number of cleavage-stage embryo transfers (69.2% vs. 54.0 p=.028) (OR 1.9 [1.08-3.33], p=.025); Two or more embryos transferred (OR 2.5 [1.12-5.70], p=.025), all associated with greater ectopic pregnancy risk. Oocyte recipient patients were excluded from this analysis, but when included a difference was found when comparing the groups (9.4% (10/106) vs. 3.0% (13/434), p=.007), (OR 3.3 [1.41-7.98] p=.005); this result should be interpreted with caution because of the sample size. CONCLUSIONS: In high-risk patients, a single blastocyst transfer seems to be a reasonable approach to decrease the ectopic pregnancy risk.

Ectopic pregnancy in left ovary and contralateral uterine tube diagnosed one week apart in In Vitro Fertilization with donor eggs: Case report.

Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.

Preservação da fertilidade em mulheres com câncer / Fertility preservation in women with cancer

Introdução: A fertilidade em mulheres que passaram por tratamento oncológico é um assunto de suma relevância no cenário da medicina atual. É importante que tais pacientes estejam cientes dos possíveis danos à fertilidade que o tratamento para neoplasias pode acarretar; assim como, é essencial que os médicos que lidam com elas saibam expor as opções para a preservação da fertilidade. Métodos: Os artigos foram pesquisados na base de dados PubMed em junho de 2018, utilizando os termos descritores oncologia; câncer, mulheres e fertilidade. Como critérios de inclusão, foram considerados artigos publicados nos últimos 10 anos, no período de junho de 2008 a junho de 2018, artigos que abordassem pesquisas apenas com humanos e aqueles publicados em língua portuguesa, inglesa ou espanhola. Resultados: Na pesquisa inicial, utilizando os termos descritores, foram encontrados 4173 artigos; restringindo aos últimos 10 anos, restaram 2370 artigos; desses, foram selecionados apenas aqueles com pesquisas em seres humanos, restaram 2201 artigos e desses foram selecionados 2063 que estão nos idiomas escolhidos. Elegeu-se 8 artigos para a elaboração desta revisão da literatura. Conclusões: Através deste artigo, foi possível revisar evidências atuais referentes a preservação da fertilidade em mulheres com diagnóstico de câncer. Atualmente há uma ampla variedade de abordagens para manutenção da fertilidade. Diante do desejo de gestar, as escolhas vão depender, principalmente, da idade da paciente, da reserva ovariana e da presença de parceiro.

Introduction: Fertility in women whom went through an oncologic treatment is a subject of utmost importance in the current medical scenario. It is important that these patients are aware of the possible damages to fertility due to oncologic treatments; as well as, it is essential for physicians that deal with cancer patients knowing how to disclose the options available for fertility preservation. Methods: The articles were researched in the PubMed database in June 2018, using descriptor terms as oncology; cancer; women; and fertility. As an inclusion criterion, articles published in the last 10 years were considered, from June 2008 to June 2018, articles whose research was based solely on humans and those published in Portuguese, English and Spanish. Results: In the initial research, using the descriptor terms, 4173 articles were found; restricting those to the last 10 years, 2370 were left; of these, 2201 articles whose research was solely based on humans were selected, of which 2063 are on the selected languages. Eight articles were elected for the formulation of this literature review. Conclusions: Through the elaboration of this article, it was possible to review the current relative evidence to the conservation of fertility in women with the diagnosis of cancer. Nowadays there is a broad range of approaches for the preservation of fertility. Faced on the desire to gestate, choices will vary from the age of the patient and ovarian reserve, to the presence of a male partner.