Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair.

STUDY

OBJECTIVE

To determine the incidence of interstitial pregnancy after in vitro fertilization/embryo transfer (ET) treatment and report on our experience of laparoscopic cornuostomy or cornual repair for interstitial pregnancy.

DESIGN

Single-center, retrospective review (Canadian Task Force classification II-3).

SETTING

University hospital.

PATIENTS: Thirty-eight women diagnosed with interstitial pregnancy, which developed after 10,143 ET cycles, managed in our center between April 2011 and April 2014.

INTERVENTIONS: All 38 cases of interstitial pregnancy were managed by laparoscopic cornuostomy or cornual repair. No patient was converted to laparotomy.

MEASUREMENTS AND MAIN

RESULTS

Of 43 cases of interstitial pregnancy, 38 were managed in our department. The overall incidence of interstitial pregnancy was .4% per ET cycle (43/10 143), or .8% per pregnancy (43/5297), but comprising 35.5% of all ectopic pregnancy cases. The risk factors for interstitial pregnancy included tubal infertility, cleavage ET, and frozen ET. Twenty-seven subjects (71.1%) had undergone bilateral salpingectomy. Among the 38 cases, 27 were intact, with no persistent ectopic pregnancy after surgery, but there were 3 cases (28.3%) of persistent pregnancy in the 11 ruptured cases. Among the 38 subjects, 15 conceived again with 14 live births and 1 ongoing pregnancy, without uterine rupture.

CONCLUSION

Laparoscopic cornuostomy or cornual repair appears to be an effective treatment in intact cases, although it sometimes needs to be combined with methotrexate therapy in ruptured cases complicated by persistent disease.