Pregnancies of unknown location after in vitro fertilization: minimally invasive management with Karman cannula aspiration.

OBJECTIVE

To describe a standardized protocol for the assessment of asymptomatic patients with pregnancies of unknown location (PUL) after IVF.

DESIGN

Retrospective cohort study.

SETTING

University-based infertility clinic.

PATIENT(S): Women undergoing fresh IVF/intracytoplasmic sperm injection (ICSI) cycles between 2005 and 2011.

INTERVENTION(S): Endometrial sampling using Karman suction cannula in patients with PUL and abnormal β-hCG trend (increase <53% or decrease <15% in 2 days) and a pelvic ultrasound unremarkable for an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP).

MAIN OUTCOME MEASURE(S): Proportion of patients spared methotrexate (MTX) administration.

RESULT(S): Endometrial sampling was performed in 45 patients. Of these, 31 (68.9%) were diagnosed with failed IUP by either a sampling after the β-hCG decline (≥15%) and/or the presence of villi on final pathology. No further intervention was required. Fourteen patients (31.1%) were diagnosed with presumed EP by persistent β-hCG level after negative pathology. Ten of these patients (71%) were successfully treated with a single dose of MTX; three required an additional dose, and one required laparoscopy for a ruptured EP.

CONCLUSION(S): In asymptomatic patients with PUL and abnormal β-hCG trends after IVF, the utility of Karman aspiration to confirm an IUP may obviate treatment with MTX in more than two-thirds of patients.