{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:44:21Z","timestamp":1793252661275,"version":"4.5.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>With the widespread application of assisted reproduction technology (ART) and increased pelvic inflammatory disease, the incidence of heterotopic pregnancy (HP) has risen. However, the risk factors and treatment of HP remain indefinite.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore risk factors affecting the incidence of HP secondary to <jats:italic>in vitro<\/jats:italic> fertilization-embryo transfer (IVF-ET) and pregnancy outcomes after surgical treatment of HP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>29 patients with HP and 116 with an intrauterine-only pregnancy (IUP) after IVF-ET during the same period were included retrospectively from January 2015 to September 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with HP had a higher proportion of previous ectopic pregnancies, multiple abortion history (\u22672 times) and tubal indication for IVF than IUP. Besides, they had a greater possibility to end in spontaneous abortion (31.03 vs.13.79%, <jats:italic>P<\/jats:italic> = 0.028) and preterm delivery (25.00 vs. 7.00%, <jats:italic>P<\/jats:italic> = 0.035), less possibility to result in a live birth (58.62 vs. 78.45%, <jats:italic>P<\/jats:italic> = 0.028). History of multiple abortions (\u22652 times) [odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087\u20138.453; <jats:italic>P<\/jats:italic> = 0.034], tubal infertility (OR 3.844, 95% CI 1.268\u201311.656; <jats:italic>P<\/jats:italic> = 0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625\u20138.490; <jats:italic>P<\/jats:italic> = 0.021) and number of embryo transfer (OR 0.300, 95% CI 0.092\u20130.983; <jats:italic>P<\/jats:italic> = 0.037) resulted in an elevated proportion of HP in IVF treatment. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Previous history of ectopic pregnancy, multiple abortions, tubal infertility and multiple-embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.864560","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T05:20:00Z","timestamp":1655875200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Heterotopic Pregnancy Secondary to in vitro Fertilization-Embryo Transfer: Risk Factors and Pregnancy Outcomes"],"prefix":"10.3389","volume":"9","author":[{"given":"Shaomi","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyue","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianqing","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinxiu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.fertnstert.2006.05.085","article-title":"Heterotopic pregnancy: two cases and a comparative review","volume":"87","author":"Barrenetxea","year":"2007","journal-title":"Fertil Steril"},{"key":"B2","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.rbmo.2015.02.003","article-title":"A case of avoidable heterotopic pregnancy after single embryo transfer","volume":"30","author":"Gergolet","year":"2015","journal-title":"Reprod Biomed Online."},{"key":"B3","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.jmig.2020.07.008","article-title":"Laparoscopic management of a heterotopic pregnancy in the tubal stump","volume":"28","author":"Balafoutas","year":"2021","journal-title":"J Minim Invasive Gynecol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1186\/s12884-020-03214-1","article-title":"Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Pregnancy Childbirth."},{"key":"B5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.tjog.2019.11.010","article-title":"Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer","volume":"59","author":"Lv","year":"2020","journal-title":"Taiwan J Obstet Gynecol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1056\/NEJMicm1509537","article-title":"Heterotopic pregnancy","volume":"375","author":"Goettler","year":"2016","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1055\/s-0040-1708093","article-title":"A rare case of bilateral tubal ectopic pregnancy following intracytoplasmic sperm injection-embryo transfer (ICSI-ET)","volume":"42","author":"Acet","year":"2020","journal-title":"Rev Bras Ginecol Obstet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/humupd\/dmp057","article-title":"Current knowledge of the aetiology of human tubal ectopic pregnancy","volume":"16","author":"Shaw","year":"2010","journal-title":"Hum Reprod Update."},{"key":"B9","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.ejogrb.2014.07.049","article-title":"Risk factors for ectopic pregnancy in women with planned pregnancy: a case\u2013control study","volume":"181","author":"Li","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.ejogrb.2020.08.046","article-title":"Ectopic pregnancy following in vitro fertilization after bilateral salpingectomy: a review of the literature","volume":"254","author":"OuYang","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.fertnstert.2017.10.032","article-title":"Effect of air bubbles localization and migration after embryo transfer on assisted reproductive technology outcome","volume":"109","author":"Fi\u00e7icioglu","year":"2018","journal-title":"Fertil Steril."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01443615.2021.2001794","article-title":"Heterotopic pregnancy after bilateral salpingectomy, IVF and multiple embryos transfer. a case report and systematic review of the literature","volume":"12","author":"Karampas","year":"2022","journal-title":"J Obstet Gynaecol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1111\/ajo.12727","article-title":"Hospital admission and surgical approach to tubal ectopic pregnancy in Australia 2000 to 2014: a population-based study","volume":"58","author":"Paull","year":"2018","journal-title":"Aust N Z J Obstet Gynaecol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1016\/S0140-6736(14)60123-9","article-title":"Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial","volume":"383","author":"Mol","year":"2014","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"l6283","DOI":"10.1136\/bmj.l6283","article-title":"Ectopic pregnancy and miscarriage: diagnosis and initial management: summary of updated NICE guidance","volume":"367","author":"Webster","year":"2019","journal-title":"BMJ."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.864560\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T05:20:01Z","timestamp":1655875201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.864560\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,22]]},"references-count":15,"alternative-id":["10.3389\/fmed.2022.864560"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.864560","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,22]]},"article-number":"864560"}}