{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:06:00Z","timestamp":1784009160885,"version":"3.55.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"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>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study was designed to explore the impacts of clinical features, surgical timing, embryo transfer type, and ectopic pregnancy location on intrauterine pregnancy outcomes among heterotopic pregnancy patients, with the goal of offering evidence-based guidance for clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 33 patients with clinically diagnosed heterotopic pregnancy admitted to our center between June 2019 and September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      This study included 33 patients with heterotopic pregnancy one conceived after ovulation induction and 32 via\n                      <jats:italic>in vitro<\/jats:italic>\n                      fertilization (IVF). Final follow-up data showed that 66.67% of patients attained viable ongoing intrauterine gestation or live birth; no fetal structural malformations were observed during the entire follow-up period. Sequential identification of an intrauterine gestational sac, embryo and fetal cardiac activity on ultrasound was associated with progressively higher odds of successful intrauterine pregnancy among patients with heterotopic pregnancy. All three sonographic markers predicted favorable pregnancy outcomes (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Visualized fetal cardiac activity exhibited the strongest predictive value for sustained pregnancy and live birth (OR = 22.00, 95% CI 3.24\u2013149.30,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). No significant differences in pregnancy outcomes were observed between blastocyst (D5) and fresh embryo transfers compared with D3 cleavage-stage embryos (OR = 0.42, 95% CI 0.08\u20132.14,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.412; OR = 0.67, 95% CI 0.05\u20138.91,\n                      <jats:italic>P<\/jats:italic>\n                      = 1.000, respectively). Cases with better intrauterine embryonic development had significantly higher odds of favorable pregnancy outcomes versus those with poorer intrauterine development (OR = 28.75, 95% CI 2.62\u2013315.41,\n                      <jats:italic>\n                        <jats:underline>P<\/jats:underline>\n                      <\/jats:italic>\n                      = 0.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ultrasonic indicators reflecting the development of the intrauterine gestational sac, such as the timing of yolk sac and fetal heartbeat visualization, and crown-rump length, were significantly superior to those of the ectopic gestational sac, indicating a favorable prognosis for the intrauterine pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1849479","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:39:10Z","timestamp":1784007550000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A case series: thirty-three cases with heterotopic pregnancy after assisted reproductive technology"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinyang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ninglu","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayi","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis and Reproductive Medicine Center, The First Hospital of Jilin University, Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e00423","DOI":"10.1016\/j.crwh.2022.e00423","article-title":"Spontaneous ovarian and intrauterine non-viable heterotopic pregnancy at 12 weeks of gestation: a case report.","volume":"5","author":"Maree","year":"2022","journal-title":"Case Rep Women\u2019s Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e9","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":"B3","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1002\/uog.12341","article-title":"Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo 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cycles.","volume":"25","author":"Zhang","year":"2018","journal-title":"Reprod Sci"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3386","DOI":"10.3390\/jcm11123386","article-title":"Differences in ectopic pregnancy rates between fresh and frozen embryo transfer after In vitro fertilization: a large retrospective study.","volume":"11","author":"Hu","year":"2022","journal-title":"J Clin Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0169837","DOI":"10.1371\/journal.pone.0169837","article-title":"Reduced ectopic pregnancy rate on day 5 embryo transfer compared with day 3: a meta-analysis.","volume":"12","author":"Zhang","year":"2017","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1002\/uog.29270","article-title":"Impact of endometrial thickness on reproductive outcome in fresh and frozen\u2013thawed embryo transfer: systematic review and meta-analysis.","volume":"66","author":"P\u00e9rez-Mil\u00e1n","year":"2025","journal-title":"Ultrasound Obstet Gynecol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849479\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:39:12Z","timestamp":1784007552000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1849479\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":15,"alternative-id":["10.3389\/fmed.2026.1849479"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1849479","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"1849479"}}