Ovarian pregnancy after an IVF program in a patient with reduced endometrial receptivity
Background. Despite significant achievements in the diagnosis and treatment of various gynecological diseases, the problem of extrauterine (ectopic) pregnancy remains relevant. Today ectopic pregnancy occupies one of the leading places in the structure of maternal mortality because it is very often accompanied by massive intraabdominal bleeding. The incidence of ectopic pregnancy is known to increase after assisted reproductive technology (ART) programs. This is facilitated by a number of the features that are characteristic of ART programs and absent in natural conception. In addition, impaired endometrial receptivity (including that due to disturbed methylation of a number of HOX family genes, etc.) may be a risk factor for ectopic pregnancy.Knyazeva E.A., Alieva K.U., Kalinina E.A.
Description. The paper describes the clinical case of a 35-year-old female patient who applied to an IVF program because of primary male factor infertility and reduced endometrial receptivity. The IVF/ICSI program with embryo transfer (ET) in the stimulation cycle resulted in ectopic (ovarian) pregnancy.
Conclusion. In addition to the traditional list of necessary analyses and diagnostic tests, it is recommended that evaluation of endometrial receptivity (including HOXA10 and HOXA11 gene methylation) should be included in a comprehensive examination of women before the IVF program, especially women with failed IVF attempts in their histories and/or with recurrent miscarriage.
Keywords
IVF
infertility
ectopic pregnancy
endometrial receptivity
implantation window
DNA methylation
HOX genes
HOXA10
HOXA 11
References
1. Jurkovic D., Wilkinson H. Diagnosis and management of ectopic pregnancy BMJ. 2011; 342: d3397.
2. Huang B., Hu D., Qian K., Ai J., Li Y., Jin L. et al. Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy? An analysis of more than 30,000 cycles. Fertil. Steril. 2014; 102(5): 1345-9.
3. Londra L., Moreau C., Strobino D., Garcia J., Zacur H., Zhao Y. Ectopic pregnancy after in vitro fertilization: differences between fresh and frozenthawed cycles. Fertil. Steril. 2015; 104(1): 110-8.
4. Lin S., Yang R., Chi H., Lian Y., Wang J., Huang S. et al. Increased incidence of ectopic pregnancy after in vitro fertilization in women with decreased ovarian reserve. Oncotarget. 2017; 8(9): 14570-5.
5. Refaat B., Dalton E., Ledger W.L. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod. Biol. Endocrinol. 2015; 13: 30.
6. Chang H.J., Suh C.S. Ectopic pregnancy after assisted reproductive technology: what are the risk factors? Сurr. Opin. Obstet. Gynecol. 2010; 22(3): 202-7.
7. Pandian Z., Marjoribanks J., Ozturk O., Serour G., Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst. Rev. 2013; (7): CD003416.
8. Sivalingam V.N., Duncan W.C., Kirk E., Shephard L.A., Horne A.W. Diagnosis and management of ectopic pregnancy. J. Fam. Plann. Reprod. Health Care. 2011; 37(4): 231-40.
9. Князева Е.А., Калинина Е.А., Быстрицкий А.А., Алиева К.У., Байрамова Г.Р. Роль НОХ-генов при заболеваниях репродуктивной системы женщины, ассоциированных с бесплодием. Акушерство и гинекология. 2017; 11: 16-22. https://dx.doi.org/10.18565/aig.2017.11.16-22 [Knyazeva E.A., Kalinina E.A., Bystritsky A.A., Alieva K.U., Bairamova G.R. Role of HOX genes associated with infertility in female reproductive system diseases. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (11): 16-22. (in Russian) https://dx.doi.org/10.18565/aig.2017.11.16-22]
10. Yang Y., Chen X., Saravelos S.H., Liu Y., Huang J., Zhang J., Li T.C. HOXA-10 and E-cadherin expression in the endometrium of women with recurrent implantation failure and recurrent miscarriage. Fertil. Steril. 2016; 107(1): 136-43.
11. Maria Sidonia S., Vaduva C., Comanescu A., Veliscu A., Comanescu C., Patrascu A. Management of the ectopic pregnancy located at the level of the uterine scar. JFIV Reprod. Med. Genet. 2016; 4(3): 1-5.
12. Xu B., Geerts D., Bu Z., Ai J., Jin L., Li Y. et al. Regulation of endometrial receptivity by the highly expressed HOXA9, HOXA11 and HOXD10 HOX-class homeobox genes. Hum. Reprod. 2014; 29(4): 781-90.
13. Адамян Л.В., Чернова И.С., Козаченко А.В. Комбинированное лечение женщин с шеечной беременностью. Акушерство и гинекология. 2012; 4-2: 103-8. [Adamyan L.V., Chernova I.S., Kozachenko A.V. Combination treatment in women with cervical pregnancy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (4-2): 103-8. (in Russian)]
14. Лебедев В.А., Шахламова М.Н., Давыдов А.И. Редкие формы эктопической беременности. Трудный пациент. 2016; 8-9: 13-8. [Lebedev V.A., Shakhlamova M.N., Davydov A.I. Rare forms of ectopic pregnancy. Trudnyy patsiyent. 2016; 8-9: 13-8. (in Russian)]
15. Di Luigi G., Patacchiola F., La Posta V., Bonitatibus A., Ruggeri G., Carta G. Early ovarian pregnancy diagnosed by ultrasound and successfully treated with multidose methotrexate. A case report. Clin. Exp. Obstet. Gynecol. 2012; 39: 390-3.
16. Rovei V., Dalmasso P., Gennarelli G., Lantieri T., Basso G., Benedetto C. et al. IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles. Reprod. Biol. Endocrinol. 2013; 11: 14.
17. Cenksoy P.O., Ficicioglu C., Yesiladali M., Akcin O.A., Kaspar C. The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 172: 46-50.
Received 08.12.2017
Accepted 22.12.2017
About the Authors
Knyazeva, Ekaterina A., post-graduate student of B.V. Leonov Department of Auxiliary Technologies in Infertility Treatment, National Medical ResearchCenter of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954382501. E-mail: knyazeva.ea@gmail.com
Alieva, Kamila U., PhD, Researcher of B.V. Leonov Department of Auxiliary Technologies in Infertility Treatment, National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381341. E-mail: kaya79@mail.ru
Kalinina, Elena A., MD, The chief of B.V. Leonov Department of Auxiliary Technologies in Infertility Treatment, National Medical Research Center of Obstetrics,
Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381341. E-mail: e_kalinina@oparina4.ru
For citations: Knyazeva E.A., Alieva K.U., Kalinina E.A. Ovarian pregnancy after an IVF program in a patient with reduced endometrial receptivity. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (8): 180-4. (in Russian)
https://dx.doi.org/10.18565/aig.2018.8.180-184
Similar Articles
