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 beta-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 beta-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 beta-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 beta-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. (C) 2014 by American Society for Reproductive Medicine.