Intrauterine pregnancy outcomes after laparoscopic heterotopic pregnancy management: a retrospective study of identifying risk factors and prognostic indicators

This study aimed to identify the risk factors and potential prognostic indicators associated with intrauterine pregnancy outcomes following laparoscopic management of heterotopic pregnancies (HPs). A retrospective analysis was conducted on 87 patients who underwent assisted reproductive technology (ART) and laparoscopy at our hospital from January 2010 to May 2023. Based on postoperative intrauterine pregnancy outcomes, the patients were classified into a miscarriage group (n = 15) and a delivery group (n = 72). Demographic, embryonic, surgical, and pregnancy outcome data were analyzed using statistical methods and and receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for prognostic indicators. In the cohort, 82.76% of postoperative intrauterine pregnancies resulted in live births. Compared with the delivery group, the miscarriage group had a significantly lower number of high-quality transferred embryos (median: 1 vs. 2, P < 0.001) and a lower rate of intrauterine fetal heartbeat detection on the day of surgery (26.67% vs. 79.17%, P < 0.001). Serum estradiol (E2) and β-human chorionic gonadotropin (β-HCG) levels in the miscarriage group were significantly reduced both at 14 days after embryo transfer (ET) (667.00 pmol/L vs. 1554.00 pmol/L and 305.01 mIU/mL vs. 541.86 mIU/mL, respectively; both P < 0.05) and at 3 days after surgery (1698.00 pmol/L vs. 5104.50 pmol/L and 32290.00 mIU/mL vs. 103821.50 mIU/mL, respectively; both P < 0.05). ROC analysis identified optimal cutoff values for predicting successful intrauterine pregnancy as follows: E2 ≥704.50 pmol/L and β-HCG ≥ 332.54 mIU/mL at 14 days after ET, and E2 ≥2315.00 pmol/L and β-HCG ≥ 42502.00 mIU/mL at 3 days after surgery. Most HP patients achieve favorable intrauterine pregnancy outcomes after laparoscopy. The transfer of high-quality embryos and systematic monitoring of serum β-HCG and E2 levels are closely associated with successful postoperative intrauterine pregnancy.These findings highlight the importance of targeted preoperative assessments and vigilant postoperative monitoring in this high-risk patient population, suggesting a pathway for improved clinical protocols and therapeutic interventions.