**5.2.11 Assisted hatching**

Hagemann et al, found no difference in ectopic pregnancy rates in patients that their embryos had assisted hatching or not (Hagemann et al., 2008). From the other side Milki et al, in a large series of retrospectively examined patients saw that a significant higher ectopic pregnancy rate was found in cases where assisted hatching (AH) was performed when compared with cases that hatching was not preformed (Milki et al., 2004). Possible explanation for that is: 1) assisted hatching may accelerate embryo implantation, 2) a mechanism exists, that prevents embryos that reached fallopian tube to divert back to uterus and 3) the much higher embryo transfer volume that used in certain IVF programs.

### **5.2.12 Air bubble position after embryo transfer**

No difference in ectopic pregnancy rates was observed with different distances of embryo deposition from the uterine fundus (10-15 mm or < 10 mm) (Pacchiarotti et al., 2007).

## **5.2.13 Reanastomosis**

Patients with tubal infertility may undergo microsurgical reconstructive surgery of the fallopian tubes for adhesiolysis, anastomosis, fimbrioplasty, salpingostomy, and refertilization after former sterilization. These patients, if choose the microsurgical approach, show higher ectopic pregnancy rates after a single IVF trial (Schippert et al., 2009). From the other side, in a small series of patients, higher incidence of ectopic pregnancies was observed when previous tubal sterilization was reversed by laparoscopy than open microsurgical reversal (Tan et al, 2010). Even if suture less laparoscopic tubal re-anastomosis was performed (using a serosamuscular fixation/biological glue technique) an ectopic pregnancy rate of 3.9% was observed (Schepens et al., 2011). In a small series of robotic tubal reanastomosis (Dharia Patel et al., 2007) more ectopic pregnancies were observed when compared with open reanastomosis.

#### **5.2.14 Other complications of ectopic pregnancies**

Rh immunization could be observed in ruptured ectopic pregnancy.
