Korean J Obstet Gynecol.  2011 Dec;54(12):802-806. 10.5468/KJOG.2011.54.12.802.

Two cases of rare heterotopic pregnancy following in vitro fertilization and embryo transfer

Affiliations
  • 1Department of Obstetrics and Gynecology, Wallace Memorial Baptist Hospital, Busan, Korea. ktggyn@gmail.com
  • 2Mirae Obstetrics and Gynecology Hospital, Busan, Korea.
  • 3Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea. kuslee@pusan.ac.kr

Abstract

Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Early diagnosis of heterotopic pregnancy is often difficult because clinical symptoms and signs are not specific. We experienced two rare cases of heterotopic pregnancy following in vitro fertilization and embryo transfer. First case was the triplet pregnancy, which was combined one intrauterine pregnancy and two extrauterine pregnancy in bilateral tube. Second case was the unruptured heterotopic pregnancy by midtrimester, which had not any symptom and was diagnosed by ultrasound. We report two cases of rare heterotopic pregnancy following in vitro fertilization with brief review of literature.

Keyword

Pregnancy, combined; In vitro fertilization; Embryo transfer; Pregnancy, tubal, bilateral; Midtrimester

MeSH Terms

Early Diagnosis
Embryo Transfer
Embryonic Structures
Female
Fertilization in Vitro
Humans
Incidence
Pregnancy
Pregnancy Trimester, Second
Pregnancy, Heterotopic
Pregnancy, Triplet
Reproductive Techniques, Assisted

Figure

  • Fig. 1 Preoperative magnetic resonance imaging. (A) Arrow indicates the embryo of intauterine pregnancy. (B) Arrow indicates right. tubal pregnancy. (C) Arrow indicates left. tubal pregnancy. (D) Arrows indicate multilocular cysts on both ovaries (maybe thecaluteal cyst).

  • Fig. 2 Preoperative transverse abdominal sonogram shows one intrauterine pregnancy at 13 gestational weeks and another gestational sac with fetal pole in the left. fallopian tube.

  • Fig. 3 Pathologic finding: measuring 32.5 g in weigh and 10.2×2.5×2.1 cm in dimensions. Salpinx is dilated and shows hemorrhagic surface. On section, it shows fetus, yellowish villous soft tissue and hemorrhage.


Reference

1. Rojansky N, Schenker JG. Heterotopic pregnancy and assisted reproduction--an update. J Assist Reprod Genet. 1996. 13:594–601.
2. Lee HS, Kim JM, Yoo JH, Yook JH, Kim ML, Yoon JB, et al. Pregnancy outcomes of heterotopic pregnancy. Korean J Obstet Gynecol. 2009. 52:559–564.
3. Winer AE, Bergman WD, Fields C. Combined intra- and extrauterine pregnancy. Am J Obstet Gynecol. 1957. 74:170–178.
4. Steadman HE. Combined intrauterine and extrauterine pregnancy. Obstet Gynecol. 1953. 2:277–280.
5. DeVoe RW, Pratt JH. Simultaneous intrauterine and extrauterine pregnancy. Am J Obstet Gynecol. 1948. 56:1119–1126.
6. Felbo M, Fenger HJ. Combined extra- and intrauterine pregnancy carried to term. Acta Obstet Gynecol Scand. 1966. 45:140–154.
7. Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril. 1996. 66:1–12.
8. Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol. 2000. 182:1264–1270.
9. Marcus SF, Macnamee M, Brinsden P. Heterotopic pregnancies after in-vitro fertilization and embryo transfer. Hum Reprod. 1995. 10:1232–1236.
10. Reece EA, Petrie RH, Sirmans MF, Finster M, Todd WD. Combined intrauterine and extrauterine gestations: a review. Am J Obstet Gynecol. 1983. 146:323–330.
11. Inion I, Gerris J, Joostens M, De Vree B, Kockx M, Verdonk P. An unexpected triplet heterotopic pregnancy after replacement of two embryos. Hum Reprod. 1998. 13:1999–2001.
12. Scheiber MD, Cedars MI. Successful non-surgical management of a heterotopic abdominal pregnancy following embryo transfer with cryopreserved-thawed embryos. Hum Reprod. 1999. 14:1375–1377.
13. Goldman GA, Fisch B, Ovadia J, Tadir Y. Heterotopic pregnancy after assisted reproductive technologies. Obstet Gynecol Surv. 1992. 47:217–221.
14. Rothman A, Shapiro J. Heterotopic pregnancy after homolateral salpingo-oophorectomy. Report of a case. Obstet Gynecol. 1965. 26:718–720.
15. Gjelland K, Hordnes K, Tjugum J, Augensen K, Bergsjo P. Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy. Acta Obstet Gynecol Scand. 1995. 74:629–634.
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