Bilateral tubal pregnancy after assisted reproduction techniques: case report and literature review

Abstract

Introduction: An ectopic pregnancy (EP) occurs when a fertilised ovum implants outside the nor­mal uterine cavity. The occurrence of ectopic pregnancy varies between 0.3% - 1.4% and is signifi­cantly higher after assisted reproduction techniques (ART). Ectopic pregnancy is still a leading cause for maternal morbidity and mortality. Bilateral tubal ectopic pregnancy is the rarest form of ectopic pregnancy and may occur in one per 200,000 pregnancies. The incidence is higher in women under­going assisted reproductive techniques or ovulation induction. Materials and Methods: A case report of a 38-year-old woman with secondary infertility is presented. The preceding diagnostic laparoscopy excluded the presence of tubal factor infertility. The results of the spermogram show average to severe form of oligoasthenozoospermia. A short Gonadotropin-Re­leasing Hormone (GnRH) antagonist protocol was performed and two embryos were transferred on the third day. Results: β-Human Chorionic Gonadotropin (β-hCG) serum concentration was measured as 650 mIU/ mL on the 12th day after embryo transfer (ET). Transvaginal ultrasonography performed at the 22nd day did not detect intrauterine pregnancy or ectopic gestational sac. On the 36th day after the ET the patient was hospitalized with abdominal pain in the right hypogastric region, clinical and ul­trasound indications for hemoperitoneum. Urgent laparotomy was performed followed by salpingec­tomy dextra due to hemoperitoneum caused by tubal abortion. The examination of the left adnexa re­vealed ruptured tubal pregnancy in the isthmic part of the tube and the decision for salpingectomy sinistra was taken. Histological examinations confirmed the diagnosis of ectopic pregnancy in both tubes. Conclusion: Rare forms of ectopic pregnancy are likely to occur after ART. Therefore it is compulso­ry to perform an early β-hCG monitoring and transvaginal ultrasonography even in women without known risk factors in order to discover possible EP at an early stage.