Ovarian pregnancy following intrauterine insemination

Abstract

Primary ovarian pregnancy, which was first reported by Saint Maurice in 1692 [1], represents 1e3% of all ectopic pregnancies [2,3]. Its incidence after natural conception ranges from 1 in 7000 to 1 in 60,000 [2,4,5], and it remains a rare phenomenon despite the increased incidence of ectopic pregnancies following assisted conception [6]. Ovarian pregnancy occurs in the corpus luteum and often results in ovarian rupture and massive hemoperitoneum. Clinical diagnosis is tricky, and intraoperative detection requires a high index of suspicion. Several theories have been suggested to explain the ovarian implantation of the conceptus following natural conception [3,7] and in vitro fertilization [6e8]. Here, we report a case of ruptured intrafollicular primary ovarian pregnancy with hemoperitoneum that followed superovulation and intrauterine insemination. A nulliparous 24-year-old woman presented to the emergency room with bilateral lower abdominal pain. She had a 2year history of primary infertility and had been diagnosed with polycystic ovarian syndrome. She underwent two controlled, ovarian stimulation cycles induced by clomiphene citrate (Clomid; Merrel-Dow, France S.A., Neuilly-sur-Seine, France). The insufficient ovarian response prompted a third cycle with 100 mg clomiphene citrate for 5 consecutive days beginning on days 3e7 of the cycle, and two ampoules of human menopausal gonadotropin (Pergonal; I.F. Serono S.P.A., Rome, Italy) per day on days 5e9. Baseline transvaginal ultrasound (US) scan was performed at the beginning of the first treatment cycle to exclude residual ovarian cysts. US scans were repeated between days 10 and 12 of the cycle to confirm the follicular development. The scan on the night of cycle day 12 revealed three large follicles on the left ovary (mean diameter: 17 2.1 mm) and two large follicles on the right ovary