An ectopic pregnancy masked by follicular initiation of gonadotropin-releasing hormone agonist for pituitary desensitization prior to in vitro fertilization

Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube

We report a case of a twin ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF-ET). A 24-year-old nulligravida presented with lower abdominal pain and vaginal bleeding 4 weeks after embryo transfer. Serum beta-HCG levels were 40 IU/mL, 90 IU/mL, and 1970 IU/mL on ET days 12, 14, and 23, respectively. Ultrasound examination revealed two ectopic gestational sacs with fetal heart beats in the left adnexa, without evidence of intrauterine pregnancy. At laparoscopy, one isthmic and another ampullary sac were detected in the left tube and left salpingectomy was performed. The patient was discharged healthy on postoperative day 2. Albeit extremely rare, ectopic pregnancies with abnormal presentation can be encountered following IVF-ET. Single embryo transfer may be advised to protect from ectopic pregnancies after IVF-ET.

Bilateral ectopic pregnancy after transfer of two embryos

OBJECTIVE

To report a case of bilateral tubal ectopic pregnancy (EP) after the transfer of two embryos.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 43-year-old multigravida with bilateral tubal pregnancy.

INTERVENTION(S)

Operative laparoscopy with right linear salpingostomy and left salpingectomy.

MAIN OUTCOME MEASURE(S)

Laparoscopy revealed an unruptured left isthmic tubal EP and an unruptured right ampullary tubal EP.

RESULT(S)

Pathology confirmed immature placental villi in the right tube and placental tissue in the left tube. The patient was discharged home without incident on the day after surgery.

CONCLUSION(S)

This is a rare case of bilateral tubal pregnancy after the transfer of only two embryos. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube after surgery for EP.

Should we still advise infertile couples to use (barrier) contraception before IVF down-regulation?

OBJECTIVE

To determine the outcome of spontaneous conceptions in women who received GnRH agonists during mid-luteal phase down-regulation before IVF treatment.

DESIGN

Retrospective analysis of case records and study of the literature.

SETTING

Two university-affiliated reproductive medicine units.

PATIENT(S)

Seventy-three women who conceived spontaneously after starting down-regulation with a GnRH agonist before controlled ovarian hyperstimulation.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Course and clinical outcome of pregnancies.

RESULT(S)

Seventy-four pregnancies occurred in 73 women who received a GnRH agonist. Of these patients, 6 (8%) had a biochemical pregnancy, 6 (8%) had an ectopic pregnancy, 21 (28%) miscarried, and 41 pregnancies resulted in successfully delivered babies; there were 2 cases of congenital abnormalities.

CONCLUSION(S)

These cases, together with other published data, suggest that pregnancy outcome is not adversely affected by exposure to GnRH agonist during luteal-phase down-regulation. A central register of pregnant women who received a GnRH agonist is needed.