Simultaneous cul-de-sac and tubal pregnancy following in vitro fertilization

The aim of this study is to share a valuable experience of heterotopic pregnancy following in vitro fertilization.

A 37-year-old, gravida 3, para 2 (cesarean section 2 times), woman underwent in vitro fertilization with three embryos transferred. On Day 23 after the embryo transfer, right tubal pregnancy with a 0.7-cm gestational sac was found by ultrasound, and her serum β-human chorionic gonadotropin level was 81,388 mIU/mL. She underwent a laparotomy with right salpingectomy. On Day 43 after the embryo transfer, intermittent abdominal pains developed. A live fetus with a crown-rump length of 2.0 cm was found in the cul-de-sac. Under the diagnosis of abdominal pregnancy, she was admitted for sona-guided KCl and methotrexate injections. She received four units of packed red blood cells due to a drop in hemoglobin level from 12.5 g/dL to 8.6 g/dL. The patient recovered well, and the serum β-human chorionic gonadotropin declined to <10 mIU/mL.

Various forms of ectopic pregnancy should be kept in mind in early pregnancy following in vitro fertilization.