A Case of Pre-Existing Pregnancy During an In-Vitro Fertilization Cycle

Area of Science:

• Reproductive Endocrinology
• In-Vitro Fertilization (IVF)
• Early Pregnancy Detection

Background:

• Serum progesterone monitoring before oocyte retrieval is standard in IVF to optimize embryo transfer.
• Elevated progesterone levels can negatively impact IVF success rates.
• Normal progesterone levels may warrant investigation for alternative explanations, including early pregnancy.

Observation:

• A 37-year-old patient underwent controlled ovarian hyperstimulation in an IVF cycle.
• Despite adequate follicular response, no oocytes were retrieved during oocyte retrieval.
• Her serum progesterone level on the trigger injection day was 57.8 nmol/L.

Findings:

• The patient had an undetected early pregnancy at the time of the IVF cycle.
• A pregnancy of unknown location was diagnosed three weeks post-oocyte retrieval.
• The patient was successfully treated with systemic methotrexate.

Implications:

• This case underscores the necessity of considering early pregnancy in patients undergoing IVF, especially with unexpected outcomes like failed oocyte retrieval.
• Clinicians should be vigilant for pregnancy of unknown location when progesterone levels are incongruent with IVF cycle response.
• Accurate early pregnancy diagnosis is crucial to prevent unnecessary or potentially harmful IVF interventions and ensure appropriate management.