Heterotopic pregnancy following ovulation induction with clomiphene citrate therapy: A case report

A heterotopic pregnancy is a rare, life-threatening condition in which an intrauterine and ectopic pregnancy occur simultaneously. The incidence of these pregnancies is increasing as the use of assisted reproductive technology and ovulation-inducing agents becomes more common and accessible. A 31-year-old woman with polycystic ovarian syndrome conceived following clomiphene citrate-induced ovulation and was later diagnosed with a heterotopic pregnancy at 10 weeks 2 days of intrauterine gestation and 9 weeks 2 days of ectopic gestation by transvaginal ultrasound following painless vaginal bleeding and rectal pain. The ectopic pregnancy was managed surgically, and the intrauterine pregnancy progressed to a full-term vaginal delivery. This case calls attention to the importance of physicians maintaining a high index of suspicion for heterotopic pregnancy in patients undergoing ovulation induction, despite reassuring imaging and nonspecific symptoms.