Heterotopic Pregnancy After Ovulation Induction by Clomiphene Citrate: A Case Report

Heterotopic pregnancy (HP), when intrauterine and ectopic pregnancies occur together, is uncommon but dangerous. While rare in spontaneous conception, the risk increases with fertility treatments like clomiphene citrate (CC). These cases are easily missed because doctors may be reassured by the intrauterine pregnancy and overlook the ectopic one. We describe a 31-year-old woman with primary infertility who conceived following clomiphene-induced ovulation. At seven weeks, she developed pelvic pain and vaginal bleeding. She was hemodynamically unstable with tachycardia and low blood pressure. Ultrasound showed an intrauterine sac alongside a left adnexal sac without fetal heartbeat, plus fluid in the pelvis indicating bleeding. We diagnosed HP and performed emergency laparotomy with left salpingectomy due to her unstable condition. She recovered well with first-trimester progesterone support and delivered vaginally at 40 weeks without complications. This case highlights how challenging HP can be to diagnose. Even when an intrauterine pregnancy is visible, clinicians should consider HP in patients with pelvic pain and fertility treatment history. Clomiphene increases this risk even without other predisposing factors. Ultrasound must include careful adnexal examination to avoid missing the diagnosis. Hemodynamically unstable patients need immediate surgery to control bleeding and protect the intrauterine pregnancy. With timely recognition and proper management, including progesterone support, good outcomes are possible. Vigilance is essential for all patients undergoing ovulation induction.