Combined intrauterine, tubal, and cervical pregnancies following in vitro fertilization and embryo transfer (original) (raw)
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Cervical Ectopic Pregnancy of 45,XO Embryo After In Vitro Fertilization/Embryo Transfer
Türk Üreme Tıbbı ve Cerrahisi Dergisi
ervical pregnancy is usually considered as a life threatening event. It is a rare form of ectopic gestation and accounts for less than 1% of all pregnancies. 1 Cervical pregnancy was defined as implantation of the gestation in the endocervical canal. The incidence is approximately 1 in 2500-12000 pregnancies. 2 It is a well known complication of ART procedures. Early diagnosis is important and allows conservative treatment option to preserve fertility. Hysterectomy was the only treatment for cervical pregnancy in the past. 2 Current treatment modalities include aspiration curettage with hypogastric/uterine artery embolization, curettage and local prostoglandin injection, insertion of foley catheter in the cervical canal after curettage , local administration of methotrexate (MTX) with/without local potassium chloride, systemic administration of MTX and hysterescopic resection of the gestation in conjuction with uterine artery embolization. 3-5 Early diagnosis is important to prevent serious complications such as
Heterotopic pregnancy from in vitro fertilization
Journal of In Vitro Fertilization and Embryo Transfer, 1985
A case ofheterotopic or combined intrauterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of five four-cell embryos. The phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with underlying tubal disease. This patient had both variables. Techniques applied at the time of embryo transfer are also implicated, namely, the use of culture medium with 50% maternal serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer.
Ovarian pregnancy after in-vitro fertilization with embryo transfer: A case report
Case Report, 2024
Background: Ovarian pregnancy, a rare but life-threatening complication, has seen an increase in incidence with the development of assisted reproduction technology (ART). The exact mechanism of ovarian pregnancy after IVF remains unclear; however, factors such as reverse migration of embryos and in-vivo fertilization of anovulated oocytes have been proposed. Case Presentation: We present a case of a 42-year-old woman with poor ovarian reserve who underwent IVF-ET using donor follicles. Despite adherence to instructions against coitus during and after the IVF cycle, a transvaginal ultrasound revealed a right ovarian pregnancy, which ruptured during ultrasound examination. The patient underwent exploratory laparotomy, and had a satisfactory recovery. Conclusion: This case emphasizes the importance of considering ovarian pregnancy in the differential diagnosis of ectopic gestations post-IVF as early recognition and intervention are paramount for optimal patient outcomes. Surgical treatment with wedge resection of the ovary alongside the gestation or product of conception has been considered gold standard of care. Keywords: Ovarian pregnancy; Ectopic pregnancy; In vitro fertilization; Embryo transfer; Wedge resection; Oophorectomy
Reproductive biology and endocrinology : RB&E, 2015
Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. The...
Heterotopic Pregnancy Complicating In Vitro Fertilization
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 1998
A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% ( 5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.
Heterotopic pregnancy and assisted reproduction—an update
Journal of Assisted Reproduction and Genetics, 1996
Purpose: Heterotopic pregnancy, an extremely rare event #~ the past. has become a common conwlication of assisted reproduction techniques. Methods and Results: This serious sequetla of IVF/ET or GIFT is probably the result of ovarian hyperstimulation and the transfer of several emb~. os into the uterus or tubes of a preselected population suffering from mechanical infertili~'. The techniques and medium used for embryo transfer may also be involved. Delayed diagnosis resulting in rupture, hemorrhage, and emergency intera,ention with its serious consequences is being reported in nearly half of the cases. Conclusions: The prognosis Jbr a viable intrauterine pregnancy, however, is good, and these combined pregnancies have produced a living child in about 70% of cases. A High index of suspicion, repeated ultrasounds, and early intetwention are mandator?; to salvage the viable intrauterine pregnancy and avoid maternal mortali~.
Heterotopic cervical pregnancy after in-vitro fertilization - case report and literature review
JBRA assisted reproduction, 2019
Heterotopic cervical pregnancy is an uncommon condition, with a rising incidence due to the increasing number of pregnancies resulting from in-vitro fertilization (IVF). Although it is associated with maternal-fetal complications, there is no consensus in the literature about the best approach for this condition. This study aims to report a case of cervical heterotopic gestation after IVF in which the intrauterine pregnancy was preserved, with spontaneous elimination of the cervical gestational sac after patient sedation and introduction of the vaginal speculum. In addition, we reviewed the literature on the subject, which demonstrated that most cases have a favorable outcome, especially after treatment with surgical excision of the cervical pregnancy. The growing body of evidence is still scarce to define the best treatment for this condition.