Combined intrauterine and tubal pregnancy after in vitro fertilization and embryo transfer

Heterotopic pregnancy and assisted reproduction--an update

PURPOSE

Heterotopic pregnancy, an extremely rare event in the past, has become a common complication of assisted reproduction techniques.

METHODS AND RESULTS

This serious sequella of IVF/ET or GIFT is probably the result of ovarian hyperstimulation and the transfer of several embryos into the uterus or tubes of a preselected population suffering from mechanical infertility. The techniques and medium used for embryo transfer may also be involved. Delayed diagnosis resulting in rupture, hemorrhage, and emergency intervention with its serious consequences is being reported in nearly half of the cases.

CONCLUSIONS

The prognosis for 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 intervention are mandatory to salvage the viable intrauterine pregnancy and avoid maternal mortality.

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993

OBJECTIVE

To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies.

DATA IDENTIFICATION

Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993.

CONCLUSIONS

The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future.

Heterotopic pregnancy following administration of human menopausal gonadotropin and following in vitro fertilization and embryo transfer: two case reports and review of the literature

We report two cases of heterotopic (combined intra- and extra-uterine) pregnancy in women treated for infertility. In the first case the patient conceived following administration of human menopausal gonadotropin. In the seventh week of gestation she had a spontaneous abortion and in the eighth week required urgent laparotomy for acute abdomen due to the rupture of pregnant right tube. In the second case the patient conceived from IVF-ET; in the eighth week a salpingectomy was made. The intrauterine pregnancy continued regularly until term and the patient was delivered of a healthy baby by caesarean section. We reviewed the literature and we found that heterotopic pregnancy is an insidious disease with a constant increase of incidence, especially in infertile women submitted to therapy for ovulation induction or assisted reproductive techniques. All the patients who have risk factors should be submitted to careful controls in early pregnancy, including an ultrasound transvaginal scan.