First trimester bleeding has been investigated in 72 pregnant women undergoing in-vitro fertilization and embryo transfer and was compared to 70 pregnant patients in whom ovulation was induced, in addition to 70 spontaneous pregnancies. Abortion rates did not differ significantly between the first two groups but were significantly higher in comparison to normal pregnancies. Furthermore, among IVF pregnancies that continued, a high incidence of first trimester bleeding occurred (P less than 0.01). This complication was mainly related to luteal insufficiency and multiple pregnancies, whereas hyperstimulation was the major risk factor for bleeding in pregnancies arising from HMG-induced ovulation. Other currently unknown, aetiological factors for first trimester bleeding in IVF pregnancies remain to be investigated.

Key Clinical MessageThis case is extraordinary because it was never before described in English literature. The case describes a long‐standing debate about the safety of carrying this pregnancy to term. Some authors are for and some are against. The risks and benefits should be thoroughly reviewed before a decision is made.

Evaluation for complete removal of laminaria is critical. Retention of laminaria should be considered in the workup of patients who have pelvic inflammatory disease or genital infections and have received laminaria in the past.