Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen‐thawed embryo transfer

Abstract

A case of heterotopic triplet pregnancy after frozen-thawed embryo transfer is presented. The patient conceived after transfer of three frozen-thawed embryos at a fertility clinic where she had previously undergone laparoscopic left salpingectomy due to pyosalpinx. Approximately 4 weeks after the embryo transfer, she presented with a complaint of abnormal genital bleeding and was diagnosed by ultrasound as having a dichorionic twin pregnancy. One week later, she was referred to our hospital because of lower abdominal pain. Hematoperitoneum was suspected based on findings of low blood pressure and tachycardia. Diagnostic emergent laparoscopy demonstrated an ectopic pregnancy in the remnant isthmic portion of the left tube. Laparoscopic excision of the remnant fallopian tube was performed, but the procedure resulted in early-pregnancy loss of one of the twins. The risk of heterotopic pregnancy is not small under assisted reproductive technology. Attention should be paid to the risk of tubal pregnancy after transferring more than two embryos or controlled ovarian hyperstimulation, even after salpingectomy has been performed.

Heterotopic Triplet Pregnancy after In Vitro Fertilization with Favorable Outcome of the Intrauterine Twin Pregnancy Subsequent to Surgical Treatment of the Tubal Pregnancy

“…Although long-term effects of laparoscopic surgery during pregnancy on the fetus have not been well studied [ 9 , 12 ], laparoscopy has been increasingly used in surgical procedures in pregnant women and according to the literature no increase in adverse outcomes has been reported [ 9 , 13 , 14 ]. Conservative treatment by locally injecting potassium chloride or hyperosmolar glucose is an option in HP, especially in cases involving cervical pregnancy [ 5 , 8 , 15 ]. The use of methotrexate has detrimental effects on the residual intrauterine pregnancy and is not an alternative [ 8 , 9 ].…”

Surgical management of cornual heterotopic using intraoperative sonography depth resection guidance: case report

“…In natural conception the incidence of HP is low occurring in one in every 30,000 pregnancies. 3,4 This incidence is significantly increased with the use of IVF-ET with some theoretical models suggesting rates as high as one in every 119 pregnancies. 3,4 This risk is further increased when multiple embryos are transferred during a single implantation procedure.…”