Intrafollicular ovarian pregnancy after ovulation induction/intrauterine insemination: pathophysiological aspects and diagnostic problems

Abstract

Ovarian pregnancy is a rare variant of ectopic implantation. A case of an intrafollicular ovarian pregnancy after ovulation induction/intrauterine insemination is presented. The woman had primary infertility of 4 years. Diagnostic laparoscopy revealed endometriosis and adhesions. After adhesiolysis and laser vaporization of endometriotic implants, the patient underwent ovulation induction with artificial insemination by husband/intrauterine insemination; she conceived at her second attempt. The pregnancy proved to be an ovarian intrafollicular one. She was treated by right partial ovariectomy. Three months later she conceived spontaneously with an intrauterine pregnancy which is still ongoing. The diagnostic problems resulting from the coexistence of ovarian hyperstimulation and the intrafollicular development of pregnancy are discussed. A re-evaluation of the criteria for the diagnosis of ovarian pregnancy based on the currently available diagnostic methods is proposed. Moreover, the pathophysiology of ovarian and especially intrafollicular implantation is reviewed.

A 34-week ovarian pregnancy: case report and review of the literature

“…To the best of our knowledge, only 11 cases of advanced ovarian pregnancy have been previously reported based on a literature search carried out on PUBMED for the period from 1948 to 2013 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The pathogenic mechanism is thought to be fertilisation occurring outside the tube, followed by implantation within the ovary or the failure of follicular extrusion (15,16). Due to the extreme rarity of ovarian pregnancy, the risk factors are not as well established as in tubal pregnancy.…”

“…Due to the extreme rarity of ovarian pregnancy, the risk factors are not as well established as in tubal pregnancy. Possible risk factors in the literature include previous ectopic pregnancy, pelvic inflammatory disease, IUD use, endometriosis, previous abdominal surgery, uterine anomalies and assisted reproductive techniques (ART) (15)(16)(17)(18)(19). In a series of 49 cases where ovarian pregnancy was confirmed, the most common risk factors were found to be previous abdominal surgery for 19 cases and endometriosis for 16 cases.…”

Ovarian Pregnancy: Report of Two Cases

“…Ovarian pregnancies are often confused with corpus luteum cysts [4]. Three-dimensional ultrasound imaging has been used to distinguish ovarian pregnancy from corpus luteum cysts.…”

Ovarian ectopic pregnancy: diagnosis, treatment, correlation to Carnegie stage 16 and review based on a clinical case

“…The causes for the development of ovarian pregnancies is a result of secondary implantation or of failure of follicular extrusion (3,4). Extrafollicular pregnancies are interstitial, cortical, superficial, or juxtafollicular (5).…”