Local medical treatment of interstitial pregnancy after in-vitro fertilization and embryo transfer (IVF—ET): two case reports

Abstract

Two cases of interstitial pregnancy (one singleton, one heterotopic twins) were confirmed 31 and 34 days after in-vitro fertilization. Serum human chorionic gonadotrophin concentrations were 35,000 and 86,000 mlU/ml, respectively. They were treated conservatively with transvaginal ultrasonically guided intra-ovular injection of either methotrexate in the singleton pregnancy, or potassium chloride into the ectopic sac of the heterotopic twins. No complications were observed. The intra-uterine pregnancy continued and the patient delivered a 3350 g healthy baby at 39 weeks.

Interstitial Pregnancy Treated with Local and Systemic Methotrexate

“…A central liquefaction observed in our case at the 27th day appears to occur in about 33% of the formerly solid masses [41]. Other authors also documented the heterogeneous aspect of persistent masses [27,29,30,32,34,36]. These sonographic findings seem to be independent of the administration route of MTX.…”

“…The classical treatment of interstitial pregnancy is surgical consisting of laparoscopy and/or laparotomy with resection of the involved uterine horn or even hysterectomy, at times requiring multiple blood transfusions. According to the literature, exclusive medical treatment using methotrexate (MTX) [29][30][31][32][33][34][35][36], potassium chloride [27,28] or even actinomycin D [37] could become an effective alternative. We present a case of a viable interstitial pregnancy which was successfully treated with a combined local and systemic MTX administration.…”

Assisted Reproduction

“…407,408 The ectopic pregnancy can be treated either by surgical removal or by the selective injection of potassium chloride or hyperosmolar glucose. 409,410 If the ectopic pregnancy is to be treated surgically, salpingectomy rather than salpingostomy is appropriate; in a heterotopic pregnancy, it is not possible to determine whether the salpingostomy has been successful, because the intrauterine pregnancy maintains elevated hCG levels, so that documentation of complete resolution by following hCG levels down is not possible. If the ectopic pregnancy is removed surgically, vasopressin should be avoided, and sutures or the harmonic scalpel may be preferable to electrocautery to minimize the chance of diminished blood flow to the intrauterine pregnancy.…”

Management of interstitial pregnancy – a case managed with ultrasound guidance and a review of literature

“…We found 41 patients treated with local methotrexate. 9,16,20,25,28,29,[36][37][38] Only two patients required additional treatment with laparotomies.…”

“…Potassium chloride 20% (KCl) is the preferred local agent for interstitial pregnancies that are associated with a viable intrauterine pregnancy (heterotopic pregnancy). 9,13,25,37,39 Other chemotherapeutic agents such as etoposide 33 have been used successfully when injected directly into interstitial pregnancies. There was one series of five heterotopic pregnancies with live interstitial pregnancies.…”