Ovarian pregnancy associated with a fresh blastocyst transfer following in vitro fertilization

Abstract

Ovarian pregnancy is a rare subtype of ectopic pregnancy, and its mechanisms have not been clarified. We report a case of ovarian pregnancy that supports a blastocyst migration mechanism. An infertile woman became pregnant after a single blastocyst transfer following in vitro fertilization during a fresh non-donor cycle. Transvaginal ultrasound revealed a gestational sac-like structure containing an active fetus that was located adjacent to the corpus luteum of the right ovary. Laparoscopy identified a red, swollen implantation site in the ovary, which was completely removed by wedge resection without damaging the remaining parenchyma. This case demonstrated that a fresh blastocyst transferred into the endometrial cavity migrated through the fallopian tube, implanted on an ovarian surface, and formed an ovarian pregnancy.

Ovarian Ectopic Pregnancy as IVF Complication: First Report in a Gestational Carrier

“…General risk factors include pelvic inflammatory diseases, previous gynecologic surgery, tubal pathology, and IUD use. Possible explanations for the increased risk with IVF procedures include higher volume of the culture medium, a higher pressure of injection into the uterus, ovarian surface scars from oocyte retrieval, high estrogen levels, progesterone levels, ovarian hypervascularity after ovarian stimulation, a high number of transferred embryos, and transfer of blastocyst [3, 4, 6].…”

“…To our knowledge, there have been two reports of ovarian pregnancy with donor embryos, but we believe this is the first case in a gestational carrier [4, 5]. The mechanisms behind ovarian pregnancy are not completely understood; however, two distinct mechanisms have been established: direct fertilization inside the ovary and ectopic implantation of a fertilized embryo with retrograde migration from the endometrial cavity to the ovarian surface [6]. The latter would be the mechanism in cases occurring after ART.…”

Case Report: Ovarian pregnancy, a rare but lethal condition: An analysis of 112 cases

“…The risk factors of OP include intrauterine device, assisted reproductive technology, pelvic inflammatory disease, etc. (3,4). The clinical manifestations of OP, including amenorrhea, abdominal pain and vaginal bleeding, have no obvious specificity compared with tubal pregnancy (TP) (5).…”

Ectopic ovarian pregnancy following in vitro fertilization: case report

“…2,3 Two different mechanisms can explain the occurrence of ovarian pregnancy: direct fertilization of an ovulated mature egg inside the ovary (primary, follicular fertilisation) or ectopic implantation of a fertilized embryo with retrograde migration from the endometrial cavity to the ovarian surface (secondary). 4 The latter mechanism would most likely be responsible for ovarian ectopic after IVF-ET. Detecting ovarian ectopic at an early stage is challenging and in most cases the diagnosis is made during work up for acute abdominal pain or bleeding.…”