Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after froz
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CASE REPORT
Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen-thawed embryo transfer Yoshinori Okamura • Futoshi Arakane • Yumiko Nagayoshi-Taura • Ritsuo Honda Takashi Ohba • Hidetaka Katabuchi
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Received: 10 April 2011 / Accepted: 15 June 2011 / Published online: 29 June 2011 Ó Japan Society for Reproductive Medicine 2011
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.
Introduction Heterotopic pregnancy (HP) is the coexistence of a pregnancy with intrauterine development and at least one ectopic pregnancy at any site. The incidence of HP in natural conception is low, occurring in one of 30,000 pregnancies [1–3], but the incidence of HP rises to 1 in every 100 pregnancies conceived by in vitro fertilization and embryo transfer (IVF-ET) [4, 5]. The increased incidence of HP is a serious problem, as the diagnosis of this condition is quite difficult and the management of HP is challenging. Here we present a case of heterotopic triplet pregnancy with isthmic implantation in the left remnant tube and intrauterine twin pregnancy after frozen-thawed embryo transfer. Surgical treatment of the isthmic portion of the left remnant tubal pregnancy resulted in the birth of a healthy girl. To our knowledge, this is the first report of a case of heterotopic triplet pregnancy with the ectopic site occurring in the remnant tube after ipsilateral salpingectomy.
Case report Keywords Heterotopic pregnancy In vitro fertilization and embryo transfer Laparoscopic surgery Remnant fallopian tube
Y. Okamura (&) F. Arakane Y. Nagayoshi-Taura R. Honda T. Ohba H. Katabuchi Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, Kumamoto 860-8556, Japan e-mail: [email protected]
A 31-year-old woman (gravida 2, para 0) with a 6-year history of infertility consulted a private clinic for evaluation. Diag
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