Simultaneous bilateral tubal pregnancy after in vitro fertilization and embryo transfer.

OBJECTIVE

Ectopic pregnancies are known to occur with increased frequency after in vitro fertilization (IVF) and related techniques. We present a case of bilateral tubal pregnancy following IVF and embryo transfer (ET).

CASE REPORT: A 27-year-old woman was referred to our IVF clinic because of primary infertility, and underwent three cycles of IVF-intracytoplasmic sperm injection treatment. In her third cycle, 32 days after ET, she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonography revealed bilateral tubal ectopic pregnancy with fluid in the pouch of Douglas but no intrauterine gestational sac. One of the embryos had fetal heart motion. Laparoscopic bilateral salpingostomy was performed immediately. The postoperative course was uneventful. Pathologic examination also identified chorionic villi and placental tissue in both tubes, and an Arias-Stella reaction without villi in the endometrium.

CONCLUSION

The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.