Severe ovarian hyperstimulation syndrome and combined intrauterine and tubal pregnancy after in-vitro fertilization and embryo transfer.

Ovarian hyperstimulation syndrome (OHSS) and heterotopic pregnancy are two well recognized entities occurring after in-vitro fertilization (IVF). This is the first reported case of a severe OHSS and coexistent heterotopic pregnancy after IVF and embryo transfer. Diagnosis of tubal pregnancy was obscured both by stimulated ovaries which prevented accurate ultrasound definition and the coexistence of an intrauterine pregnancy which accounted for human chorionic gonadotrophin (HCG) concentrations and also for aggravation of the OHSS. The roles of transvaginal ultrasound, diagnostic laparoscopy and early paracentesis in the management of this rare complication of assisted reproductive technologies are discussed.