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. 2011 Jun 29;10(4):283-286.
doi: 10.1007/s12522-011-0098-1. eCollection 2011 Dec.

Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen-thawed embryo transfer

Yoshinori Okamura  1 , Futoshi Arakane  1 , Yumiko Nagayoshi-Taura  1 , Ritsuo Honda  1 , Takashi Ohba  1 , Hidetaka Katabuchi  1
Affiliations

Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen-thawed embryo transfer

Yoshinori Okamura et al. Reprod Med Biol. .

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.

Keywords: Heterotopic pregnancy; In vitro fertilization and embryo transfer; Laparoscopic surgery; Remnant fallopian tube.

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Figures

Figure 1
Figure 1
a Findings of the ruptured isthmic portion of the left remnant tube (arrow) with hematoperitoneum during laparoscopic surgery. b A piece of free tissue (arrow) was recovered from the ruptured isthmic portion of the left remnant tube
Figure 2
Figure 2
Intraoperative macroscopic view of the left uterine cornu during laparoscopic surgery for ectopic pregnancy. The left isthmic portion was closed with two‐layer sutures
Figure 3
Figure 3
Vaginal ultrasonography of the uterus showed intrauterine dichorionic twin pregnancy with (arrow) and without (arrow head) cardiac activity on the fourth postoperative day
Figure 4
Figure 4
Intraoperative macroscopic view of the left uterine cornu during Caesarean section. No muscle layer defect in the left isthmic portion was found
See this image and copyright information in PMC

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