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Acta Medica Medianae
Correspondence to:
Ginekološko-akušerska klinika Kliničkog centra Zmaj Jovina 2–24 34000 Kragujevac, Srbija Tel.: 38164 616999 E- mail: dloncar@ptt.yu
Copyright 2007 by Faculty of Medicine, University of Nis |
HETEROTOPIC PREGNANCY AFTER IN VITRO FERTILIZATION AND EMBRYO TRANSFER (IVF-ET)
Dragan Lončar, Ivanela Čitaković i Bogoje Nikolov
Ginekološko-akušerska klinika Kliničkog centra u Kragujevcu
The incidence of heterotopic pregnancy in general population is about 1 per 7000 pregnancies, but reaches 1 per 100 pregnacies conceived by ovarian stimulation and in vitro fertilization and embryo transfer. After the application of adequate stimulation with menotrophine and achieved estradiol (E2) level of 989 pg/ml on day, we followed follicular growth by transvaginal ultrasonography. Under ultrasonography control and intravenous sedation, we retrived 6 oocytes. Four of the 6 mature oocytes were fertilized and according to the patient’s wish, all 4 embryos were transferred transcervically 2 days after the aspiration. The patient received progesterone supplementation after the embryo transfer. Her preg-nancy test was positive at day 15, with β-hCG level of 150 mlU/ml. At week 6, her β-hCG level was 350 mlU/ml. During that period, she reported sparse bleeding. At week 7, β-hCG level was 2122 mlU/ml and ultrasonography scan verified gestational sac consistent with the date. At week 8, by transvaginal ultrasonography the gestational sac within uterine cavity with signs of collapse was registered, and another gestational sac outside uterus, while the β-hCG level was 29 700 mlU/ml. At that time, she reported severe pain and ultrasonography revealed foreign fluid in pouch of Douglas. The puncture showed it was blood effusion. We performed laparotomy with left tubal salpingectomy at the site of extrauterine pregnancy. Revision of uterine cavity was also performed for missed abortion, which histologically verified immature chorion villi with embryonic tissue. After embryo transfer, the initial ultrasonography should be performed at week 4. Even with intrauterine pregnancies, adnexae should be carefully inspected, and even earlier investigation must by carried out in case of abdominal pain and non-specific complaints. β-hCG level and its early rise should raise a suspicion index. Acta Medica Medianae 2007;46(3):66-67.
Key words: heterotopic pregnancy, fertilization in vitro, embryo transfer
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