Post-salpingectomy interstitial heterotopic pregnancy after in vitro fertilization and embryo transfer: A case report

Background: Heterotopic pregnancy (HP) refers to the coexistence of ectopic pregnancy and intrauterine pregnancy. Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer (IVF-ET) to reduce the risk of HP. HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy, even though it is extremely rare.

Case summary: A case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented. The main symptom was a sudden and worsening pelvic pain. Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs. Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus. Her hemoglobin concentration was 8.0 g/dL, and serum human chorionic gonadotropin value was 171116.9 mIU/mL. With the diagnosis of ruptured HP with internal bleeding, an emergency laparoscopic resection of left cornu was performed. The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy. After the surgical treatment, the intrauterine pregnancy continued with no complications. A healthy baby was delivered by caesarean section at 39 wk. Outcomes of another three cases are further summarized.

Conclusion: Post-salpingectomy HP is a rare but challenging condition. Surgical treatment is preferred in the case with a viable intrauterine pregnancy.