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Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Case Report

Heterotopic Triplet Pregnancy after Double Frozen Embryo Transfer Resulting in Delivery of Healthy Twins at Term: A Case Report

Author(s): Firas Al-Rshoud*, Tamara Darwish, Rami Kilani, Lina Almahmoud and Emad Aldeen AL-Sharua

Volume 19, Issue 4, 2023

Published on: 29 December, 2022

Article ID: e251122211273 Pages: 4

DOI: 10.2174/1573404819666221125145304

Price: $65

Abstract

Background: Sonographic visualization of intrauterine pregnancy after multiple embryo transfers does not preclude the coexistence of an ectopic pregnancy, which should be excluded routinely. Heterotopic pregnancy carries high morbidity and mortality. Therefore, it needs high index of suspicion to diagnose and manage accordingly.

Case Presentation: Our case reports a 39-year-old woman who presented with heterotopic triplet pregnancy at 5 weeks and 5 days of gestation. It resulted in a successful delivery of intrauterine monozygotic twins at 37 weeks. This pregnancy is an outcome of ICSI treatment due to low ovarian reserve. Only two embryos were obtained through the protocol and double frozen embryo transfer was done afterwards. Tubal pregnancy was successfully managed expectantly.

Conclusion: Our case highlights the importance of early surveillance and close monitoring of patients undergoing multiple embryo transfers. Thus, keeping the possibility of heterotopic pregnancy in mind after ART cannot be over-emphasized.

Keywords: Heterotopic, pregnancy, monozygotic, twins, embryo, transfer.

Graphical Abstract
[1]
DeVoe, R.W.; Pratt, J.H. Simultaneous intrauterine and extrauterine pregnancy. Am. J. Obstet. Gynecol., 1948, 56(6), 1119-1126.
[http://dx.doi.org/10.1016/S0002-9378(48)90357-3] [PMID: 18893768]
[2]
Wallach, E.E.; Tal, J.; Haddad, S.; Gordon, N.; Timor-Tritsch, I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil. Steril., 1996, 66(1), 1-12.
[http://dx.doi.org/10.1016/S0015-0282(16)58378-2] [PMID: 8752602]
[3]
Anastasakis, E.; Jetti, A.; Macara, L.; Daskalakis, G. A case of heterotopic pregnancy in the absence of risk factors. A brief literature review. Fetal Diagn. Ther., 2007, 22(4), 285-288.
[http://dx.doi.org/10.1159/000100792] [PMID: 17356286]
[4]
Rojansky, N.; Schenker, J.G. Heterotopic pregnancy and assisted reproduction-an update. J. Assist. Reprod. Genet., 1996, 13(7), 594-601.
[http://dx.doi.org/10.1007/BF02066615] [PMID: 8844319]
[5]
Buca, D.I.P.; Murgano, D.; Impicciatore, G.; Castigliego, A.P.; Iannantuono, C.; Leombroni, M.; Falò, E.; Liberati, M. Early diagnosis of heterotopic triplet pregnancy with an intrauterine and bilateral tubal pregnancy after IVF: A case report. J. Obstet. Gynaecol., 2015, 35(7), 755-756.
[http://dx.doi.org/10.3109/01443615.2014.993940] [PMID: 25526510]
[6]
Oliveira, F.G.; Abdelmassih, V.; Costa, A.L.E.; Balmaceda, J.P.; Abdelmassih, S.; Abdelmassih, R. Rare association of ovarian implantation site for patients with heterotopic and with primary ectopic pregnancies after ICSI and blastocyst transfer. Hum. Reprod., 2001, 16(10), 2227-2229.
[http://dx.doi.org/10.1093/humrep/16.10.2227] [PMID: 11574520]
[7]
Lautmann, K.; Staboulidou, I.; Wüstemann, M.; Günter, H.; Scharf, A.; Hillemanns, P. Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child. Eur. J. Ultrasound, 2007, 30(01), 71-73.
[8]
Nabi, U.; Yousaf, A.; Ghaffar, F.; Sajid, S.; Ahmed, M.M.H. Heterotopic pregnancy - A diagnostic challenge. Six case reports and literature review. Cureus, 2019, 11(11), e6080.
[9]
Luo, X.; Lim, C.E.D.; Huang, C.; Wu, J.; Wong, W.S.F.; Cheng, N.C.L. Heterotopic pregnancy following in vitro fertilization and embryo transfer: 12 cases report. Arch. Gynecol. Obstet., 2009, 280(2), 325-329.
[http://dx.doi.org/10.1007/s00404-008-0910-2] [PMID: 19127369]
[10]
Shavit, T.; Paz-Shalom, E.; Lachman, E.; Fainaru, O.; Ellenbogen, A. Unusual case of recurrent heterotopic pregnancy after bilateral salpingectomy and literature review. Reprod. Biomed. Online, 2013, 26(1), 59-61.
[http://dx.doi.org/10.1016/j.rbmo.2012.10.006] [PMID: 23177413]
[11]
Mustafa, K.B.; Hamid, H.A.; Lim, P.S.; Razi, Z.R.M.; Omar, M.H. Heterotopic triplet pregnancy with bilateral tubal ectopic post-IVF–ICSI of two 12-cell embryos. Taiwan. J. Obstet. Gynecol., 2016, 55(1), 142-144.
[http://dx.doi.org/10.1016/j.tjog.2015.04.006] [PMID: 26927270]
[12]
Hyaswicaksono, P.; Harzif, A.K.; Kurniawan, R.; Wiweko, B. Heterotopic pregnancy: Diagnosis and pitfall in ultrasonography. Gynecol. Minim. Invasive Ther., 2021, 10(1), 53-56.
[http://dx.doi.org/10.4103/GMIT.GMIT_92_19] [PMID: 33747776]
[13]
Liu, M.; Zhang, X.; Geng, L.; Xia, M.; Zhai, J.; Zhang, W. Risk factors and early predictors for heterotopic pregnancy after in vitro fertilization. PLoS One, 2015, 10(10), e0139146.
[http://dx.doi.org/10.1371/journal.pone.0139146]
[14]
Li, X.H.; Ouyang, Y.; Lu, G.X. Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer. Ultrasound Obstet. Gynecol., 2013, 41(5), 563-569.
[http://dx.doi.org/10.1002/uog.12341] [PMID: 23610036]
[15]
Kaushal, M.; Karmalkar, H.K.; Sahu, P.; Kadhi, P.; Daval, B.; Baxi, A. Successful expectant management of tubal heterotopic pregnancy. J. Hum. Reprod. Sci., 2010, 3(2), 108-110.
[http://dx.doi.org/10.4103/0974-1208.69333] [PMID: 21209757]

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