11/42. Unsuccessful methotrexate treatment of a tubal pregnancy with a live embryo.Two cases with unsuccessful local and systemic methotrexate (MTX) therapy of tubal pregnancy with fetal heart rate activity are reported. The three modes of therapy, the first with local potassium chloride solution injection, the second with local MTX injection, and the third with systemic MTX injection, failed in the resolution of viable ectopic pregnancy. Therapy of MTX in cases of tubal pregnancy with demonstrable fetal heart rate beats, should be reconsidered.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
12/42. Tubal pregnancy following tubal embryo transfer into the contralateral fallopian tube.Ectopic and heterotopic pregnancy may occur with increased frequency following assisted reproductive technology (ART) procedures. In addition, there may be unusual sites of implantation, which may cause atypical and confusing clinical manifestations. We present a case of tubal pregnancy after tubal embryo transfer (TET) to the contralateral fallopian tube. Four embryos were transferred to the left fallopian tube by laparoscopy, but the patient developed a right tubal pregnancy, possibly as a result of intrauterine or intra-abdominal migration of the embryo. ART patients must be followed closely soon after the procedure, and there should be a high index of suspicion for an unusual implantation site.- - - - - - - - - - ranking = 1.75keywords = embryo (Clic here for more details about this article) |
13/42. Simultaneous bilateral tubal pregnancies and intrauterine pregnancy with five fetuses.A 28-year-old woman with severe right lower abdominal pain and vaginal bleeding at 7 weeks' ( /- 2 days') gestation was seen in the emergency room of our institution. The pregnancy was the result of natural conception after ovarian stimulation with gonadotropins. Transvaginal sonography revealed five intrauterine gestational sacs containing five live embryos. A positive fetal heartbeat was detected in the fallopian tube on the right. Laparoscopic findings disclosed the enlarged uterus with the unruptured right ectopic pregnancy in the ampullary region and an extrauterine pregnancy in the left tube as well. A linear salpingotomy was performed on the right tubal pregnancy. We decided to perform salpingectomy on the left tube because it was impossible to preserve the tube, and exploration of it showed the existence of another gestational sac. It is necessary to decry inappropriate and injudicious use of assisted reproductive technologies, especially by individuals with little or no training in monitoring the agents and treatments prescribed. In 2003, still waiting for official legislation from the Italian Parliament on assisted reproductive technology, we have to face dramatic situations, such as this very unique case of heterotopic pregnancy.- - - - - - - - - - ranking = 0.25keywords = embryo (Clic here for more details about this article) |
14/42. A case of simultaneous tubal-splenic pregnancy after assisted reproductive technology.OBJECTIVE: To present a case of simultaneous splenic and tubal pregnancy following in vitro fertilization. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 37-year-old woman who had undergone in vitro fertilization and embryo transfer for unexplained infertility at another clinic. INTERVENTION(S): laparoscopy and laparotomy. MAIN OUTCOME MEASURE(S): serum concentration of human chorionic gonadotropin (hCG) after salpingosplenectomy. RESULT(S): After transfer of three embryos following fertilization by intracytoplasmic sperm injection (ICSI) at another clinic, the patient was referred to our hospital with suspicion of ectopic pregnancy. Because tubal pregnancy was suspected, laparoscopic right salpingectomy was performed. Although villi were detected in the resected fallopian tube, the serum hCG concentration did not decrease after the operation and a new intraabdominal hemorrhage was detected. We then suspected abdominal pregnancy in the epigastric region, and performed magnetic resonance imaging, computed tomography, and ultrasound examinations, which revealed implantation at the inferior pole of the spleen. splenectomy was performed, with the resulting disappearance of intraabdominal hemorrhage and rapid fall of the serum concentration of hCG. CONCLUSION(S): Assisted reproduction sometimes results in heterotopic pregnancy, but an abdominal pregnancy involving the upper abdominal organs is considered extremely rare. Particularly, splenic pregnancy is usually overlooked and may only be discovered after a sudden intraabdominal hemorrhage. If hemorrhaging is present in the abdominal cavity but pregnancy is not detected within the pelvis, it is advisable to examine patients using imaging techniques to detect any upper abdominal pregnancies.- - - - - - - - - - ranking = 0.5keywords = embryo (Clic here for more details about this article) |
15/42. Simultaneous ectopic pregnancy with intra-uterine gestation after in vitro fertilization and embryo transfer.A case of combined intra-uterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of two four-cell and one two-cell embryos. This phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with tubal disease. Techniques applied at the time of embryo transfer, the use of culture medium with 50% fetal cord serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer are presented. The risk of multiple pregnancies and combined intra-uterine and ectopic gestations increases with numbers of transfers and large volume of transfer medium. We would therefore recommend that after IVF-ET treatment in women with tubal disease, intensive care should be taken in the early follow-up period to rule out the possibility of ectopic pregnancy. In this case, a viable ongoing intra-uterine pregnancy was confirmed after surgery for right ampullary ectopic pregnancy. And a 2,925 g male in excellent condition was delivered by cesarean section without complications.- - - - - - - - - - ranking = 1.75keywords = embryo (Clic here for more details about this article) |
16/42. Clinics in diagnostic imaging (106). Viable left tubal twin ectopic pregnancy.Live twin ectopic gestations are extremely rare. There are more than 100 reported twin tubal pregnancies but less than ten have foetal cardiac motions demonstrated in both embryos. We describe an additional patient with live twin ectopic gestation. A 32-year-old woman presented with increasing left-sided abdominal pains. She had a high beta-hCG level and a significant history of subfertility with previous surgical intervention. Transvaginal ultrasonography showed viable left tubal twin ectopic pregnancy. The diagnosis was confirmed at surgery. Factors that contribute to the risk of ectopic pregnancy, diagnosis and the management of this condition are described.- - - - - - - - - - ranking = 0.25keywords = embryo (Clic here for more details about this article) |
17/42. Second-trimester heterotopic pregnancy after in vitro fertilization and embryo transfer--a case report and review of the literature.Seven cases of heterotopic pregnancies following in vitro fertilization (IVF) and embryo transfer (ET) have been seen. In these cases, concomitant intrauterine and extrauterine pregnancies were described in the first trimester. We present the first case of second-trimester heterotopic pregnancy after IVF with successful surgical treatment of the ectopic pregnancy and subsequent full-term birth of the intrauterine pregnancy. The etiologic factors, possible explanation for the relatively frequent occurrence of heterotopic pregnancies in IVF, and the diagnostic difficulties are presented.- - - - - - - - - - ranking = 1.25keywords = embryo (Clic here for more details about this article) |
18/42. Subchorionic hematoma associated with heterotopic pregnancy following in vitro fertilization: a case report.BACKGROUND: After treatment for infertility using in vitro fertilization (IVF)-embryo transfer, a high index of suspicion must be maintained for early diagnosis and treatment of concurrent ectopic pregnancy; however, the likelihood of a positive outcome for the intrauterine pregnancy remains uncertain. CASE: A subchorionic hematoma threatening an intrauterine gestation noted concurrently with ultrasound diagnosis of a heterotopic IVF pregnancy resolved following laparoscopic salpingectomy. CONCLUSION: Although symptomatic subchorionic hematoma may be associated with an increase in the rate of spontaneous miscarriage for a singleton pregnancy, it may not present a similar risk in the presence of a concurrent heterotopic gestation.- - - - - - - - - - ranking = 0.25keywords = embryo (Clic here for more details about this article) |
19/42. Ectopic pregnancy in a preexisting hydrosalpinx during a spontaneous pregnancy.OBJECTIVE: To discuss the possible role of abnormal embryo migration as a cause of ectopic pregnancy during IVF with hydrosalpinges. DESIGN: Case report. SETTING: University-based reproductive endocrinology and fertility clinic. PATIENT(S): A patient presenting with a tubal ectopic pregnancy after spontaneous conception in a preexisting hydrosalpinx. INTERVENTION(S): Laparoscopic salpingectomy. MAIN OUTCOME MEASURE(S): Ultrasound and operative findings. RESULT(S): Case demonstration of abnormal embryo migration into a surgically documented preexisting hydrosalpinx during a spontaneous conception. CONCLUSION(S): The mechanism of increased tubal ectopic pregnancy rates during IVF with hydrosalpinges remains unexplained. This case supports abnormal embryo migration due to the hydrosalpinx as a contributing factor.- - - - - - - - - - ranking = 0.75keywords = embryo (Clic here for more details about this article) |
20/42. Mild ovarian hyperstimulation syndrome coexisting with ectopic pregnancy after in vitro fertilization.ovarian hyperstimulation syndrome (OHSS) is an entity arising in women undergoing assisted reproductive techniques (ART). The simultaneous presence of two different clinical complications such as OHSS and ectopic pregnancy (EP) is not frequent. The diagnosis of an extrauterine pregnancy can be obscured by the stimulated ovaries and ascites, and actually be missed, especially in women with increased body mass index. We report a case of a woman who presented with mild OHSS after in vitro fertilization (IVF), (intracytoplasmatic sperm injection (ICSI) and embryo transfer). The ectopic pregnancy was ascertained soon after by transvaginal ultrasound (TVS) and right salpingectomy was performed.- - - - - - - - - - ranking = 0.25keywords = embryo (Clic here for more details about this article) |
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