Simultaneous bilateral ectopic pregnancies occurring spontaneously or following assisted conception techniques, although rare, present the clinician with diagnostic uncertainty and management dilemmas which may have an implication on the patient's future fertility. A review of available literature suggests that there is no universally accepted management strategy towards this condition, and care needs to be tailored to the needs of the patient, patient's preferences and the clinical picture. We report two such rare cases of simultaneous bilateral ectopic pregnancies with different management and outcomes highlighting the fact that these cases not only pose diagnostic and management challenges but also has complex ethical issues associated with it.

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