Heterotopic pregnancy and the influence of letrozole

Abstract

Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case. Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition. Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.