Heterotopic Pregnancy with Suspicion of Superfetation after the Intrauterine Insemination Cycle with Ovulation Induction Using Clomiphene Citrate: A Case Report

Ito, Ayumu; T, Furukawa; Nakaoka, Kentaro; Hayashi, Ryohei; Namihira, Tadashi; Kasai, Sadanori; Shimai, Kazuko; Takahashi, Kenji; Nakakuma, Masahito

doi:10.4081/cp.2019.1129

Cited by 6 publications

(16 citation statements)

References 14 publications

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“…While the incidence of heterotopic pregnancy is estimated to be 1 in 30,000 spontaneous pregnancies, the rate increases to as high as 1 in 100 pregnancies when ART is used. 4 Our review of the literature found that the strongest risk factor for developing a heterotopic pregnancy was ovarian hyperstimulation, which is commonly seen in females using ART. We suggest that heterotopic pregnancy should be considered in the differential diagnosis of abdominal pain for females who have undergone ovarian stimulation.…”

Section: Discussionmentioning

confidence: 93%

“…Human superfetation has been proposed previously, but evidence is considered circumstantial, and reports are extremely rare. 4 Nonviable pregnancies, such as those destined to miscarry and tubal ectopic pregnancies, also follow different growth trajectories than viable pregnancies. 6 …”

Section: Discussionmentioning

confidence: 99%

“…While heterotopic pregnancy is very rare, the condition has been documented in the literature, almost always in the setting of ART. 1 , 3 , 4 This complicated condition is challenging in terms of diagnosis and treatment. The most common area of ectopic pregnancy implantation is the fallopian tube, so heterotopic pregnancies can sometimes present for the first time as a ruptured ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Superfetation refers to the coexistence of 2 or more fetuses of different gestational ages as a result of ovulation, fertilization, and implantation during an existing pregnancy. 4 Superfetation is purported in certain mammalian species such as rodents and rabbits, marsupials, and other species that exhibit placentotrophy. The phenomenon has been demonstrably proven in certain species of Poeciliidae that utilize nutrient exchange via placentotrophy.…”

Section: Introductionmentioning

confidence: 99%

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Heterotopic Triplet Pregnancy After Clomiphene Citrate

Morong

Janssen

Morgan

et al. 2021

TOJ

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Background: Heterotopic pregnancy is an exceedingly rare condition in which an intrauterine and extrauterine pregnancy coexist. Superfetation refers to the coexistence of 2 or more fetuses of different gestational ages as a result of ovulation, fertilization, and implantation during an ongoing pregnancy. We present a case of heterotopic triplet pregnancy with a difference in gestational age by crown rump length of more than 1 week between the twin intrauterine pregnancy and the singleton tubal ectopic. Case Report: A 31-year-old gravida 3, para 2002 presented to the emergency department with abdominal pain at 9 weeks 2 days’ gestation dated by last menstrual period, consistent with ultrasound. She was discharged home with a diagnosis of ruptured hemorrhagic cyst but returned 4 days later with ruptured tubal ectopic pregnancy measuring 9 weeks’ gestation and ongoing twin gestation measuring 10 weeks 1 day. She was taken to the operating room for laparoscopic salpingectomy, and ectopic pregnancy was confirmed on tissue diagnosis. Conclusion: Heterotopic pregnancy presents a diagnostic challenge for obstetricians/gynecologists. Superfetation has never been demonstrably proven in humans but has been suggested in the literature. This report adds to the literature that perhaps superfetation can be artificially induced in humans in the presence of assisted reproductive technologies.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Heterotopic Triplet Pregnancy After Clomiphene Citrate

Morong

Janssen

Morgan

et al. 2021

TOJ

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“…This phenomenon arises when superfetation occurs intrauterine on top of an ectopic pregnancy or vice versa. 4,5,7,14,15 This coexistence of both intrauterine and extrauterine pregnancies is referred to as HP. 16 HP, a rare phenomenon in spontaneous pregnancies with an incidence of 1 in 30,000, has seen a noteworthy increase in occurrence due to the widespread use of ARTs.…”

Section: F I G U R Ementioning

confidence: 99%

Superfetation and heterotopic pregnancy: Case report of two rare phenomena coexisting and implications in the era of assisted reproductive technologies

Badran,

Labib,

Abouali

et al. 2024

Clinical Case Reports

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Key Clinical MessageTo raise awareness about the increasing incidence of superfetation and heterotopic pregnancy in patients with ovarian induction, their insidious symptoms of abdominal pain, anemia, and hemodynamic instability in early pregnancy, and the usefulness of transvaginal ultrasound (TVUS) and quantitative beta human chorionic gonadotrophin (b‐hCG) for diagnosis.AbstractSuperfetation, occurrence of ovulation, fertilization, and implantation during an ongoing pregnancy and heterotopic pregnancy (HP) simultaneous presence of intrauterine and extrauterine pregnancies are infrequent phenomena. We report a case where both coexisted, challenges in diagnosis and management and association with the widespread use of assisted reproductive technologies (ARTs). A 32‐year‐old woman, who previously underwent ovulation induction therapy, presented with abdominal pain at 8 weeks pregnancy according to her last menstrual period. The patient had high quantitative serum beta‐human chorionic gonadotropin (b‐hCG) (30,883 mIU/mL). She was vitally stable and not anemic. Transvaginal ultrasound (TVUS) revealed two pregnancies at different gestational ages: an intrauterine pregnancy at 5 weeks and 3 days, and a right intact tubal ectopic pregnancy at 10 weeks and 5 days. Superfetation resulting in HP was then diagnosed. Subsequently, the patient underwent right laparoscopic salpingectomy. The intrauterine pregnancy progressed normally, resulting in delivery of a healthy full‐term neonate via Cesarean section at 38 weeks. Superfetation is typically rare from suppression of follicular development and ovulation during pregnancy. Various theories have been proposed to explain its etiology, including polyovulation, delayed blastocyst implantation, and abnormal estrogen and b‐hCG surges. In superfetation, an embryo resulting from a previous conception coexists with another embryo, either intrauterine, resulting in diamniotic dizygotic twins with significantly different gestational ages, or extrauterine resulting in HP. Despite being particularly challenging to diagnose because its presenting symptoms can overlap with those of other more common clinical conditions in early pregnancy, HP is increasingly seen with ARTs. In addition, the treatment of HP is versatile, ranging from expectant management to laparoscopic surgery. High level of suspicion for HP and superfetation is crucial in patients who, after ART, present with abdominal pain, hemodynamic instability, or anemia. Additionally, patients planning to undergo subsequent ART cycles should be thoroughly screened with b‐hCG and TVUS to exclude an ongoing intrauterine or extrauterine pregnancy.

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