In-vitro fertilization resulting in heterotopic pregnancy, ovarian hyperstimulation and paralytic ileus: A case report

Abstract

Heterotopic pregnancy followed by ovarian hyperstimulation syndrome and paralytic ileus are rare and potentially fatal complications associated with assisted reproduction. A 37-year-old nulliparous woman, after in-vitro fertilization and embryo transfer, presented to the gynaecology department with severe abdominal distension, diffuse abdominal pain and vaginal bleeding. Transvaginal ultrasound examination revealed an intrauterine pregnancy, with both ovaries enlarged, measuring 10cmx10cm, with free fluid in the pouch of Douglas. Another gestational sac was visualized in the left adnexal region with a viable pregnancy, crown–rump length (CRL) 6.6 mm at 6 weeks of gestation. Left salpingectomy via laparotomy and uterine evacuation were performed. The patient's postoperative course was complicated by the development of ovarian hyperstimulation syndrome and paralytic ileus. The patient recovered well after receiving supportive therapy. Clinicians should always be aware of the complications associated with assisted reproductive techniques.

Heterotopic pregnancy and the influence of letrozole

“…Nabi et al preferred TVUS compared to transabdominal ultrasound and suggested that if exams are inconclusive, high resolution TVUS or even magnetic resonance imaging (MRI) could be employed [11]. One might also consider taking into 160 consideration an elevated white blood cell (WBC), which was recorded in our case and several others, such as those described by Madžarac et al, who recorded a WBC of 31.8 × 10 9 /L, and Černiauskaitė et al, who described a WBC of 18.11 × 10 9 /L [6,12].…”

“…Letrozole, an aromatase inhibitor, works similarly by blocking the conversion of androgens into estrogen, which causes a subsequent increase in FSH, encouraging the growth and development of multiple follicles in the ovaries of women who are seeking fertility treatment [5]. Theoretically, since letrozole stimulates ovulation there is an increased risk of multiple gestation, and by default an increased risk of heterotopic pregnancy [6]. Interestingly, despite this theoretical risk, only one other case of heterotopic pregnancy has been documented in a patient with letrozole augmentation, making this a noteworthy exhibition [7].…”