Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy

Abstract

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient's reproductive goals and overall risk profile.

Pregnancy Outcomes in Patients with Anovulatory Infertility in Different Ovulation Induction Programs

“…If the follicle monitoring finds the follicle is abnormally large or the follicular development is poor and the dominant follicle is not formed, then stop the monitoring 1 w later after the expected ovulation day. Ovulation signs: Observing the disappearance of continuous enlarged dominant follicles or shrink of the follicle volume, the follicular wall collapses, there is a light spot in the follicle, and there is effusion in the uterus rectum [13][14][15] .…”