Laparoscopic management of an ectopic pregnancy after in vitro fertilization and embryo transfer at CHRACERH: A case report

Étienne Belinga, Noa Ndoua Claude Cyrille, Gregory Ayissi, Kasia Onana Yves Bertrand, Kasia Jean-Marie
In: Laparoscopic, Endoscopic and Robotic Surgery · 2018 · vol. 1(3) , pp. 70–73 · doi:10.1016/j.lers.2018.08.001 · W2892121653
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This case report details the successful laparoscopic management, including salpingectomy, of an ectopic pregnancy that occurred after in vitro fertilization and embryo transfer in a patient with a history of tubal infertility.

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Abstract

Abstract Background Ectopic pregnancy (EP) is the location of the pregnancy outside the intrauterine cavity. Following in vitro fertilization and embryo transfer (IVF-ET), both the infertility history of the patient and specific factors related to IVF-ET techniques can increase the risk of EP. We report a case of a laparoscopic management of an ectopic pregnancy after in vitro fertilization and embryo transfer in Cameroon, at the Hospital Center for Research and Application in Endoscopic Surgery and Human Reproduction (CHRACERH) in which we discuss the etiologic factors. Case presentation A 34-year-old patient gravida 1 Para 1 010, with a past history of one spontaneous miscarriage, bilateral hydrosalpinx, low ovarian reserve (AMH: 0.98 ng/L) and severe oligoasthenospermia in the husband followed-up at CHRACERH since 2 years, for couple infertility. She underwent a diagnostic laparoscopy prior to the IVF where a pelvic adhesiolysis and a simple opening of the hydrosalpinx were done. She was admitted in IVF and stimulated by the long agonist protocol. At day 22 post implantation, the onset of breakthrough bleeding associated with a pain in the left iliac fossa, motivated the request of an endovaginal ultrasound, which showed an unruptured ectopic pregnancy in the left fallopian tube. The management consisted on a laparoscopic treatment with a left retrograde salpingectomy, pelvic adhesiolysis, and right tubal exclusion. The postoperative course was uneventful. Conclusion We reported a successful laparoscopic management of an ampullary pregnancy following IVF-ET at CHRACERH. It appears that, patients with a history of tubal infertility should be given special attention in IVF-ET, because IVF-ET itself even increases the risk of ectopic pregnancy. The condition for laparoscopic treatment is early diagnosis of ectopic pregnancies thanks to ultrasound and hCG. However, the risk of persistence of trophoblastic tissues and ectopic pregnancy remains significant in the conservatory approach.

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