Ectopic Pregnancy in In-Vitro Fertilisation - Embryo Transfer in a Patient with Natural Killer Cell Imbalance and Endometriosis

This paper reports a 32-year-old woman with primary infertility, an incidental 3×4 cm ovarian endometrioma, and elevated serum natural killer (NK) cells who experienced recurrent implantation failure after multiple frozen embryo transfers following IVF and PGT. After reducing serum NK cells to normal, she had another failed transfer; later, after alpha-thymosin therapy for 2 weeks, a subsequent transfer ended in a blighted ovum followed by an ectopic pregnancy in a later frozen cycle, confirmed by transvaginal ultrasound and managed medically with methotrexate and serial beta-hCG. The authors discuss possible roles of altered tubal/uterine conditions in endometriosis and immune imbalance, but they explicitly note limitations including reliance on serum NK testing without uterine NK assessment and inability to clearly attribute causality. Relevance to endometriosis: endometriosis is central to the case interpretation and is used to contextualize increased ectopic pregnancy risk and potential NK-cell–mediated implantation failure, with the patient having an ovarian endometrioma—This paper is centrally about endometriosis — it links a case of ectopic pregnancy after IVF/embryo transfer to ovarian endometrioma and presumed immune/NK-cell imbalance in an endometriosis setting.

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