Unilateral triplet ectopic pregnancy after in vitro fertilization and embryo transfer

Objective To present a case report of a unilateral triplet ectopic pregnancy (EP) conceived by IVF–embryo transfer. Design Case report. Setting University Hospital, Budapest, Hungary. Patient(s) A 26-year-old infertile woman with a history of right salpingectomy, hyperprolactinemia, and male factor infertility underwent IVF–embryo transfer of three embryos. Early transvaginal sonography revealed a triplet pregnancy in the left fallopian tube (two at interstitial and one at ampullary location). Intervention(s) Multiple dose methotrexate (MTX) therapy was applied. Main Outcome Measure(s) Follow-up pelvic ultrasounds and laboratory testing confirmed fetal cardiac activity cessation and decreasing β-hCG levels. Result(s) In spite of the decreasing β-hCG levels the tube's diameter increased, the patient's symptoms escalated, and finally, the level of hemoglobin and hematocrit decreased. Laparotomy was performed with the removal of the left tube and cornual part of the uterus. Conclusion(s) Our case represents a very rare condition, a unilateral triplet EP after IVF–embryo transfer—the first one ever reported in the literature. After IVF–embryo transfer early ultrasound examinations are important to identify EPs at an early stage when medical management can still be taken into consideration. Strict monitoring is necessary to identify the success of medical intervention or the need for surgery.