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Primary Ovarian Pregnancy After Donor Embryo Transfer: Early Diagnosis and Laparoscopic Treatment

Gavrilova-Jordan L, Tatpati L, Famuyide A - JSLS (2006 Jan-Mar)

Bottom Line: A high index of clinical suspicion, abnormal human chorionic gonadotropin levels, and early ultrasound evaluation may aid timely diagnosis and appropriate management.Information is provided herein regarding the diagnosis and management of primary ovarian pregnancy in women treated with in vitro fertilization.We review the criteria for early diagnosis and treatment options.

Affiliation: Minimally Invasive Gynecological Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

ABSTRACT

Primary ovarian pregnancy is a rare type of ectopic pregnancy, particularly following in vitro fertilization. Although there have been a few reported cases of primary ovarian pregnancy following in vitro fertilization embryo transfer, we believe this is the first report involving donor embryo transfer. A high index of clinical suspicion, abnormal human chorionic gonadotropin levels, and early ultrasound evaluation may aid timely diagnosis and appropriate management. This report provides a reminder to practitioners to advise patients undergoing embryo transfer of the primary ovarian pregnancy risk. Information is provided herein regarding the diagnosis and management of primary ovarian pregnancy in women treated with in vitro fertilization. We review the criteria for early diagnosis and treatment options.

Photograph of the left ovary with the ovarian pregnancy (OP) at laparoscopy.
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Figure 3: Photograph of the left ovary with the ovarian pregnancy (OP) at laparoscopy.

Mentions: The patient returned to our fertility center for further care. Human chorionic gonadotropin (HCG) levels were followed. The initial value was only 5 IU/L on posttransfer day 14 with an increase to 11, 27, 47 and 653 IU/L on days 16, 18, 20 and 27, respectively (Figure 1). Ultrasound evaluation on day 27 showed no intrauterine gestation and normal adnexae. A repeat ultrasound was performed 8 days later after the patient experienced vaginal spotting with rising HCG. Normal adnexa and a clot in the uterus were found. On day 40, the HCG level reached 4811 IU/L. At that time, an ultrasonogram was significant for a 1.5 cm x 1.5 cm x 1.4 cm solid echogenic structure with reinforced vascular marking within to the left ovary suggesting primary ovarian pregnancy (Figure 2). Our patient elected surgical management. An operative laparoscopy was performed on day 41 after transfer. Intraoperatively, the uterus and both fallopian tubes appeared normal. The left ovary was enlarged by a 3.0 cm x 2.0 cm heterogeneous mass consisting of several hemorrhagic bluish cysts, with a smooth external surface (Figure 3). This mass was carefully dissected using bipolar cautery and scissors. The intact ovarian pregnancy was removed through the umbilical incision by using an endobag. Intraoperative frozen section and final histology confirmed the presence of the conception products associated with ovarian tissue. The right ovary was of normal size and color. A small amount of serous fluid was in the posterior cul-de-sac. Uterine curettage showed proliferative endometrium free of chorionic villi. Intraoperative blood loss was minimal. The patient had an uneventful postoperative recovery and was discharged the same day. Follow-up quantitative HCG levels declined appropriately and reached an undetectable level (<2 IU/L) 19 days after surgery (Figure 1).

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Primary Ovarian Pregnancy After Donor Embryo Transfer: Early Diagnosis and Laparoscopic Treatment

Gavrilova-Jordan L, Tatpati L, Famuyide A - JSLS (2006 Jan-Mar)

Photograph of the left ovary with the ovarian pregnancy (OP) at laparoscopy.
© Copyright Policy
Figure 3: Photograph of the left ovary with the ovarian pregnancy (OP) at laparoscopy.
Mentions: The patient returned to our fertility center for further care. Human chorionic gonadotropin (HCG) levels were followed. The initial value was only 5 IU/L on posttransfer day 14 with an increase to 11, 27, 47 and 653 IU/L on days 16, 18, 20 and 27, respectively (Figure 1). Ultrasound evaluation on day 27 showed no intrauterine gestation and normal adnexae. A repeat ultrasound was performed 8 days later after the patient experienced vaginal spotting with rising HCG. Normal adnexa and a clot in the uterus were found. On day 40, the HCG level reached 4811 IU/L. At that time, an ultrasonogram was significant for a 1.5 cm x 1.5 cm x 1.4 cm solid echogenic structure with reinforced vascular marking within to the left ovary suggesting primary ovarian pregnancy (Figure 2). Our patient elected surgical management. An operative laparoscopy was performed on day 41 after transfer. Intraoperatively, the uterus and both fallopian tubes appeared normal. The left ovary was enlarged by a 3.0 cm x 2.0 cm heterogeneous mass consisting of several hemorrhagic bluish cysts, with a smooth external surface (Figure 3). This mass was carefully dissected using bipolar cautery and scissors. The intact ovarian pregnancy was removed through the umbilical incision by using an endobag. Intraoperative frozen section and final histology confirmed the presence of the conception products associated with ovarian tissue. The right ovary was of normal size and color. A small amount of serous fluid was in the posterior cul-de-sac. Uterine curettage showed proliferative endometrium free of chorionic villi. Intraoperative blood loss was minimal. The patient had an uneventful postoperative recovery and was discharged the same day. Follow-up quantitative HCG levels declined appropriately and reached an undetectable level (<2 IU/L) 19 days after surgery (Figure 1).

Bottom Line: A high index of clinical suspicion, abnormal human chorionic gonadotropin levels, and early ultrasound evaluation may aid timely diagnosis and appropriate management.Information is provided herein regarding the diagnosis and management of primary ovarian pregnancy in women treated with in vitro fertilization.We review the criteria for early diagnosis and treatment options.

Affiliation: Minimally Invasive Gynecological Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

ABSTRACT

Background: Primary ovarian pregnancy is a rare type of ectopic pregnancy, particularly following in vitro fertilization. Although there have been a few reported cases of primary ovarian pregnancy following in vitro fertilization embryo transfer, we believe this is the first report involving donor embryo transfer. A high index of clinical suspicion, abnormal human chorionic gonadotropin levels, and early ultrasound evaluation may aid timely diagnosis and appropriate management. This report provides a reminder to practitioners to advise patients undergoing embryo transfer of the primary ovarian pregnancy risk. Information is provided herein regarding the diagnosis and management of primary ovarian pregnancy in women treated with in vitro fertilization. We review the criteria for early diagnosis and treatment options.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3015663&rFormat=json&query=null&req=5