A Rare Presentation of Heterotopic Pregnancy Presenting at Different Periods in the Same Embryo Transfer Cycle

Ab s t r Ac t Background: Heterotopic pregnancy (HP) is a rare complication of conceptions following ovarian stimulation. Its incidence is increasing with the use of assisted reproductive techniques (ART). Case description: We are reporting a rare presentation of bilateral ectopic pregnancies together with intrauterine pregnancy which resulted from the transfer of three embryos in a single fresh transfer cycle. The presentation was unique because the pregnancies presented at different times. The intrauterine pregnancy (miscarriage) and the left ectopic pregnancy (EP) presented earlier and the right EP presented late. This is possibly due to the differential implantation and growth potential of the three embryos obtained from a single ART cycle. The patient had to undergo laparoscopy twice in a gap of 12 days. Conclusion: A high index of suspicion will help to decrease the consequences of HP, especially in ART cycles. Elective single embryo transfer would be the best preventive measure. Clinical significance: An early diagnosis of HP will help to prevent the dilemmas associated with it. Meticulous sonography and careful inspection of the contralateral tube should be the dictum in cases of HP.