Heterotopic pregnancy, which is rare after ovulation induction with clomiphene citrate and timed intercourse.

Year 2018, , 169 - 172, 14.05.2018

Ümit Çabuş

https://doi.org/10.5505/ptd.2018.37929

Abstract

The condition of the coexistence of intrauterine and extrauterine pregnancies is called as heterotopic pregnancy. The incidence is 1/30000 with natural conception and increases up to 1/100 with assisted reproductive techniques (ART). Clomiphene Citrate, a drug for ovulation induction, is used as a treatment approach for the patients with oligo-ovulation and subfertility with normal estrogen levels. This treatment may lead to the development of more than one follicle, ovarian hyperstimulation and multiple gestations. Increased estrogen level after ovulation induction disrupts tubal transport and increases ectopic pregnancy risk. In our case, we aimed to emphasize the difficulties of diagnosing heterotopic pregnancy, which is rare after ovulation induction with clomiphene citrate and timed intercourse, current diagnosis and treatment methods, as well as the importance of clinical and ultrasonographic evaluation of pelvic and adnexial structures of all terminated or ongoing first trimester pregnancies.

İngilizce Kısa Başlık: Clomiphene citrate induction and heterotopic pregnancy

Keywords

Ovulation induction, Clomiphene Citrate, Heterotopic pregnancy

Klomifen sitrat ile ovulasyon indüksiyonu ve doğal ilişki sonrası ender görülen heterotopik gebelik

Abstract

İntrauterin ve ekstrauterin gebeliğin aynı anda birlikte bulunmasına
heterotopik gebelik adı verilir. İnsidansı doğal ilişkiyle 1/30000 iken
yardımcı üreme teknikleri sonrasında 1/100 e kadar ulaşmaktadır. Ovulasyon
indüksiyonu yöntemlerinden Klomifen Sitrat normal östrojenize oligo-ovulasyonlu
ve subfertillerde seçilen bir tedavi yöntemidir. Bu tedavi birden fazla folikül
gelişmesine, ovaryan hiperstimülasyona ve çoğul gebeliğe neden olmaktadır.
Ovulasyon indüksiyonu sonrası artan östrojen seviyesi tubal transportu bozmakta
ve ektopik gebelik riskini arttırmaktadır. Biz olgumuzda klomifen sitrat
indüksiyonu ve doğal ilişki sonrası ender görülen heterotopik gebeliğin
teşhisinin zorluklarını, güncel tanı ve tedavi yöntemlerini, sonlanan veya
devam eden tüm ilk trimester gebeliklerde pelvik ve adneksiyel yapılarının
klinik ve ultrasonografik olarak değerlendirilmesinin önemini vurgulamayı
amaçladık.

Türkçe Kısa Başlık: Klomifen Sitrat indüksiyonu ve heterotopik gebelik

Keywords

Ovulasyon indüksiyonu, Klomifen Sitrat, Heterotopik gebelik

References

• 1- Bright DA, Craupp FB. Heterotopic pregnancy: a reevaluation. J Am Board Fam Pract 1990;3:125-128.
• 2- Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 1996;66:1-12.
• 3- Reece EA, Petrie RH, Sirmans MF, Finster M, Todd WD. Combined intrauterine and extrauterine gestations: a rewiev. Am J ObstetGynecol 1983;146:323-330.
• 4- Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum reprod Update 1997;3:359-365.
• 5- Dickey RP, Holkamp DE. Development, pharmacology and clinical experience with clomiphene citrate. HumReprod Update 1996;2:483-506.
• 6- Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol 2000;182:1264-1270.
• 7- Wang PH, Chao HT, Tseng JY, Yang TS, Chang SP, Yuan CC. Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review. Eur J Obstet Gynecol Reprod Biol 1998;80:267-271.
• 8- Yenen MC, Dede M, Göktolga Ü, Küçük T, Alanbay İ, Pabuçcu R. Ektopik gebelikte risk faktörleri. Gülhane Tıp Dergisi 2003;45:244-248.
• 9- Tandon R, Goel P, Kumar Saha P, Devi L. Spontaneous heterotopic pregnancy with tubal rupture: a case report and review of the literature. Journal of Medical Case Reports 2009;3:8153.
• 10- Birkhahn RH, Gaeta TJ, Van Deusen SK, et al. The ability of traditional vital signs and shock index to identify ruptured ectopic pregnancy. Am J Obstet Gynecol 2003;189:1293-1296.
• 11- Jacobson A, Galen D. Heterotopic pregnancies and ivf. Fertil Steril 1990;54:179-180.
• 12- Guirgis RR, Craft IL. Ectopic pregnancy resulting from gift and ivf: Role of ultrasonography in diagnosis and treatment. J Reprod Med 1991;36:793-796.
• 13- Ankum WM, Van der Veen F, Hamerlynck JV et al. Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach. Hum Reprod 1993;8:1307-1311.
• 14- Pschera H, Kandemir S. Laporoskopic treatment of heterotopic pregnancies: benefits, complications and safety aspects. J Turkish German Gynecol Assoc 2005;6:90-94.
• 15- Sagiv R, Debby A, Sadan O, et al. Laparoscopic surgery for extrauterine pregnancy in hemodynamically unstable patients. J Am Assoc Gynecol Laparosc 2001;8:529-532.