Heterotopic pregnancies after in-vitro fertilization and embryo transfer--a Danish survey

Thirteen cases of heterotopic pregnancy were diagnosed among1171 pregnancies established in Denmark after in-vitro fertilizationand embryo transfer (IVF-ET). Thus the frequency of heterotopicpregnancy was 13/1171 or 1.1%. In five cases the diagnosis ofheterotopic pregnancy was made by ultrasound at 6–9 weeksof gestation; three of these patients were asymptomatic, whiletwo patients presented with abdominal pain and vaginal bleeding.All these patients had an unruptured ectopic pregnancy. Eightcases were diagnosed at the time of surgery; all these patientspresented with abdominal pain. Only two of the 13 patients hadvaginal bleeding. In nine of the 13 cases the intra-uterinepregnancy resulted in term delivery, while one pregnancy isongoing. In pregnancies following IVF-ET, this diagnosis shouldparticularly be considered in cases with abdominal pain; vaginalbleeding may be absent. Ultrasound examination may lead to earlydiagnosis even in asymptomatic cases. In most cases, removalof the ectopic gestation will allow the intrauterine pregnancyto proceed to term.