Double Trouble: A Case Report of Bilateral Tubal Ectopic Pregnancy After Intrauterine Insemination Along With a Literature Review

TL;DR

A rare case of bilateral tubal ectopic pregnancy after intrauterine insemination is reported, highlighting diagnostic and management challenges.

Contribution

Presents a novel case report of BTP following IUI and emphasizes the importance of thorough diagnostic evaluation.

Findings

Bilateral tubal ectopic pregnancy can occur after IUI with ovarian stimulation.

Diagnostic laparoscopy is crucial for identifying BTP when clinical signs are ambiguous.

Salpingostomy is preferred over salpingectomy to preserve fertility in BTP cases.

Abstract

Bilateral tubal ectopic pregnancy (BTP) is a rare variant of ectopic pregnancy (EP). Besides sharing the same risk factors, the similarity in clinical presentation between BTP and EP hamper the diagnosis, often made only during surgery. The management of BTP is complex, raising considerations for fertility-preserving surgery. While evidence is limited, salpingostomy is typically preferred over salpingectomy, as it does not compromise fertility outcomes.

The document includes a case report of a 40-year-old woman with a surgically diagnosed and treated BTP five weeks after an intrauterine insemination procedure with ovarian stimulation. Diagnostic laparoscopy revealed a ruptured right fallopian tube and a mass in the left fallopian tube, despite no prior indications of left-side abnormalities. A right salpingectomy was performed. Post-surgery, a follow-up ultrasound showed a left para-adnexal mass, and beta-human chorionic gonadotropin (beta-HCG) levels fluctuated, initially decreasing but later rising, prompting the need for surgical treatment.

This case report emphasizes the need for careful management and thorough inspection of both adnexal areas to improve recognition and care.

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