Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10310
Peer-review started: May 23, 2022
First decision: June 16, 2022
Revised: July 3, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: October 6, 2022
Processing time: 127 Days and 5.7 Hours
Due to a slight rise in beta-human chorionic (β-hCG) levels that are undetectable, and vaginal bleeding that is similar to regular menstruation, ectopic pregnancy (EP) that occurs during the expected menstrual cycle prior to ovulation induction as part of in vitro fertilization (IVF) is likely to be undiagnosed. We present two cases of unexpected EP and emphasize the importance of the β-hCG assay when an unexplained increase in progesterone is present prior to the triggering of ovulation during controlled ovarian stimulation (COS).
A 26-year-old woman with primary infertility and a 31-year-old woman with secondary infertility. Both patients sought IVF treatment due to fallopian tube obstruction and underwent COS using the gonadotropin-releasing-hormone (GnRH)-antagonist protocol. In the late stage of COS, progesterone levels in both patients significantly increased, and luteinizing hormone levels decreased, followed by oocyte retrieval failure. A right salpingectomy was performed and tubal ectopic pregnancy was diagnosed by pathology in the first patient, and the second patients was diagnosed with a suspected EP abortion because her β-hCG levels declined to 12.5 mIU/mL. After full recovery for 2 mo, the first patient entered a new IVF treatment cycle with a GnRH-antagonist regimen and successfully achieved eight oocytes and three viable embryos. After 6 mo, the second patient received another COS treatment with a progestin-primed ovarian stimulation protocol and successfully achieved nine oocytes and five viable embryos.
β-hCG levels in the initial and midterm phases of COS must be considered in patients with unusual hormone dynamics.
Core Tip: In this report, we present two cases of undiagnosed ectopic pregnancies during controlled ovulation stimulation (COS) who sought in vitro fertilization treatment due to fallopian tube obstruction. In the late stage of COS, progesterone levels in both patients significantly increased and luteinizing hormone (LH) levels decreased, followed by oocyte retrieval failure. These cases emphasized the importance of vigilance about patients with unexplained increases in progesterone and decreases in LH during the COS process. Further, the examination of human chorionic gonadotropin in the initial and midterm phases of COS should be considered essential for patients with unusual hormone dynamics.