A. Ellenbogen

Unusual case of recurrent heterotopic pregnancy after bilateral salpingectomy and literature review.

Heterotopic pregnancy occurs in up to 1% of pregnancies after IVF and embryo transfer. A case of a 35-year-old woman undergoing IVF treatment who had had previous laparoscopic bilateral salpingectomy due to hydrosalpinges is presented. She had had two heterotopic pregnancies in both tubal stumps in consecutive pregnancies achieved by IVF. The intrauterine pregnancies ended in spontaneous abortions. The possibility of a heterotopic pregnancy needs to be considered when more than one embryo has been transferred in a cycle, especially when an inappropriately high serum β-human chorionic gonadotrophin concentration is associated with an ultrasound finding of singleton intrauterine pregnancy.

A follicular scoring system for monitoring ovulation induction in polycystic ovary syndrome patients based solely on ultrasonographic estimation of follicular development

OBJECTIVE To assess the predictive value of a follicular scoring system for monitoring ovulation induction in polycystic ovary syndrome (PCOS) patients, solely with ultrasound (US). DESIGN Ultrasound measurements were performed on alternate days to define a serial follicular score for monitoring ovulation induction with hMG alone, as well as GnRH analogue and hMG, in comparison with E2 concentration obtained on the same day. SETTING Outpatient Infertility Clinic, Department of Obstetrics and Gynecology. PATIENTS Thirty-four consecutive PCOS patients treated for 63 cycles. MAIN OUTCOME MEASURE The follicular score was established considering the summation of points obtained after measuring the mean diameter of each follicle > 5 mm, as follows: 5 to 8 mm = 1 point, 9 to 12 mm = 1.5 points, 13 to 16 mm = 2 points, > or = 17 mm = 3 points. RESULTS Follicular score correlated positively with E2 concentrations. A score of > or = 30 points was associated with E2 levels of concentration that reached > 1,500 pg/mL (conversion factor to SI unit, 3.671) and could predict ovarian hyperstimulation. A lower follicular score allowed hCG administration. CONCLUSIONS A follicular scoring system may be a safe, simple, and highly efficient method to replace serial E2 measurements in monitoring ovulation induction. Moreover, ovarian hyperstimulation may be predicted.