Our Summary

This research paper discusses two unusual cases of heterotopic pregnancy, which is when a woman is pregnant in two different places at the same time - one pregnancy is inside the uterus (where it’s supposed to be), and the other is outside the uterus (which is not normal). This can happen in up to 1% of pregnancies achieved through in-vitro fertilization (IVF), a process where an egg is combined with sperm outside the body and then placed in the woman’s uterus.

In the first case, a 28-year-old woman who had previously had both fallopian tubes removed due to a tubal pregnancy and a blocked tube, became pregnant in her ovary after undergoing IVF. She had to have emergency surgery but the pregnancy inside her uterus continued without any issues and she eventually gave birth to a healthy baby.

The second case involved a woman who had pregnancies in her uterus and also in the part of her fallopian tube that’s closest to the uterus, after having her tubes tied to treat blocked fallopian tubes and then undergoing IVF.

The paper concludes that even though it’s very rare, doctors should be aware that heterotopic pregnancy can occur in women who have had both fallopian tubes removed or tied, even if a pregnancy in the uterus has been confirmed, especially if IVF is used.

FAQs

  1. What is a heterotopic pregnancy?
  2. Can a heterotopic pregnancy occur after a bilateral tubal ligation?
  3. What is the possibility of a heterotopic pregnancy occurring after in vitro fertilization?

Doctor’s Tip

A doctor might advise a patient who has undergone bilateral tubal ligation to be aware of the rare possibility of a heterotopic pregnancy, where both an intrauterine and ectopic pregnancy occur simultaneously. It is important for patients undergoing in vitro fertilization to be vigilant and inform their healthcare provider if they experience any unusual symptoms.

Suitable For

Patients who are typically recommended bilateral tubal ligation are those who desire permanent contraception and are at risk for pregnancy complications, such as those with a history of ectopic pregnancy, recurrent pregnancy loss, or medical conditions that would make pregnancy dangerous. Additionally, patients who have completed their desired family size and wish to prevent unplanned pregnancies may also be recommended for bilateral tubal ligation.

Timeline

  • Before bilateral tubal ligation:
  1. Patient undergoes counseling with their healthcare provider about permanent birth control options
  2. Patient decides to proceed with bilateral tubal ligation procedure
  3. Patient goes through pre-operative preparation and evaluation
  4. Patient undergoes bilateral tubal ligation surgery
  • After bilateral tubal ligation:
  1. Patient experiences recovery period post-surgery
  2. Patient may have mild discomfort or pain at the surgical site
  3. Patient is advised to rest and avoid strenuous activities for a certain period of time
  4. Patient follows up with their healthcare provider for post-operative care and monitoring
  5. Patient no longer needs to worry about the risk of pregnancy as bilateral tubal ligation is a permanent form of contraception.

What to Ask Your Doctor

  1. What is the risk of developing a heterotopic pregnancy after undergoing bilateral tubal ligation?
  2. How will a heterotopic pregnancy be diagnosed and managed?
  3. What are the potential complications associated with a heterotopic pregnancy?
  4. Are there any specific precautions or monitoring that should be taken during pregnancy after bilateral tubal ligation?
  5. How will the presence of a heterotopic pregnancy affect the ongoing intrauterine pregnancy?
  6. What is the likelihood of a successful outcome for both pregnancies in the case of a heterotopic pregnancy?
  7. Are there any additional tests or screenings that should be considered in the case of a heterotopic pregnancy after bilateral tubal ligation?
  8. What steps can be taken to reduce the risk of a heterotopic pregnancy in future pregnancies after bilateral tubal ligation?

Reference

Authors: Xu Y, Lu Y, Chen H, Li D, Zhang J, Zheng L. Journal: J Minim Invasive Gynecol. 2016 Mar-Apr;23(3):338-45. doi: 10.1016/j.jmig.2015.11.013. Epub 2015 Dec 10. PMID: 26687016