Heterotopic pregnancy following ovulation induction by Clomiphene and a healthy live birth: a case report

We present the case of a 22-year-old Iranian woman who developed a simultaneous extra -and intrauterine pregnancy after the induction of ovulation with Clomiphene. In this case, there was a delay in the detection of the ectopic pregnancy component resulting in an emergency laparotomy being performed. Fortunately after the laparotomy, the intrauterine pregnancy was not affected and it progressed satisfactorily until 37 weeks. A healthy male baby was delivered by caesarean section.This case suggests that a heterotopic pregnancy must always be considered in patients presenting with pelvic pain even in a confirmed intrauterine pregnancy, particularly after the induction of ovulation by Clomiphene Citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.A coexistence of an extra -and intrauterine pregnancy (IUP) is defined as a heterotopic pregnancy (HTP) [1-3]. It is a rare form of twin pregnancy, with an estimated incidence of 1/7000 to 1/30,000 in spontaneous pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology (ART) [1,2,4,5]. Clomiphene Citrate (CC) which increases the rate of twinning could be associated with a HTP rate of 1/900 [6]. Aside from the difficulty of diagnosing the problem, management can be difficult and may be life threatening even when surgical intervention with laparotomy is performed [2].This study describes the ruptured tubal HTP in a patient who conceived with the aid of CC, who presented at six weeks of gestation and was treated with an immediate laparotomy. The remaining course of the pregnancy was uneventful, with a caesarean section (CS) delivery of a healthy infant at 37 weeks of gestation.A 22-year-old nulliparous Iranian woman presented with 2 weeks of amenorrhea, mild lower