title: Unilateral triplet ectopic pregnancy after in vitro fertilization and embryo transfer.
abstract: OBJECTIVE
  To present a case report of a unilateral triplet ectopic pregnancy (EP) conceived by IVF-embryo transfer.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University Hospital, Budapest, Hungary.
  
  
  METHODS
  A 26-year-old infertile woman with a history of right salpingectomy, hyperprolactinemia, and male factor infertility underwent IVF-embryo transfer of three embryos. Early transvaginal sonography revealed a triplet pregnancy in the left fallopian tube (two at interstitial and one at ampullary location).
  
  
  METHODS
  Multiple dose methotrexate (MTX) therapy was applied.
  
  
  METHODS
  Follow-up pelvic ultrasounds and laboratory testing confirmed fetal cardiac activity cessation and decreasing beta-hCG levels.
  
  
  RESULTS
  In spite of the decreasing beta-hCG levels the tube's diameter increased, the patient's symptoms escalated, and finally, the level of hemoglobin and hematocrit decreased. Laparotomy was performed with the removal of the left tube and cornual part of the uterus.
  
  
  CONCLUSIONS
  Our case represents a very rare condition, a unilateral triplet EP after IVF-embryo transfer-the first one ever reported in the literature. After IVF-embryo transfer early ultrasound examinations are important to identify EPs at an early stage when medical management can still be taken into consideration. Strict monitoring is necessary to identify the success of medical intervention or the need for surgery.
authors.affiliation: First Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary. eniko.berkes@mail.datanet.hu
authors.forename: Eniko
authors.initials: E
authors.lastname: Berkes
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Szendei
authors.forename: Laszlo
authors.initials: L
authors.lastname: Csabay
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Sipos
authors.forename: Jozsef Gabor
authors.initials: JG
authors.lastname: Joo
authors.forename: Janos
authors.initials: J
authors.lastname: Rigo
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000032:Abortion, Therapeutic; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011274:Pregnancy, Tubal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D016896:Treatment Outcome; D014310:Triplets; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate