Intramyometrial ectopic pregnancy in an ICSI patient following uterine artery embolization.
Myometrial pregnancy represents a rare subtype of ectopic pregnancy. A history of uterine artery embolization (UAE) because of symptomatic uterine fibroids, and assisted reproductive treatment may predispose to this unusual implantation site. A 40-year-old woman with a history of uterine fibroids underwent a transfer of two embryos after intracytoplasmic sperm injection treatment. The combined findings on transvaginal ultrasound scan, pelvic magnetic resonance imaging scan, suction curettage, diagnostic hysteroscopy and laparoscopy were compatible with a diagnosis of ectopic pregnancy within the myometrium, at the site of a necrotized intramyometrial fibroid following UAE. Treatment with systemic methotrexate resulted in successful resolution of this ectopic pregnancy. In conclusion, this study reports a pregnancy within a previously necrotized fibroid. Findings suggest that in patients with a history of UAE for the treatment of uterine fibroids and who subsequently undergo assisted reproductive treatment, the risk of an ectopic pregnancy within the myometrium has to be considered.
Leyder
M
M
Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. MLeyder@uzbrussel.be
De Vos
M
M
Popovic-Todorovic
B
B
Dujardin
M
M
Devroey
P
P
Fatemi
H M
HM
D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000473:pathology*; D020554:Sperm Injections, Intracytoplasmic; D014463:Ultrasonography; D055357:Uterine Artery Embolization