title: Twin tubal pregnancy: a rising complication?
abstract: OBJECTIVE
  To present four cases of twin tubal pregnancies and discuss possible etiologies. Twin tubal pregnancies are a rare event, with incidence rates estimated as 1 out of 725-1,580 of tubal pregnancies.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Department of obstetrics and gynecology at a tertiary health care facility.
  
  
  METHODS
  All women with twin tubal pregnancy diagnosed and treated in the department during the years 2007-2009, according to electronic files and histologic reports.
  
  
  METHODS
  None.
  
  
  METHODS
  Artificial reproductive technique preceding twin tubal pregnancies
  
  
  RESULTS
  We diagnosed four twin pregnancies of 163 tubal pregnancies, an incidence of 2.4%. Of the four cases, two conceived after gonadotropin stimulation and intrauterine insemination. The third conceived following in vitro fertilization and intracytoplasmic sperm injection. The fourth was a spontaneous conception diagnosed as monochorial monoamniotic twin tubal pregnancy.
  
  
  CONCLUSIONS
  Twin tubal pregnancies may not be as rare as previously thought. Three of the four cases identified during a 2-year period followed artificial reproductive technique. We hope that this report will promote the study of the epidemiology of this event, improve diagnosis, and encourage the development of treatment modalities.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Svirsky
authors.forename: Ron
authors.initials: R
authors.lastname: Maymon
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vaknin
authors.forename: Sonia
authors.initials: S
authors.lastname: Mendlovic
authors.forename: Ariel
authors.initials: A
authors.lastname: Weissman
authors.forename: Reuvit
authors.initials: R
authors.lastname: Halperin
authors.forename: Arie
authors.initials: A
authors.lastname: Herman
authors.forename: Moti
authors.initials: M
authors.lastname: Pansky
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D011274:Pregnancy, Tubal / Q000175:diagnosis / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted; D014427:Twins