Noncommunicating Fimbrial Ectopic Pregnancy Due to Intraperitoneal Transmigration of Sperm: A Case Report

Ectopic pregnancies (EPs) involve the implantation of a gestational sac outside of the uterine cavity and are commonly described based on the implantation location, with most occurring within the fallopian tubes. There are a wide variety of known risk factors for EP; however, a less commonly acknowledged hypothesis includes intraperitoneal transmigration of sperm, ovum, and/or embryos. Comparatively, there are few published case reports illustrating this phenomenon, and there have been no known published case reports supporting this hypothesis involving patients without congenital uterine abnormalities. This case describes a 26-year-old G6P1132 female with a history of salpingostomy and unilateral partial salpingectomy secondary to prior EP presenting with a noncommunicating fimbrial EP likely resulting from intraperitoneal transmigration of sperm. This patient failed medical management of fimbrial EP and underwent successful surgical intervention with diagnostic laparoscopy and fimbriectomy. This case report ultimately contributes to ongoing research supporting the transmigration of gametes or embryos as a cause of EP, particularly in situations where a noncommunicating fallopian tube may still allow implantation and fertilization. Given the rising recurrence rates with each subsequent EP, implementing complete salpingectomies instead of partial salpingectomies may help lower the risk of future occurrences, even in patients who wish to preserve future fertility.