Chronic ectopic pregnancy after intrauterine insemination: A case report and review of the literature

Introduction: Chronic ectopic pregnancy is a rare form of ectopic pregnancy characterized by repeated tubal injury and bleeding, leading to development of a chronic, inflammatory pelvic mass. Patients often present with mild, nonspecific symptoms, and a low beta-human chorionic gonadotropin (βhCG) level. Despite the established association between assisted reproductive technology and increased risk of ectopic pregnancy, this is the first reported case of a chronic ectopic pregnancy following intrauterine insemination. Case Report: A 27-year-old primigravid female with primary infertility in the setting of polycystic ovary syndrome initially developed an ectopic pregnancy after underdoing ovulation induction and intrauterine insemination. After successful treatment with methotrexate, she was later found to have a complex pelvic mass despite a negative βhCG level, suggestive of chronic ectopic pregnancy. She underwent laparoscopic left salpingectomy with excision of adnexal mass and diagnosis was confirmed on intraoperative and histopathological findings. Conclusion: Chronic ectopic pregnancy is a rare complication of assisted reproductive technology. Nonetheless, it should be considered in the setting of a new pelvic mass, negative pregnancy test, and recent history of ectopic pregnancy. Although conservative management is attractive, definitive treatment involves removal of the pelvic hematocele, effectively achieved through surgical intervention.