A Rare Heterotopic Pregnancy Following Frozen Embryo Transfer: A Diagnostic and Therapeutic Challenge

Ectopic pregnancy is a common obstetric emergency, occurring in approximately 2–3% of pregnancies. Heterotopic pregnancy, defined as the coexistence of intrauterine and ectopic gestations, is rare but increasingly encountered with the widespread use of assisted reproductive technologies, accounting for nearly 1% of in vitro fertilisation (IVF) pregnancies. Early diagnosis remains challenging, particularly in IVF patients, where ovarian hyperstimulation–related ascites may obscure clinical and ultrasonographic findings. We report a case of a 32-year-old woman with primary infertility who conceived following IVF and frozen embryo transfer and presented with mild abdominal pain and vaginal bleeding after a positive pregnancy test. Ultrasonography revealed twin intrauterine gestations with a concomitant ruptured right tubal ectopic pregnancy and free intraperitoneal fluid. Emergency laparoscopic evaluation confirmed a ruptured right ampullary ectopic pregnancy, and laparoscopic salpingectomy was successfully performed. The patient had an uneventful postoperative recovery and was discharged on postoperative day one. The intrauterine twin pregnancy progressed without complications, and at 36 weeks of gestation, an emergency caesarean section was performed for premature rupture of membranes with breech presentation of both fetuses, resulting in the delivery of healthy male and female neonates. This case highlights that heterotopic pregnancy should be considered even in the presence of a confirmed intrauterine gestation, particularly following assisted reproductive techniques. Early transvaginal ultrasonography by experienced clinicians is essential for timely diagnosis, and laparoscopic management of the ectopic component is a safe and effective treatment option that can preserve the ongoing intrauterine pregnancy and achieve favourable maternal and perinatal outcomes.