Successful management of a triplet heterotopic caesarean scar pregnancy after in vitro fertilization-embryo transfer

Objective: To report a case of a triplet heterotopic caesarean scar pregnancy (CSP) with two gestational sacs implanted in the caesarean scar after in vitro fertilization-embryo transfer. Design: Case report. Settings: Private reproductive medicine center and obstetric department of a university hospital. Patient(s): A 31-year-old woman with previous caesarean section affected by secondary infertility related to male azoospermia. Intervention(s): In vitro fertilization-embryotransfer followed by early ultrasound diagnosis of heterotopic CSP and selective embryo reduction performed by transvaginal ultrasound-guided potassium chloride and methotrexate injection in the ectopic gestational sacs. Main outcome mesure(s): Successful pregnancy outcome. Result(s): An ongoing intrauterine pregnancy with a live birth after successful management of ectopic gestational sacs. Conclusion(s): Triplet heterotopic CSP with two ectopic gestational sacs may occur after IVF-ET and, to our knowledge, this is the first time such a complication has been reported. Ultrasound is the main tool allowing early diagnosis of this condition, and the injection of potassium chloride and methotrexate is a safe and efficacious treatment method. The gynecologist managing early pregnancy should be aware of the possibility of CSP, and patients must be appropriately counseled about the different treatment options. (Fertil Steril (R) 2011;95:291.e1-e3. (C) 2011 by American Society for Reproductive Medicine.)