SEVERE OVARIAN HYPERSTIMULATION SYNDROME AND COMBINED INTRAUTERINE AND TUBAL PREGNANCY AFTER IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER

Ovarian hyperstimulation syndrome (OHSS) and heterotopic pregnancy are two well recognized entities occurring after in-vitro fertilization ( IVF). This is the first reported case of a severe OHSS and coexistent heterotopic pregnancy after IVF and embryo transfer. Diagnosis of tuba l pregnancy was obscured both by stimulated ovaries which prevented ac curate ultrasound definition and the coexistence of an intrauterine pr egnancy which accounted for human chorionic gonadotrophin (HCG) concen trations and also for aggravation of the OHSS. The roles of transvagin al ultrasound, diagnostic laparoscopy and early paracentesis in the ma nagement of this rare complication of assisted reproductive technologi es are discussed.