Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer - A case report

BACKGROUND: Cesarean scar pregnancy is an exceedingly rare occurrence. We p resent the first case of cesarean scar pregnancy following in vitro fertili zation-embryo transfer (IVF-ET). CASE: A 40-year-old women with a history of a previous cesarean section pre sented with five years of unexplained infertility. The patient complained o f abdominal pain 16 days after embryo transfer. Ultrasonography revealed a gestational sac with cardiac activity located outside the lower segment of the Icterus. Dilatation and curettage was,as performed due to misdiagnosis of inevitable abortion. Two weeks later, repeated sonography demonstrated a sacculus, 4.07x4.07 cm, within the uterine isthmus with only 7.1 mm of thi ckness separating the sac from the urinary bladder. Normal cervical length without ballooning was noted. Cesarean scar pregnancy was diagnosed. Local injection of methotrexate (MTX) under ultrasound guidance was performed. Pl asma beta-hCG levels declined from 23,328 to 8 mIU/mL within two months. CONCLUSION: For women with cesarean scar pregnancy who desire fertility, co nservative treatment using MTX is an excellent choice.