32 years Mrs. X , Married for 3 years presented with primary inferlity for 3 years on September 2011. Menstrual cycles were regular, she was hypothyroid on 75 µ gm eltroxin.

On investigation, Haemogram was within normal limits, RBS 119 mg/dl, infection screening negative, FSH 6.10 miu/ml, LH 3.5miu/ml, TSH 6.10 uiu/ml, Prolactin 25.18 ng/ml, AMH 2.8.

HSG-normal
Husband’s Semen- Normal
March 2011 hysteroscopy –normal
Laparoscopy- endometriotic spots in POD
(L) ovary chocolate cyst approx 2 cm, removed, edges fulgurated
(R) ovary functional cyst ruptured
(L) tube restricted spill, (R) tube free spill

On USG we found uterus – normal, Right ovary solid looking , AFC 1-2 , L ovary chocolate cyst 2 cm, AFC 2-3.
She was advised IVF-ET(Antagonist protocol) in view of poor ovarian reserve and endometriosis. On stimulation with injection Gonal-F 300 IU for 4 days, there was no response. So IVF –ET with donor oocytes in agonist protocol was advised. 3 embryos were transferred.

Β-HCG was positive on day 14 of ET -500 miu/ml
USG at 6 wks ~ SLF corresponding to 6 wks.

At 7+4wks of gestation, she presented with vomiting and pain lower abdomen.
On USG – heterotopic pregnancy with Right tubal pregnancy. She was taken up for emergency surgery. There was haemoperitoneum approx. 200ml blood. Suction done. Laparoscopic right salpingectomy with removal of ectopic gest sac was done.

Post Op- viability of intra uterine pregnancy was confirmed.
HPE of specimen – (R) tube and products of conception was confirmed. Patient is fine and is an ongoing pregnancy of 11 + 5 wks on 6th August 2012.