Primary Ovarian Pregnancy Following Ovulation Induction with Clomiphene Citrate

Abstract

Abstract

Background: Ovarian pregnancy associated with ovulation induction via clomiphene citrate is rare. Case: A 24-year-old woman with primary infertility of 2 years' duration was diagnosed with polycystic ovarian syndrome (PCOS) based on Rotterdam criteria. She was taking clomiphene citrate at a dose of 50 mg/day for ovulation induction from the second to sixth day of her menstrual cycle, and she took metformin, 500 mg, thrice daily throughout the cycle. She had 50 days of amenorrhea during her second cycle and presented with vaginal bleeding and abdominal pain simulating her previous cycles. Her erum β–human chorionic gonadotrophin (β-hCG) was 1000 international units (IU)/mL, and transvaginal sonography revealed an extrauterine gestational sac with minimal free fluid. A diagnosis of a ruptured ectopic pregnancy was made, and the patient was sent for an emergency laparotomy because of the lack of facilities for an emergency laparoscopy in the emergency room, where she first was seen. At the laparotomy, the ectopic pregnancy was in her right ovary, with dark blood oozing from its surface. Both fallopian tubes were normal, and there were no adhesions. Resection of the ectopic pregnancy and bilateral ovarian drilling were performed. Results: The patient had a good outcome. She conceived after 8 months following the surgery after induction with clomiphene citrate during her second cycle and this time had intrauterine gestation. Conclusions: Because of the thick capsule that occurs in PCOS, the ovum would not have been released and fertilization would have taken place on the surface of the ovary, resulting in a primary ovarian pregnancy. The clinical presentation of ovarian ectopic pregnancy can mimic the menstrual pattern of PCOS. (J GYNECOL SURG 27:289)