Incompletely evaluated ART leading to ectopic pregnancy and cerebral thrombosis

ABSTRACT

We presented a cerebral venous thrombosis case associated with lack of proper medical evaluation required for confirmation of suppression and exclusion of current pregnancy before starting assisted reproductive technology [ART] cycle. This is a case-report study about a 37-year-old woman who presented to emergency room with abdominal pain and tenderness. Initial human chorionic gonadotropin [hCG] value was 17616 IU/L. Endometrium was heteregenous and incompatible with a normal intrauterine pregnancy. She had a history of antagonist protocol/controlled ovarian hyperstimulation [COH] started 38 days ago in a different in vitro fertilization [IVF] center. Because of the fertilization failure, she had no embryo transfer. With ectopic pregnancy diagnosis, we made surgical exploration and observed a material which was consistent with ectopic pregnancy on the right tuba uterina. Partial salpingectomy was applied because of actively bleeding ectopic pregnancy. Two days after discharging from hospital; she presented to emergency room again with syncope and generalized tonic-clonic seizure. By cranial tomography generalized edema, cerebral venous thrombosis was established. Enoxaparine sodium 0.6 ml twice daily was administered. Six days after hospitalisation, she was discharged with normal neurological examination under phenytoin 200 mg daily and enoxaparine sodium 0.6 ml daily. Before ART treatment, clinicians must always rule out the likelihood of existing pregnancy by measuring estradiol, follicle stimulating hormone [FSH], and luteinizing hormone [LH]. On the other hand, low-molecular-weight heparine may be effective in cerebral venous thrombosis treatment. Therefore, intracerebral thrombosis is one of the rare mortal complications of ART