Akademik Veri Yönetim Sistemi
FERTILITY AND STERILITY, cilt.124, sa.6, ss.1, 2025 (SCI-Expanded, Scopus)
OBJECTIVE
To report a rare case of live birth in a patient with bilateral endometriomas following in vitro fertilization, despite an atypical β-hCG progression.MATERIALS AND METHODS
A 31-year-old woman with unexplained infertility and bilateral endometriomas underwent an ovarian stimulation and intrauterine insemination (IUI) cycle. Due to multifollicular development during stimulation with daily 75 IU follitropin alfa, the cycle was converted to in vitro fertilization (IVF) to avoid cancellation. Five mature oocytes were retrieved and fertilized via intracytoplasmic sperm injection (ICSI), followed by the transfer of a single fresh blastocyst. Luteal phase support was provided with 800 mg/day of vaginal progesterone. On day 8 post-embryo transfer, the serum β-hCG level was 35 mIU/mL. On the same day, the patient presented with acute abdominal pain. Emergency laparoscopy revealed a ruptured left ovarian endometrioma with intra-abdominal fluid. The contents of the ruptured cyst and pelvic fluid were aspirated, and the abdominal cavity was irrigated. Bilateral endometriomas were not excised in order to minimize operative time during this very early stage of pregnancy.RESULTS
Postoperative serum β-hCG levels remained low and stable—20, 20, 18, and 21 mIU/mL—on postoperative days 2 to 5 (corresponding to days 10 to 13 post-embryo transfer), suggesting a biochemical pregnancy. However, on days 18, 19, and 20 post-transfer, β-hCG levels rose to 217, 215, and 304 mIU/mL, respectively. The patient was subsequently discharged. At follow-up on day 23 post-transfer, β-hCG was 892 mIU/mL, and an intrauterine gestational sac was visualized. By day 25, the β-hCG level had increased to 2,823 mIU/mL, and transvaginal ultrasonography confirmed an intrauterine pregnancy with fetal cardiac activity at 6 weeks and 3 days of gestation. The pregnancy progressed uneventfully, and the patient delivered a healthy 3,180-gram infant at 39 weeks and 6 days of gestation.CONCLUSIONS
Atypical early β-hCG dynamics after IVF may be concerning, but they can still lead to successful pregnancies, requiring individualized assessment.IMPACT STATEMENT
Atypical early β-hCG trajectories following IVF can still lead to successful, full-term pregnancies. Clinical decision-making should be guided by serial monitoring and the patient’s overall stability to avoid premature interventions or termination in pregnancies that may ultimately be viable.REFERENCES
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