Ruptured tubal pregnancy after low hCG prompted discontinuation of luteal support : a case report of vitrified-warmed embryo transfer in a hormone replacement cycle.
Kuniaki Ota, Toshifumi Takahashi, Yuka Furukawa et al.
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Case in brief
A 30-year-old woman conceived after vitrified-warmed embryo transfer in a hormone replacement cycle. At 4+1 weeks, serum hCG was 6.6 mIU/mL, and luteal hormone support was stopped on the assumption of biochemical pregnancy loss. She had no subsequent hCG testing or transvaginal ultrasound. At 8+1 weeks, acute abdominal pain led to diagnosis of a ruptured tubal ectopic pregnancy with massive hemoperitoneum. Emergency laparoscopy found 1,500 mL of intra-abdominal bleeding; right salpingectomy was performed, and histopathology confirmed tubal pregnancy.
What made this case unusual
A very low early hCG result after embryo transfer was interpreted as pregnancy loss, yet the pregnancy continued as a tubal ectopic and later ruptured with massive hemoperitoneum.
Diagnostic / clinical pearl
A single low but detectable hCG measurement after embryo transfer does not exclude an ongoing or ectopic pregnancy. Serial hCG assessment and early imaging can help avoid delayed diagnosis.