Heterotopic Triplet Pregnancy after Double Frozen Embryo Transfer Resulting in Delivery of Healthy Twins at Term: A Case Report

Background: Sonographic visualization of intrauterine pregnancy after multiple embryo transfers does not preclude the coexistence of an ectopic pregnancy, which should be excluded routinely. Heterotopic pregnancy carries high morbidity and mortality. Therefore, it needs high index of suspicion to diagnose and manage accordingly. Case Presentation: Our case reports a 39-year-old woman who presented with heterotopic triplet pregnancy at 5 weeks and 5 days of gestation. It resulted in a successful delivery of intrauterine monozygotic twins at 37 weeks. This pregnancy is an outcome of ICSI treatment due to low ovarian reserve. Only two embryos were obtained through the protocol and double frozen embryo transfer was done afterwards. Tubal pregnancy was successfully managed expectantly. Conclusion: Our case highlights the importance of early surveillance and close monitoring of patients undergoing multiple embryo transfers. Thus, keeping the possibility of heterotopic pregnancy in mind after ART cannot be over-emphasized.