However, in ART cycles, due to the presence of multiple oocytes or multiple embryos and special manipulations, ectopic or heterotopic pregnancies
may occur more than usual.
The literature to date involves discussion of the management of the more "traditional" heterotopic pregnancies
with successful results.
Majority of reported heterotopic pregnancies
are of singleton intrauterine pregnancies.
Approximately 80% of heterotopic pregnancies
end during the first trimester, so advanced pregnancies are extremely rare.
Molar ectopic pregnancy becomes even more difficult to diagnose when it occurs in heterotopic pregnancies
, where the patient may present with shock, weeks after evacuation of the intrauterine pregnancy (9).
after in vitro fertilization and embryo transfer.
I had the pleasure of reading this paper from 1961 describing his series of heterotopic pregnancies
. As he mentioned, these cases were diagnosed at the time of surgery and subsequent delivery in most cases without the availability of ultrasonography and quantitative hCG levels.
But in the vast majority of cases, heterotopic pregnancies
are discovered during the first three months of pregnancy and terminated because of the danger to the mother's life, the Jerusalem Post said.
 With increasing usage of assisted reproduction, the frequency of heterotopic pregnancies was cited to be between 1:100 and 1:7,000.
DISCUSSION: Heterotopic pregnancies presents as an intrauterine pregnancy and tubal, abdominal, corneal, cervical or ovarian pregnancy.
Few heterotopic pregnancies
are identified before surgery
We had 5 special cases, one each of interstitial pregnancy, scar ectopic, cervical pregnancy and 2 cases of heterotopic pregnancies
. 35(30Tubal+5Special) presented in unruptured stage, 23 after rupture and 12 as tubal abortions.