Abstract
Heterotopic pregnancy followed by ovarian hyperstimulation syndrome and paralytic ileus are rare and potentially fatal complications associated with assisted reproduction. A 37-year-old nulliparous woman, after in-vitro fertilization and embryo transfer, presented to the gynaecology department with severe abdominal distension, diffuse abdominal pain and vaginal bleeding. Transvaginal ultrasound examination revealed an intrauterine pregnancy, with both ovaries enlarged, measuring 10cmx10cm, with free fluid in the pouch of Douglas. Another gestational sac was visualized in the left adnexal region with a viable pregnancy, crown-rump length (CRL) 6.6 mm at 6 weeks of gestation. Left salpingectomy via laparotomy and uterine evacuation were performed. The patient's postoperative course was complicated by the development of ovarian hyperstimulation syndrome and paralytic ileus. The patient recovered well after receiving supportive therapy. Clinicians should always be aware of the complications associated with assisted reproductive techniques.