Discriminatory Serum hCG Level for Ectopic Pregnancy

A 38-year-old patient was admitted for suspected ectopic pregnancy after in vitro fertilization (IVF) treatment for male factor infertility. Three embryos were transferred 16 days prior to her admission. Serum beta-hCG measurement 4 days before her admission was 3200 mIU/mL and repeat testing 2 days later demonstrated a betahCG level of 2980 mIU/mL. She was hemodynamically stable, with very mild right abdominal pain. Transvaginal ultrasound (TVUS) revealed enlarged ovaries with multiple corpora lutea and a small amount of fluid in the cul-de-sac. The right fallopian tube seemed distended. Beta-hCG level on admission was 3000 mIU/mL. With the possibility of a right ectopic pregnancy, the consulting gynecologist prescribed methotrexate.