Case Report Miracle baby: Very rare case of heterotopic pregnancy with cervical ectopic in elderly primigravida with very poor ovarian reserve with oligoastheno-terato-zoospermia conceived with IVF

A 42 year old with primary infertility over 2 years with poor ovarian reserve (AMH 0.02) with an Oligoastheno-terato-zoospermia had 3 attempts of embryo transfer with her own egg. USG showed a heterotopic pregnancy with fundal 5-6 weeks intrauterine gestational sac with a cervical ectopic with small subchorionic collection along with posterior uterine wall. Despite embryo reduction, it still showed a persistent heterotopic pregnancy with an increasing subchorionic collection in the cervical canal. There was PROM at 27 weeks and under adequate antibiotic and steroid cover, classical caesarean section was done. Due to an adherent cervical pregnancy remnant, bilateral internal iliac artery ligation with an obstetric hysterectomy was done. As few cases exist in literature, there are no specific and no universally accepted treatment modality for heterotopic cervical pregnancy and treatment depends on experience, equipment of medical team and maternal conditions.