An ectopic IVF pregnancy that eluded ultrasound and two laparoscopies was eventually discovered in one of the least likely places.

The patient, a nulliparous Indian woman in her early 30s, presented with lower abdominal pain eight days after IVF embryo transfer.

The woman had undergone a laparoscopic bilateral ovarian cystectomy four years prior and a bilateral salpingectomy immediately before her current IVF cycle.

Tests showed a markedly elevated serum beta human chorionic gonadotropin (β-hCG) level (27,894 IU/mL).