Bilateral tubal obstruction in vitro fertilization embryo transfer (IVF-ET) after simultaneous intrauterine and ectopic pregnancy 1. The patient had 3 abortions in 6 years after marriage. She had normal menstruation in the past, but in the past 4 years, she had 2-3 days/25-26 days of menstruation, with moderate menstrual flow and no dysmenorrhea. Past history, personal history and family history were not special; physical examination: T: 36.5°C, P: 76 beats/min, R: 18 beats/min, BP: 110/70 mmHg. general condition, clear, mental, heart and lungs (-), abdominal softness, liver and spleen were not detected; gynecological examination: normal vulvar development, vaginal patency, smooth cervical, hypertrophy, posterior uterine body, no obvious abnormalities in both adnexa. The woman’s basal endocrine: FSH:15.3mIU/ml, LH:4.63mIU/ml, PRL:13.8ng/ml, T:0.2nmol/l, E2:195.51pmol/l hysterosalpingogram:: normal uterine cavity morphology, bilateral tubal obstruction. The husband’s semen routine suggested normal semen. The proposed IVF-ET, using a short protocol of superovulation, trichostatin 0.1mg, subcutaneous injection, once a day, starting on the second day of menstruation to the day of HCG injection, high-purity urotropin 225IU, starting on the third day of menstruation, intramuscular injection once a day, vaginal ultrasound on the eighth day of menstruation showed: endometrial thickness: 0.6cm, type A, right follicle 1.3cm 1, 1.2cm2 1, 1.1 1 cm; left follicle: 1.2 cm and 3 follicles. The endometrial thickness was 0.8 cm, type A, 1.6 cm, 1.5 cm2, 1.3 cm1; the left follicle was 1.5 cm2, 1.2 cm1. 150 IU of urotropin was administered for 2 days, and the endometrial thickness was 0.6 cm, type A, 1.8 cm1, 1.7 cm1. 1.7 cm2, 1.65 cm1; left follicle: 1.75 cm2, 1.4 cm1, HCG 10,000 IU was given intramuscularly, 6 eggs were obtained, 2 embryos were formed, progesterone 60 mg was given intramuscularly once a day to support the corpus luteum on the day of egg retrieval, 2 embryos were transferred on the second day after egg retrieval under the direction of abdominal ultrasound. On the second day after egg retrieval, 2 embryos were transferred under the direction of abdominal ultrasound. The patient was found to have positive urine HCG and blood β-HCG 518.3mIU/ml 14 days after the transfer. 30 days after the transfer, the patient developed lower abdominal pain with a small amount of vaginal bleeding, vaginal ultrasound indicated intrauterine pregnancy with a single fetus, gestational sac size 2.2×2.0cm, good fetal heartbeat, 4.3×3.4cm heterogeneous echogenic mass in the left ovary, gestational sac-like echogenicity was seen inside the sac. The fetal buds and fetal heartbeat were not seen inside the sac, and the fetal buds were not seen inside the sac. The fetal heartbeat was detected, so immediate surgery was performed after communication with the patient and family. A small amount of blood in the pelvic cavity and bleeding from the dilated umbilical end of the left fallopian tube were seen during the operation, so a left tubectomy was performed. The pathological diagnosis was gestational chorionic tissue. She was discharged 6 days after surgery. Regular labor and delivery was performed at 39 weeks of gestation by cesarean section 1 male baby weighing 3300 g 2 . Discussion Simultaneous intrauterine and ectopic pregnancy (HP) refers to the coexistence of intrauterine pregnancy and ectopic pregnancy, a pathological pregnancy that is extremely rare, with an incidence of 0.95%, in a patient in a natural state or after (ultra)ovulation treatment. At least 2 eggs are fertilized or more than 2 embryos are transferred by IVF-ET, and they implant and develop in the uterus and outside the uterus at the same time. With the development of assisted reproductive techniques and the use of ovulation-promoting drugs, the incidence has increased, and its occurrence is related to the use of ovulation-promoting drugs and tubal factors, etc. In this case, the patient occurred after assisted reproductive techniques and the presence of tubal factors. The author was aware of this disease due to a clear medical history and 2 embryos transferred, and the possibility of this disease should be thought of when the blood was already checked 14 days after the transfer to determine a biochemical pregnancy and vaginal bleeding and abdominal pain were present. In this case, the diagnosis was clear before the surgery of simultaneous intrauterine and ectopic pregnancy, and surgical treatment was performed in time to preserve the intrauterine fetus, and a better outcome was obtained. Conclusion The incidence of HP increases significantly after IVF-ET, especially in those with a history of pelvic or tubal disease or transfer of multiple embryos. Strengthening ultrasound monitoring helps to detect and diagnose the pregnancy site before it ruptures, and timely surgical treatment. The operation should be performed gently to avoid intrauterine pregnancy abortion by not disturbing the intrauterine pregnancy as much as possible, and the postoperative treatment should be strengthened to prevent adverse consequences.