When trying to conceive, there’s nothing greater than seeing those two pink lines. But occasionally an ectopic pregnancy can occur, where the embryo implants outside the uterus, usually within a fallopian tube, which, in a normal pregnancy, is supposed to transport the fertilized egg to the uterus.
In very rare cases, an embryo can also attach to the cervix, an ovary or an organ in the abdomen. Sadly, an ectopic pregnancy isn’t viable, and early diagnosis with an ultrasound is crucial to minimize any health or fertility complications. Here’s what you need to know.
“Early on this condition can be asymptomatic or mimic normal pregnancy—women may have nausea and vomiting as well as breast tenderness,” says Brock McKinney, an OB/GYN in Orillia, Ont. A woman may experience one or more of the following symptoms: vaginal spotting or bleeding, abdominal or pelvic pain, which is usually one-sided and can vary from a dull ache to a sharp, stabbing sensation.
In instances of severe pain, explains McKinney, the ectopic pregnancy has likely grown large enough that it has burst the fallopian tube and requires immediate medical attention. Shock, which can be fatal, often develops at this stage, with symptoms like shortness of breath or heart palpitations. But McKinney warns, “In up to 50 percent of women who have a tube rupture, there are no warning signs such as mild pain or vaginal bleeding.”
The biggest risk factor for ectopic pregnancy is having already had one, which increases your chances by 15 percent; and 25 percent if you’ve previously had two. Other factors include scarring from surgery on your fallopian tubes or other pelvic organs, a history of endometriosis, sexually transmitted infections, in vitro fertilization (IVF) or infertility.
Contrary to popular belief, an intrauterine device (IUD) does not elevate your chances, says McKinney, who notes that up to half of the women who experience this condition have none of these risk factors.
In very rare cases, some women don’t require treatment but will be monitored closely through blood work and ultrasound. “This is only an option in very early ectopic pregnancies that the body has started to absorb on its own, where the pregnancy hormone is very low and on the decline,” says McKinney.
A medication called methotrexate, which is administered by injection and works by dissolving the pregnancy, is typically recommended for women whose condition is caught early enough—often around the six-week mark—that they don’t require surgery and don’t have other risk factors. This treatment requires a patient to be monitored by a doctor until her pregnancy hormone levels return to zero to ensure it has been successful.
If an ectopic pregnancy is caught after six weeks, or if you don’t meet the methotrexate criteria or are at risk of internal bleeding caused by a ruptured tube, then surgery is the next step. “The gynecologist can either remove the tube with the ectopic pregnancy inside or make an incision in the tube and remove it that way,” says McKinney.
“The choice between the two options depends on the patient’s preference and how damaged the tube is at the time of surgery.” If a tube is cut—a procedure called a salpingostomy—then a patient must be followed by her doctor to ensure tissue has stopped developing. The surgery is typically done laparoscopically and only takes a few days to recover.
Your chance of conceiving following an ectopic pregnancy may not be reduced, even if one of your fallopian tubes is damaged or removed, according to Jackie Thomas, an OB/GYN at Mount Sinai Hospital in Toronto.
For example, if your left ovary releases an egg but your left tube is no longer intact, the egg can still be taken in by your right tube, which could lead to conception. However, because you’re at a greater risk for future ectopic pregnancies, it’s critical to tell your OB/GYN about your history if you become pregnant again so you can be properly monitored.
Age and fertility should also be considered when trying to conceive after an ectopic pregnancy. For example, if you’re 38, you probably don’t want to try for too long without consulting a fertility clinic, says Thomas.
She notes that recent evidence suggests women having IVF following an ectopic pregnancy may have decreased fertility rates, but it’s still unknown if that’s due to the pre-existing fertility issues that initially caused the ectopic pregnancy or if the condition itself caused infertility.
The most advanced ectopic pregnancy McKinney has seen was around ten weeks in a woman with two previous normal pregnancies. “The fallopian tube wasn't ruptured, but given the advanced gestation, she required surgery, which is when we discovered her tube was on the brink of rupture. It was removed without complications, and she went home a few hours after surgery, and she subsequently had another normal pregnancy.”
If you’ve had an ectopic pregnancy and wish to try to conceive again, speak with your doctor about when you can start trying as the suggested time may vary depending on your treatment or complications. Oftentimes, it’s as soon as your next period, the start of your cycle.
Remember: A past ectopic pregnancy doesn’t mean all hope is lost; it shows that your body is capable of getting pregnant. “Just try again,” says Thomas. “There’s an 85-percent chance you’ll have a normal pregnancy.”
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