Infertility Treatment & Ectopic Pregnancy

Ectopic pregnancy is a well-known but relatively rare complication of assisted conception treatments. In a majority of ectopic pregnancies the embryo implants itself outside the uterus in the fallopian tubes. There occurs a space restriction as the embryo grows and eventually the tube ruptures. This is life threatening and necessitates removal of a portion of the fallopian tube or the entire tube itself. Thus the ability to get pregnant reduces significantly.

Ectopic pregnancy may also occur in the cervix, ovary, or abdominal cavity. There's no way of transplanting an ectopic (literally, "out of place") pregnancy into the uterus, so ending the pregnancy is the only option.

What are the Causes that Lead to an Ectopic Pregnancy?
Pelvic Inflammatory Disease (PID), which leads to scarring of the tubes, is the most common cause of ectopic pregnancy. Other factors that may lead to an ectopic pregnancy include:
• Tumors or cysts in the tubes
• Endometriosis
• Fibroids in the uterus
• Previous tubal surgery
• A previous ectopic pregnancy increases risk of a second ectopic pregnancy
• Women who have had assisted conception through IVF or IUI have an increased risk of ectopic pregnancy
• Taking medication to stimulate ovulation increases the risk of ectopic pregnancy

IVF & IUI as Potential Causes for Ectopic Pregnancy

The chances of an ectopic pregnancy seem to be higher in women undergoing in vitro fertilization (IVF). They are at risk particularly if they already have problems affecting their tubes.

During IVF, ectopic pregnancy may occur if the embryos when transferred to the womb are placed too high in the womb cavity. The embryos then have a greater chance of "wandering" and implanting themselves in places where they are not supposed to be, such as the fallopian tubes. It is also possible that embryos may make their way into the fallopian tubes if they are injected into the womb with too much force.
During IUI treatment also when inserting sperm directly into the womb cavity the risk of an ectopic pregnancy developing in the fallopian tubes or elsewhere exists if the sperm is injected with too much force or is placed too high in the womb cavity.

Thus between 2 and 5 % of IVF treatments result in ectopic pregnancy. Those who become pregnant in the course of undergoing IVF or IUI treatment should be aware of and look-out for symptoms of ectopic pregnancy. Medical help should be immediately availed on experiencing any symptoms of ectopic pregnancy.

Treatment

Ectopic pregnancy can occur both with natural conception and with infertility treatment. Most ectopic pregnancies that happen in the course of IVF treatment are diagnosed early since such women are closely monitored. If it is diagnosed in the early stages it may be possible to use a drug to eliminate the ectopic pregnancy However, surgery may be the only treatment option if an ectopic pregnancy has gone past 6 weeks or if there is internal bleeding. Surgical options include laparoscopy or laparotomy. Removal of the tube (salpingectomy) remains a necessity in emergency cases.

Successful pregnancy after an ectopic pregnancy is possible. Even if one tube was injured or removed, an egg may be fertilized in the other fallopian tube before entering the uterus. If both tubes were injured or removed, IVF is a viable option. In this procedure, mature eggs are fertilized in the lab and then implanted into the uterus.

At East Bay Fertility Center, ectopic pregnancy is diagnosed very early allowing a choice between two forms of treatment: laparoscopic surgery to remove the ectopic or an injection of methotrexate to dissolve it. Under the guidance of Reproductive Endocrinologist and Medical Director Dr. Ellen U. Snowden, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. The Center specializes in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation and gestational surrogacy.

Call 925.828.9235 for a free initial consultation and for more details about infertility treatments.