If you have an ectopic pregnancy will it happen again

One Ectopic Often Predicts Another

Your chances of having a normal pregnancy are excellent, but your chances of having another ectopic pregnancy have also increased.

Question:
I had an ectopic pregnancy two years ago, and they treated it with a medication called methotrexate. What are my chances of having a normal pregnancy now, and what I should watch out for?

Answer:Jan. 22, 2001 -- Your chances of having a normal pregnancy are excellent, but your chances of having another ectopic pregnancy have also increased. An ectopic pregnancy -- one that's developing outside the uterus -- is diagnosed in about one in every 100 pregnancies. More than 95% develop in the fallopian tube, but these pregnancies can also occur in an ovary, the cervix, or even the abdomen. Risk factors for them include a previous ectopic pregnancy; tubal surgery such as tubal ligation or sterilization reversal; a past tubal infection; use of an intrauterine device (IUD); use of the "morning-after" pill; use of the progesterone-only or "mini" pill; and fertility treatments including in vitro fertilization and gamete intrafallopian transfer.

Ectopic pregnancy has traditionally been treated with surgery, which may involve removing the fallopian tube or removing the embryo. Nonsurgical treatment can be used in cases where the ectopic pregnancy is early and hasn't ruptured. It involves the injection of a chemotherapeutic medication, methotrexate, which halts the pregnancy's development.

In general, after one ectopic pregnancy your chances of having a future pregnancy that is in the uterus are about 60-70%. But women with a history of ectopic pregnancy often have difficulty getting pregnant again, and as many as 20-30% of them end up being infertile, especially if they have any of the risk factors noted above. Your risk of having another ectopic pregnancy is much higher once you've had the first; as many as one in 10 women will have a second ectopic pregnancy. The increased risk is probably about the same whether your ectopic was treated with surgery or medication, though it's too early to have much data on this.

Because the risk of a second ectopic pregnancy is so high, you should take precautions when you get pregnant again. If you miss a period and might be pregnant, let your doctor know right away. The first step is to find out if you are pregnant and where the pregnancy is located. This may be difficult early in the pregnancy, so be aware of the early signs of an ectopic pregnancy, such as pain and vaginal bleeding or spotting.

With your history, your doctor may assume you're having another ectopic pregnancy until an intrauterine pregnancy can be clearly seen on ultrasound. Your doctor will examine you, do a transvaginal ultrasound, and draw your blood for an hCG level if a pregnancy is not yet visible. When the hCG rises above 2,000 mIU/mL, your doctor should be able to see an intrauterine pregnancy; the same is true around 28 days after you last ovulated (about six weeks after your last period). Sometimes an additional blood sample for hCG level is taken 48 hours after the first and compared with the first level. An hCG level that increases but is less than double the previous one is considered abnormal and suspicious of an ectopic pregnancy.

Otherwise, your doctor will prescribe additional observation and testing. Once the pregnancy is confirmed to be inside the uterus, there's usually no further need for concern about an ectopic pregnancy

Amos Gr�nebaum is a practicing obstetrician and gynecologist in New York specializing in high-risk pregnancies.

There’s no doubt experiencing an ectopic pregnancy can be scary, but the good news is your chances of conceiving and going on to have a totally healthy pregnancy are very high.

Understanding an ectopic pregnancy and the information this will provide about your future fertility is step one.

Ectopic Pregnancy: The Diagnosis and Treatment Options

Most pregnancies implant inside the uterine cavity, however, occasionally they implant outside the endometrium (inside of the uterus) which is called an ectopic pregnancy. The most common type of ectopic pregnancy is tubal, which means the pregnancy implants in one of the fallopian tubes.

It’s important to identify an ectopic pregnancy as soon as possible because if left without treatment, these can outgrow their blood supply and rupture. The rupture of an ectopic pregnancy is a surgical emergency–women can lose a lot of blood, and potentially need a hysterectomy if this is left untreated.

What are the symptoms of an ectopic pregnancy?

Most patients expect dramatic, obvious symptoms when they have an ectopic pregnancy. However, most are asymptomatic, at least early on. Many will have the usual pregnancy symptoms, breast tenderness, fatigue, bloating, cramping, and occasional spotting.

As these progress, particularly beyond the 6-week mark, they can be associated with pelvic and abdominal pain, or even dizziness and shortness of breath. But the symptoms alone can’t lead to a diagnosis; an ultrasound is generally necessary to confirm an ectopic pregnancy and help determine the best treatment option.

There are two primary treatment options for ectopic pregnancies: medication or surgery.

If no rupture has occurred, and it’s early in the pregnancy, your doctor may recommend methotrexate shots. These shots stop the embryo’s cells from growing, and your body absorbs any cells that have already developed. This treatment option generally does not cause any scarring or damage to the fallopian tube, leaving your chances of conceiving naturally quite high.   

The other treatment option is surgically removing the pregnancy. If non-emergent, laparoscopy surgery can be done. During the procedure, a small incision is made near the belly button so that a tiny camera can be inserted for the surgeon to go in and remove the pregnancy.  

In the event of a rupture, a laparotomy is generally required, which is more invasive and involves a larger incision. Either of these procedures can cause scarring or result in the removal of some or all of the fallopian tube.

Yes, You Can Conceive after an Ectopic Pregnancy

Studies show similar rates of conception after an ectopic pregnancy, regardless of how it was treated, and numbers are high–up to 80% will go on to have a live birth. However, the risk of another ectopic is still increased in future pregnancies. That’s why it’s important to seek medical attention in the future, as soon as you detect a positive home pregnancy test.

When IVF May Be the Best Option After an Ectopic Pregnancy

Once you have experienced multiple ectopic pregnancies, had both fallopian tubes removed, or have underlying infertility, In Vitro Fertilization (IVF) may be the next best step after an ectopic pregnancy. With IVF, embryos are inserted into the center of the uterus, leaving you with a very low risk of another ectopic pregnancy–although the risk is not 0%. You’ll also be happy to learn that it has a high success rate, even for women with tubal damage.

Finding the Right Fertility Specialist after an Ectopic Pregnancy

A couple of things to keep in mind when considering getting pregnant after an ectopic pregnancy are first, that most doctors advise women to wait around 3 months to conceive if you  received methotrexate injections. Second, once you’ve had one ectopic pregnancy, you are more likely to have another one. Therefore, it’s important to have a fertility specialist closely monitor future pregnancies.

Ultimately, the right fertility specialist can guide you and help you achieve a successful pregnancy in the very near future!

Learn more about conceiving after ectopic pregnancy from Alabama Fertility in Birmingham, AL

At Alabama Fertility Specialists, we treat all patients with the care and compassion that complex reproductive issues require. We encourage you to ask your doctors and nurses at Alabama Fertility Specialists as many questions as you need to in order to find out more.

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