Pregnancy loss is common and comes in many forms. However, it is always difficult news to receive, whether or not the pregnancy was planned. An ectopic pregnancy is a type of pregnancy loss that affects 1-2% of all pregnancies and up to 4% of those receiving reproductive assistance. Knowing the signs and symptoms of ectopic pregnancy is essential for anyone pregnant or trying to become pregnant because, unless treated, it can threaten the life of the mother. The good news is that most women, even those who have lost a fallopian tube, go on to get pregnant after an ectopic pregnancy.
What is an Ectopic Pregnancy?
In a healthy, viable pregnancy, a fertilized egg travels from the ovary, down the fallopian tube, and into the uterus, where it embeds into the uterine wall and grows until delivery. An ectopic pregnancy is a pregnancy complication that occurs when a fertilized egg implants in a part of the body outside the uterus. In 90% of ectopic pregnancies, the fertilized egg implants in the fallopian tube. Less commonly, the fertilized egg implants abnormally in another part of the abdomen. The only body structure that can stretch to accommodate a pregnancy is the uterus, so an ectopic pregnancy is not viable.
At first, ectopic pregnancy has signs and symptoms similar to early pregnancy such as a missed menstrual period, tender breasts, morning sickness, and a positive pregnancy test. Early signs of an ectopic pregnancy include abnormal bleeding, low back pain, or pelvic pain. These symptoms should be reported to your OB-GYN or fertility specialist immediately. As an ectopic pregnancy grows, more serious symptoms such as severe abdominal or pelvic pain, shoulder pain, weakness, dizziness, or fainting may develop. Severe symptoms suggest a medical emergency possibly requiring emergency surgery, so immediately go to the ER if you experience symptoms indicative of an ectopic pregnancy.
What Causes Ectopic Pregnancy?
The cause is unknown in about half of all ectopic pregnancies. However, certain factors increase the risk of ectopic pregnancy, including smoking cigarettes, being over age 35, having a history of infertility, and using assisted reproductive technology, such as IVF. Other risk factors for developing an ectopic pregnancy include a previous ectopic pregnancy, prior fallopian tube surgery, a history of pelvic or abdominal surgery, certain STIs, pelvic inflammatory disease, and endometriosis. These risk factors all cause infection or inflammation in the fallopian tubes, leading to anatomical changes that cause the egg to take longer to travel down the fallopian tube upon fertilization.
How is Ectopic Pregnancy Treated?
Unfortunately, the fertilized egg cannot be moved into the uterus, so treatment always requires the removal of the fertilized egg. There are two treatment options for ectopic pregnancy: medication and surgery.
Medication
The most commonly prescribed medication to treat ectopic pregnancy is methotrexate injected into a muscle. Methotrexate stops the cells of the fertilized egg from dividing, effectively ending the pregnancy. The body reabsorbs the arrested cells over the next 4-6 weeks. This option is used if the ectopic pregnancy is identified early enough that the fallopian tube is not damaged or ruptured. You will need to do follow-up blood tests to ensure that the pregnancy hormone hCG reaches zero.
If a blood test shows that your hCG is not dropping fast enough, a second dose of methotrexate may be given. Talk to your medical provider to determine if you can manage your ectopic pregnancy with medication, because certain health conditions, including breastfeeding, are not compatible with methotrexate.
Surgery
If the ectopic pregnancy has grown so much that your fallopian tube ruptures, it requires emergency surgery. The surgery is done under general anesthesia using small incisions and a camera via a process called laparoscopic surgery. Through a procedure called a salpingostomy, the ectopic pregnancy is surgically removed, and the fallopian tube is left to heal. In a salpingectomy, the ectopic pregnancy and the fallopian tube are both removed. The type of surgery is determined by the extent of damage to the fallopian tube and whether it has ruptured.
How Does an Ectopic Pregnancy Impact Fertility?
Early diagnosis and treatment of an ectopic pregnancy are essential to avoid emergency surgery and/or removal of a fallopian tube. You can still get pregnant after the removal of a fallopian tube. Studies show that return to ovulation after ectopic pregnancy occurs within 40 days of surgery for the vast majority of women. One out of every three women who had an ectopic pregnancy goes on to have a child in the future. However, having an ectopic pregnancy in the past makes it more likely to occur again in future pregnancies.
After an ectopic pregnancy, make sure you look out for the signs and symptoms of another ectopic pregnancy. A thorough fertility treatment provider may make an early ultrasound appointment to confirm that the fertilized egg has implanted in the correct location.
Ectopic pregnancy is a sudden and often distressing loss of a pregnancy that can lead to strong feelings of grief. Feelings of uncertainty about future fertility are likely, but this does not mean you cannot get pregnant in the future. Make an appointment with Red Rock Fertility to receive compassionate, professional care to guide you on your fertility journey.
