Prevention of Ectopic Pregnancy

Over the years certain patients really stick out in your memory. This week one of my favorite fertility veterans brought in a whole box of homemade cookies to the office. Needless to say, they were consumed within 45 minutes and I got one or two but almost lost my hand in the feeding frenzy that occurred. In any case, this young woman had really been through the ringer. Low responder, high FSH, pregnancy loss, antiphospholipid antibodies requiring Lovenox, male factor….and the list always seemed to keep growing. However, the low point was an ectopic pregnancy after an IVF cycle while she was on Lovenox. Ultimately, it all worked out and they ended up with 2 beautiful children (her own eggs) who were romping around the office this week as the cookies were being delivered.

So how do we avoid a repeat ectopic pregnancy in our patients? Well, there are some ways to try and reduce the risk but even with ultrasound guided embryo transfer, those little buggers can still float out into the tubes. There are reasons that I am losing my hair and why I am getting more grey and it is not always from my own kids.

As I try to get back in the blogging routine here is another kernel of knowledge from the book soon to be made into a major motion picture: 100 Questions and Answers about Infertility.

30. If I had a previous ectopic pregnancy, what should I do to avoid another one?

The reported incidence of tubal or ectopic pregnancy in the general population is 1%. Women who have experienced an ectopic pregnancy generally have a 10% to 15% risk for another ectopic pregnancy. The good news is that most women who have had an ectopic pregnancy will not have another one. The bad news is there are no therapies available to eliminate this risk. All women who are attempting to conceive inherently are at risk for an ectopic pregnancy. Even women with absent or obstructed fallopian tubes can experience an ectopic pregnancy if the embryo becomes implanted in the section of the fallopian tube found within the muscle of the uterus (called an interstitial or cornual pregnancy). The rate of ectopic pregnancy following IVF is usually 1% to 2%, far lower than the 15% recurrence risk with a spontaneous pregnancy. Fortunately, most ectopic pregnancies are readily diagnosed very early in pregnancy using blood hormone assays for beta human chorionic gonadotropin (HCG) combined with transvaginal ultrasonography. It is now uncommon for such pregnancies to go undiagnosed or to lead to tubal rupture, hemorrhage, or death. Most ectopic pregnancies can be treated medically using low doses of methotrexate (a type of chemotherapy that selectively destroys the pregnancy tissue), thereby avoiding surgery. This medical therapy is 80% to 95% effective.