Jess mentioned in a previous post
that she couldn't understand why she had had an ectopic with IVF. As many of
you know, I worked for six years with the Ectopic Pregnancy Trust (and spent many more years on their site informally), answering
questions like hers almost daily. I gave her some information in a long comment
on her blog, but thought I would edit it a little and reproduce it here, with
some additional information. I know this isn't relevant for those of us who are
no longer trying to have children, but others might find their way here, and
find it useful. Or it might answer questions for some of you who did have
ectopics, or know someone who has had one. So I hope none of my readers mind me talking about pregnancies and loss, here where we usually focus on life after we've said good-bye to all this.
active woman of childbearing age is at risk of an ectopic pregnancy. 1-3% of all
pregnancies are ectopic (ie, not in the uterus), and 95-97% of ectopic
pregnancies are in the fallopian tubes.
However, ectopic pregnancies are more
likely if you have had:
- Pelvic Inflammatory Disease - a past
infection of the fallopian tubes (for example, chlamydia).
- Endometriosis - a condition which
could cause damage to the tubes
- Abdominal surgery - any previous
pelvic or abdominal operation, such as caesarean section, appendectomy or
previous ectopic pregnancy.
- An operation on the tubes - such as
- A contraceptive coil (IUD) fitted
- the coil prevents a pregnancy in the uterus but is less effective in
preventing a pregnancy in the tube.
- Are on the ‘mini-pill’
(progesterone-only pill) or have recently come off it – progesterone only contraception
alters motility of the tube
- Use of the morning after pill with
the pregnancy in question
- Fertility treatment (IVF)
- A previous ectopic pregnancy, and
- If you smoke
As you can see, IVF is considered to
be a risk factor. In fact, ectopic pregnancy rates through IVF are higher than
in the general population. This is often because women who need to seek IVF
treatment have an underlying, undiagnosed condition (that has contributed to
infertility) that may heighten their risk of ectopic pregnancy. Figures are
hard to get however, and of course, clinics are well-motivated to report these
differently. A few years ago, we tended to use conservative statistics, stating
the risk of ectopic with an IVF pregnancy to be at least 4-6%, or at least
twice if not three times the rate in the general populace. But the statistics
used in the UK show that the rate of ectopic pregnancy with IVF is around 10%.
When an embryo is transferred into
our uterus, it doesn't implant immediately (if, of course, it is going to
implant at all), which is why I am always doubly annoyed when the media uses
"implants" instead of "transfers." It can float around for
a day or two before implantation, and this means it can move from the transfer
site. It can therefore travel up into the fallopian tube, and implant there,
causing an ectopic pregnancy. Or it can implant at the entrance of the
fallopian tube, causing a cornual or interstitial ectopic pregnancy.
Still, 90% of women who have ectopics
go on to conceive again successfully (ie, in the right place). 50% of women who
have ectopics have none of the risk factors, and will never know what caused
their ectopics. So women who are looking for an answer, like me, struggle to
Conditions that can lead to tubal or
interstitial (at the connection of the tube to the uterus) ectopic pregnancies
with IVF (or otherwise) can include:
that are blocked or semi-blocked (so if an egg floated up, it might not get
back to the uterus),
of the cilia (these little hairs that waft the egg down to uterus can gradually
disappear, and so can't do their job), and
fallopian tube contractions that help push the egg downwards can, on occasion,
reverse. (I was told this by my own specialist, when he was trying to figure
out why I had two (one, tubal, one, interstitial, neither IVF) ectopics. I
don’t have any data, and he said that they could monitor me for hours, and not
see one of these reverse contractions, so I cannot 100% stand behind this
was told her cilia were pointing or directing the wrong way. I've never heard
of this, and wonder how they knew, as the cilia are so tiny infertility tests
can't see them. Perhaps they conducted investigations on her removed tube, or
it could simply be a case of a doctor surmising, hoping to give an answer to a
patient who is hungry for them.
Many of these conditions are almost
impossible to diagnose. Hopefully, further research will provide further
For more information on ectopic pregnancies, go to The Ectopic Pregnancy Trust website.
Previous posts where I talk about my own experience of ectopic pregnancies can be found here, and here.