Ectopic Pregnancies, including with IVF

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.

Ectopic Pregnancy

Any sexually 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 sterilisation
• 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 find one.

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:

• tubes that are blocked or semi-blocked (so if an egg floated up, it might not get back to the uterus),

• balding of the cilia (these little hairs that waft the egg down to uterus can gradually disappear, and so can't do their job), and

• the 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 last point.

• Jess 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 information.

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.