What You Need To Know About Ectopic Pregnancy and Fertility
When you’re trying to conceive, any positive test result is met with a flurry of emotions—from relief to joy to nervousness. But not all early pregnancies can be carried to term, and some conditions, such as ectopic pregnancy, can be life-threatening for the birthing parent and negatively impact future fertility if not promptly treated.
Ectopic pregnancy is the leading cause of maternal mortality in the first trimester. While the condition is rare—according to Dr. Shawna Tonick, MD, an obstetrics and gynecology specialist at the UCHealth medical system in Colorado, ectopic pregnancies impact about 2 percent of known pregnancies—understanding the signs and symptoms of an ectopic pregnancy can help you recognize it early and seek prompt medical treatment.
Tonick emphasizes that ectopic pregnancies are never viable, and should always be treated as an emergency. “An ectopic pregnancy cannot be reimplanted, it cannot travel, it cannot become a normal pregnancy that develops into a live healthy baby,” she says. “It is always life-threatening to the pregnant person.”
Read on for more on what constitutes an ectopic pregnancy, how it may impact fertility, and what to do if you’re faced with this diagnosis.
What is an ectopic pregnancy, and what are its risks?
An ectopic pregnancy is when a fertilized egg implants outside of the endometrial cavity. In more than 90 percent of cases, this type of pregnancy occurs in one of the fallopian tubes, but Tonick says embryos can implant in other uncommon areas, as well, such as in the ovary, a prior c-section scar, the cervix, or the interstitial area of the uterus, where this organ joins with the fallopian tube. If left untreated, an ectopic pregnancy could rupture, causing a life-threatening hemorrhage.
What are the symptoms of an ectopic pregnancy?
Some of the most common symptoms of ectopic pregnancy start out mild and become more severe over time. Typically, the initial signs of an ectopic pregnancy include cramping and bleeding—both of which can also occur in healthy pregnancies. But while they may be normal in early pregnancy, Tonick maintains that these symptoms should always be checked out by a provider. “If someone hasn't yet had an ultrasound that shows an intrauterine pregnancy, we really want to make sure that there is a pregnancy inside of the uterus,” Tonick says.
When diagnosed early, an ectopic pregnancy can be treated before it becomes an emergency. But if a person begins experiencing sharp or severe pain in the abdomen or pelvis, lightheadedness, dizziness, or intense shoulder pain in early pregnancy, they should immediately contact their provider and go to the emergency room. These symptoms could be signs of a ruptured fallopian tube, which can be life-threatening.
What are the risk factors associated with ectopic pregnancy?
While anyone can experience an ectopic pregnancy, there are some factors that increase your risk. The biggest risk is a history of ectopic pregnancies. “If you have one ectopic pregnancy, the risk of another pregnancy being ectopic is about 10 percent,” Tonick says. “If you have two ectopic pregnancies, the risk of your next pregnancy being ectopic is 25 percent.”
Other risk factors for ectopic pregnancy include:
- Any damage or scarring on your fallopian tube(s)
- Prior pelvic infections
- Pelvic inflammatory disease
- Pelvic or abdominal surgeries
- Certain sexual transmitted infections
- Maternal age of over 35
- Cigarette smoking
Assisted reproductive technology and certain types of infertility—tubal factor infertility in particular—can also slightly increase your risk of ectopic pregnancy. But according to Tonick, in more than 50 percent of cases of ectopic pregnancy, the pregnant individual has no risk factors at all.
I’m undergoing fertility treatments. What do I need to know about the risk of ectopic pregnancy?
Research has shown that assisted reproductive technologies can increase your risk for an ectopic pregnancy, but more studies need to be completed to fully understand the correlation. According to a 2015 study published in the Journal of Obstetrics & Gynecology, the authors noted that ectopic pregnancy was more likely when three or more embryos were transferred per cycle.
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In some cases, an ectopic pregnancy conceived via assisted reproductive technologies might be diagnosed earlier than in a traditional pregnancy. These individuals might be receiving close monitoring in early pregnancy, including repeat beta-hCG tests that indicate a pregnancy is properly progressing and early transvaginal ultrasounds that can pinpoint the location of the embryo.
Tonick says that intrauterine pregnancies can usually be seen via transvaginal ultrasounds around five weeks of gestation—far earlier than the typical eight-week ultrasound. Once an intrauterine pregnancy is established, the risk that you might have an ectopic pregnancy is greatly reduced (an exception might be in the case of heterotopic pregnancies, in which one embryo implants in the uterus, and one implants elsewhere, but this is exceedingly rare).
What are the treatment options for an ectopic pregnancy?
Treatment options for an ectopic pregnancy vary depending on a patient’s diagnosis, but the condition always requires some form of treatment. “The important thing about ectopic pregnancies is that they're treated on a case-by-case basis,” Tonick says. “It really depends on each patient's clinical situation and preferences.”
Ectopic pregnancies are treated in two ways: with medication and surgery. Uncomplicated ectopic pregnancies that are diagnosed early might be successfully treated with methotrexate, a drug that stops cells from growing and dividing and effectively ends the pregnancy. Tonick notes that there is a list of contraindications in which this drug might not be effective, such as if there is cardiac activity or a patient is at risk of having a tube rupture. If methotrexate is the chosen treatment, it will be administered by injection in the hospital, and the patient will require close follow-up.
If the ectopic pregnancy has progressed, doctors might recommend a salpingectomy, or a complete or partial removal of the affected tube. This surgery is usually performed laparoscopically under anesthesia. Other surgical options include a salpingostomy, in which a tube is cut open and an ectopic pregnancy is removed, but the tube itself is spared. This treatment option might be considered for a patient who is already missing a tube, and is hoping to spare their fertility.
Is treatment for an ectopic pregnancy considered an abortion? How does the overturning of Roe v. Wade impact treatment options for ectopic pregnancy?
Any pregnancy that is ended with medical intervention is technically considered an abortion. But Tonick believes there is an important distinction to be made in the case of ectopic pregnancies. “This is not a pregnancy that can be healthy,” she says.
While Tonick has not experienced any disruptions in care due to the recent overturning of Roe v. Wade—Colorado passed a state law earlier this year that codified the right to an abortion—she has heard stories of treatment for ectopic pregnancies being delayed in states that have passed restrictive anti-abortion laws, like Texas. And there is currently a battle waging over methotrexate across the country since the drug is also one of the drugs commonly used in medical abortions.
How does an ectopic pregnancy impact fertility?
The effect of ectopic pregnancy on one’s fertility depends on a number of factors, but the type of treatment a person receives can make a difference in fertility outcomes. According to the Mayo Clinic, ectopic pregnancies that are diagnosed early and treated solely with methotrexate have shown little impact on a person’s fertility. Tonick says they typically recommend that patients wait at least three months after taking the drug before trying to conceive again.
For those who have undergone surgery, including a unilateral salpingectomy, it is still possible to conceive naturally with one healthy fallopian tube, provided there are no issues that impact the remaining tube, such as tubal disease or blockages. However, with only one tube, it could be harder or take longer to get pregnant naturally, so seeking the advice of a reproductive endocrinologist, even preemptively, might be recommended.
In many cases, those who have experienced ectopic pregnancies have reason to be hopeful. According to March of Dimes, about one-third of women who have had an ectopic go on to have a healthy pregnancy.
Erin Skarda is a writer, editor, and digital content strategist with over 15+ years of experience. Before moving back to her hometown of Denver in 2012, Erin worked at various national media outlets in New York City, including TIME Magazine.