Ectopic Pregnancy and Infertility

Ectopic Pregnancy occurs when the pregnancy takes place outside the uterus [1]. This type of pregnancy occurs when the fertilised egg doesn’t attach to the uterus, instead, it gets attached to the fallopian tubes, cervix or abdominal cavity.

Most of the time an ectopic pregnancy occurs in the fallopian tube, such type of ectopic pregnancy is also known as Tubal Pregnancy. It is not possible for a baby to grow anywhere other than the uterus hence, an ectopic pregnancy cannot survive. Also, the pregnancy itself does not proceed normally and can be life-threatening for the mother.

Ectopic pregnancies are rare. About 2% of the general population is at risk of having an ectopic pregnancy, however, 6% to 16% of women with the first-trimester pain or bleeding may have this condition [2].

Furthermore, ectopic pregnancies can also lead to more ectopic pregnancies in the future, although it is less likely. They may also cause trouble with fertility in future and you may have to look for other options for getting pregnant.

Symptoms of Ectopic Pregnancy

The symptoms of ectopic pregnancy at the early stages are the same as of a normal pregnancy, hence, you might not be able to suspect anything. The early symptoms include breast tenderness, nausea and missed periods.

Furthermore, if you take a pregnancy test it will come out positive. Although, as the ectopic pregnancy progresses, the symptoms will become far more noticeable.

Early warning symptoms of Ectopic Pregnancy:

Some of the most common symptoms of an ectopic pregnancy that you may notice are light vaginal bleeding and pelvic pain. If there is a leakage from the fallopian tube then you might experience other symptoms as well. For example, urges to poop or shoulder pain.

Symptoms of ectopic pregnancy in its extreme condition:

When the ectopic pregnancy reaches its extreme condition, you may notice the following symptoms:

• Excessive shoulder pain
• Extreme lightheadedness
• Fainting
• Severe abdominal or pelvic pain along with vaginal bleeding

If the fertilised egg implants itself in the fallopian tube and starts to grow there, at some point it may rupture the tube which may cause heavy abdominal bleeding. This could be a life-threatening condition and a woman might have symptoms like extreme lightheadedness, shock, and fainting [3].

Consult your doctor if you notice any of the symptoms mentioned above.

Ectopic Pregnancy Causes

The actual cause of ectopic pregnancy hasn’t been found yet. But the following characteristics have been noted to be common in women suffering from this condition.

• Hormonal factors
• Inflammation or scarring in the fallopian tubes caused by a previous medical condition
• Birth defects
• Genetic abnormalities
• Medical conditions that may change the shape or condition of the fallopian tubes and other reproductive organs

Ectopic Pregnancy Risk Factors

The risk factors for any condition means that they are some factors that can put you in a higher chance of getting this condition as compared to other people. The factors that may put you at risk of having an ectopic pregnancy are:

• If you are 35 years or older at the time of delivery
• If you have a history of endometriosis, abdominal surgery or pelvic surgery
• If you had multiple abortions
• If you have a history of pelvic inflammatory disease (PID)
• If you got pregnant despite using an intrauterine device (IUD) or tubal litigation
• If your pregnancy was a result of fertility medicines or surgery
• If you smoke
• If you have a history of ectopic pregnancy, gonorrhoea, chlamydia or sexually transmitted diseases (STDs)

Ectopic Pregnancy Diagnosis

If you think you might have an ectopic pregnancy or experience any of the symptoms mentioned above, visit a doctor and get a proper diagnosis. Even though an ectopic pregnancy cannot be diagnosed by a physical exam, your doctor may perform it to rule out other conditions. Once the physical exam is done, your doctor may perform the following test to diagnose an ectopic pregnancy.

Ultrasound for diagnosing Ectopic Pregnancy

Your doctor will perform an ultrasound to determine the location of the pregnancy. They can perform an abdominal ultrasound in which the ultrasound wand is moved around your abdomen. This will help them determine if you are pregnant or not and evaluate if there is any internal bleeding.

They can also perform a transvaginal ultrasound in which a stick-like instrument will be inserted into your vagina so that the doctor can see if a gestational sac is present in the uterus.

Pregnancy Test for diagnosing Ectopic Pregnancy

Your doctor may do a pregnancy test as well. They may order the human chorionic gonadotropin (HCG) blood test to confirm you’re pregnant. HCG is a hormone whose level increases when a woman is pregnant. The doctor may repeat this test for a few days.

Note: If the levels of the HCG hormone start to decrease or appear to be the same over a few days and no gestational sac was found during the ultrasound, the pregnancy is likely to be an ectopic pregnancy.

Other blood tests

The doctor might also do other tests to check if you are suffering from anaemia or any other signs of blood loss.

As mentioned earlier, an ectopic pregnancy cannot survive and it can be dangerous for the mother as well hence the ectopic tissue has to be removed. The treatment will depend on your symptoms and the location of the pregnancy.

Medications for treating ectopic pregnancy:

If your doctor notes that the ectopic pregnancy has not reached any complications, he may suggest medications to treat ectopic pregnancy. A medication called methotrexate is one of the common medicines used by doctors. Methotrexate is a medication that can stop the growth of cells of the ectopic mass and dissolve the existing cells.

The medication is usually given through an injection. The doctor may also ask you to get regular blood tests to check if the injections are working. If the medication is working, you will start experience symptoms similar to a miscarriage. Such as:

• Vaginal bleeding
• Cramping
• Passing of the tissue

If the medications work, then future surgery may not be required. Also, you won’t be able to get pregnant for several months after the medications are taken.

Surgery for treating ectopic pregnancy:

If the medications don’t work or if your ectopic pregnancy has passed the stage of being treated by the medication, your doctor may proceed with surgery.

Salpingectomy and Salpingostomy are the two laparoscopic surgeries used to treat ectopic pregnancies. In both the surgeries, the doctor will start with making a small cut in the abdomen (near or in the navel). The doctor will then insert a device attached with a camera and light (laparoscope) through the cut to view the images of the tubal area in a video monitor.

In a salpingectomy surgery, the doctor will remove the ectopic pregnancy as well as the fallopian tube where the pregnancy was growing.

In a salpingostomy surgery, the doctor will only remove the ectopic pregnancy and the fallopian tube will be left to heal on its own.

The doctor will choose any of these surgeries depending on the amount of bleeding and the damage to the fallopian tube. Also, the rupture in the fallopian tube during the surgery may affect your fertility in future. However, it is unlikely.

An ectopic pregnancy may have a small chance of affecting your fertility. It can rupture your fallopian tubes making it hard to conceive resulting in infertility. Also, the treatment done for removing the pregnancy may also result in infertility.

The relationship between an ectopic pregnancy and infertility is complex. An ectopic pregnancy can happen because of infertility and it can also be the cause of infertility.

In a population-based study, it was found that the pregnancy rate of women who have through surgical or medical treatments for ectopic pregnancy was 66% [4].

An ectopic pregnancy can result in tubal factor infertility. Tubal factor infertility is when the fallopian tubes are blocked or damaged causing infertility. Now tubal factor infertility can not only cause infertility but can also cause another ectopic pregnancy. Hence it is important to treat this condition. One of the ways to this condition is surgery. Surgery can repair the damage of the fallopian tubes and you might be able to get pregnant again.

If the tubes are severely damaged, you have a poor chance of getting pregnant. In such cases, In vitro fertilization (IVF) will be your best option to achieve pregnancy. In this procedure, the fertilised egg will be directly placed in your uterus and your chances of getting pregnant will be more. Additionally, severely damaged fallopian tubes can decrease the IVF success rate hence, your doctor may recommend removing the damaged tube before proceeding with IVF [5].

If you have been through salpingectomy surgery for treating ectopic pregnancy and both of your fallopian tubes were removed due to severe damage, it won’t be possible for you to conceive naturally. In this case, also, IVF would be the treatment if you want to get pregnant in the future.

As the treatments for ectopic pregnancy are less invasive, recovering physically won’t take much time. You may be able to go back to your normal activities in a couple of days. But mentally, it may take some time to get over the loss. Also, it will be a good option if you take care of your daily diet and lifestyle after the treatment in order to recover fully from the treatments.

Counselling:

Losing a child can be heartbreaking from both the mother and the father and it can get hard to cope with the grief. After the treatment of the ectopic pregnancy it is possible that you and your partner feel like you have lost a baby which can put you into grief. If that happens you can always opt for counselling. Counselling sessions will help you and your partner come out of the grief and start living your lives normally. It might take some time but it will make the entire process easier.

Avoid Alcohol:

Drinking alcohol is not advised after the treatment for ectopic pregnancy. If you have been given methotrexate for its treatment, then you should avoid drinking alcohol. Methotrexate is metabolised in the liver and it has been found that it can be present 100 days after the dosage. Drinking alcohol with methotrexate in your body can damage your liver.

Include foods with folic acid in your diet:

Methotrexate reduces the levels of folic acid (folade) in your body which can cause side effects like fatigue, anemia, poor digestion, poor immune system and changes in the mood. You can include foods that are rich in folic acid to compensate for the reduced levels. You can include folic acid rich foods like legumes (beans, peas, lentils), eggs, asparagus, spinach, kale, beets, oranges, brussel sprouts, broccoli, papaya, banana, avocado, etc in your diet.

Treatment of the scars:

If you have gone through surgery for treating ectopic pregnancy, you might have small scars in your abdomen. Natural treatments can make these small scars fade over time. Drink 8 to 10 glasses of water in a day and also apply natural moisturizing oils on the scars. Almond oil and Coconut oil can be commonly found in an Indian household, and these oils are beneficial for reducing scars. For best results, gently massage the oil in the area of the scar for several months.