Occurring naturally in one to two percent of all pregnancies, an ectopic pregnancy is when a fertilized egg attaches itself someplace else other than in the uterine cavity. An ectopic pregnancy places the woman’s health at risk; early detection is hence imperative.
Daniela from Dreaming of Baby discusses the symptoms and treatment of ectopic pregnancy, as well as its incidence following fertility treatment, with Dr. Mark Trolice, M.D., a leader in the field.
What is an Ectopic Pregnancy?
Daniela: We have with us today Dr. Mark Trolice from The IVF Center and with whom we shall be discussing ectopic pregnancy. To better inform our readers, it would be great if you could introduce yourself as well as give us an overview of your experience working in this field.
Dr. Mark Trolice: Thank you, Daniela. Hello, everyone; it is my pleasure to be with you today and hopefully answer all your questions on fertility. For 20 years I have been caring for patients trying to conceive and it is a privilege that I hold dear. I see no greater purpose than to assist those struggling to have a child. My areas of expertise are in vitro fertilization, polycystic ovarian syndrome, and recurrent miscarriage. So, let’s begin!
Daniela: Thank you for that overview Dr. Trolice. To start with, what is exactly an ectopic pregnancy?
Dr. Mark Trolice: An excellent question. An ectopic pregnancy is actually a pregnancy that is located anywhere else except where it is supposed to be, that is inside the uterine cavity. It occurs naturally in approximately 1 to 2% of pregnancies though it does occur in a slightly higher percentage following fertility treatment.
Dr. Mark Trolice: “An ectopic pregnancy is actually a pregnancy that is located anywhere else except where it is supposed to be, that is inside the uterine cavity.”
Fertility Treatment and Ectopic Pregnancy
Daniela: Is there any reason in particular why it occurs more following fertility treatment?
Dr. Mark Trolice: With fertility medication and intrauterine insemination (IUI), medication is used to increase the number of follicles that will ovulate during a cycle, thereby increasing the chance of more than one egg fertilizing and the resulting embryos implanting in the wrong location. It may also have to do with a different hormonal environment as opposed to the natural cycle. Regarding in-vitro fertilization (IVF), the risk of ectopic pregnancy increases with more than one embryo being transferred into the uterus but even a single embryo transferred can result in an ectopic pregnancy. This is influenced by the technique of transfer as well as probably the hormonal environment.
Daniela: Very interesting to know. Once an ectopic pregnancy occurs following fertility treatment, can the pregnancy still be saved?
Dr. Mark Trolice: That would be wonderful but unfortunately the pregnancy is lost. There is only one published report of apparently relocating an ectopic pregnancy into the uterus successfully. However, no one has ever been able to duplicate that procedure. As a side note, I actually spoke to the author of that publication but I could not understand how he was able to successfully relocate the pregnancy.
Dr. Mark Trolice: “There is only one published report of apparently relocating an ectopic pregnancy into the uterus successfully. However, no one has ever been able to duplicate that procedure.”
Daniela: It’s still amazing to know that it has been done, even if once. In the case of a multiples pregnancy, is it possible to have one embryo implanting in the wrong location, and another safe in the uterine cavity?
Dr. Mark Trolice: Absolutely, and that is called a heterotopic pregnancy. This occurs naturally in approximately one and 10,000 pregnancies but can occur in 1% of IVF pregnancies. The treatment is much more limited because of the existing intrauterine pregnancy. Typically, surgery is performed on the ectopic pregnancy and hopefully will not disturb the existing normal pregnancy.
Daniela: So, in such cases, the intrauterine pregnancy can be saved?
Dr. Mark Trolice: Yes, usually the intrauterine pregnancy (IUP) remains undisturbed and ongoing.
Symptoms, Diagnosis, and Treatment of an Ectopic Pregnancy
Daniela: Thank you for clarifying. Going back to the basics of an ectopic pregnancy; are there any symptoms which can indicate that this has happened?
Dr. Mark Trolice: Great question! Signs and symptoms of an ectopic pregnancy include being late for your period, abdominal pain, abnormal vaginal bleeding, and nausea, all in the setting of a positive pregnancy test. We must realize an ectopic is a serious condition and potentially fatal if left untreated. In the early part of the 20th century, this kind of pregnancy had a high maternal mortality rate. By the end of the 20th century, due to advances in treatment including vaginal ultrasound for early detection and methotrexate for medical treatment, we now approach the treatment of ectopic with the intent of sparing future fertility. Surgery is the ultimate treatment option and usually, involves removal of the affected fallopian tube. Recent medical evidence demonstrates there is no advantage of trying to save the affected fallopian tube. Subsequent pregnancy rates are the same whether the fallopian tube is spared or removed, as long as the remaining tube is normal. I would like to mention that at least 90% of ectopic pregnancies occur in the fallopian tube and the locations include the ovary, cervix, and in the abdomen.
Dr. Mark Trolice: “Surgery is the ultimate treatment option and usually, involves removal of the affected fallopian tube.”
Daniela: The information you are sharing with us today is imperative in raising awareness on detecting an ectopic pregnancy as early on as possible. If a woman is experiencing these symptoms, what would be the next step for her to follow?
Dr. Mark Trolice: Once she detects a pregnancy and there are concerning symptoms of abdominal pain or vaginal bleeding, she should see her OB/GYN promptly or certainly go to the emergency room if symptoms are severe.
Daniela: And how is an ectopic pregnancy diagnosed?
Dr. Mark Trolice: We use transvaginal ultrasound for early detection of a pregnancy in the fallopian tube. Alternatively, the hormone of pregnancy, hCG, is a guide for the timing of visualizing a pregnancy inside the uterus. When levels of hCG are over 1500-2000IU/L, a pregnancy should be visualized intrauterine otherwise an ectopic pregnancy is highly suspected.
Daniela: You’ve already explained to us the treatment process followed in such a case. For the woman who has already experienced an ectopic pregnancy, what is the probability that a subsequent pregnancy will also be ectopic?
Dr. Mark Trolice: Probably in the range of 10%. Of note, there is an overall lower natural fertility rate if your first pregnancy is an ectopic pregnancy. This suggests an intrinsic damage to the tubes. Risk factors for an ectopic pregnancy are a prior pelvic infection, usually chlamydia, prior tubal surgery, along with smoking, conceiving with an intrauterine device (IUD) in place or after tubal ligation, and older aged women.
Daniela: Thank you for this insight. To close off our discussion, what would be your advice to expectant mothers in this regard?
Dr. Mark Trolice: Avoid tobacco use, use barrier contraception, and see your ObGyn promptly for concerning signs and symptoms in early pregnancy, as well as for any pregnancy that occurs while an IUD is in place or following a tubal ligation.
Daniela: Thank you, Dr. Trolice!