Ectopic Pregnancy in IVF

What is an Ectopic Pregnancy?

An ectopic pregnancy (in IVF) is a complication of pregnancy, it occurs when an embryo grows or implants outside the uterus. Since an embryo cannot survive outside the uterus, ectopic pregnancies are not viable and cannot survive. It is also a phenomenon that is considered fatal for women as it may cause death if allowed to progress. Immediate medical attention is usually required upon discovery to avoid life-threatening consequences.

What is the cause of ectopic pregnancy in IVF?

The most common and recognized cause of ectopic pregnancy is a misshapen or inflamed fallopian tube. Other causes may be from abnormal development of an egg or even hormonal imbalances

What are the risk factors of ectopic pregnancy?

In some instances, infertility may play a role in ectopic pregnancy; ectopic pregnancy may happen due to infertility. Many risk factors may elicit ectopic pregnancy especially in IVF, from fallopian tube pathology, pelvic inflammatory disorders, and even the embryo transfer technique. Some major risk factors that may cause ectopic pregnancy includes:

• Maternal age – the risk of ectopic pregnancy increases with maternal age and this is mainly attributed to an increase in chromosomal abnormalities in the trophoblastic tissue. It may also be related to age-induced changes in tubal function.
• Tubal pathology – a disorder called hydrosalpinx is the main cause of tubal infertility and is also associated with a failure of the IVF process.
• Previous extra-uterine pregnancy – there is a tendency for reoccurrence in the case of one extra-uterine pregnancy, this risk increases with two such pregnancies. However, the risk is reduced if there is a normal pregnancy after an ectopic pregnancy.
• Smoking – this increases the risk of ectopic pregnancy following IVF treatment, about three times more than seen in non-smokers.
• Previous tubal surgeries – the level of risk of ectopic pregnancy increases with damage to the fallopian tubes and their anatomic distortion. Altered tubal motility due to this damage can cause ectopic pregnancy.

What are the symptoms of ectopic pregnancy?

Ectopic pregnancy usually occurs within the fallopian tubes, referred to as tubal pregnancy. However, they may also occur in other parts of the female reproductive system like the ovaries, the cervix, and even the abdominal cavity. The first signs of an ectopic pregnancy are pelvic pain, discomfort, and some light vaginal bleeding. However, as the egg continues to grow and develop in the wrong location, the symptoms become worse and more severe. If left unattended to, the symptoms seen are:

• Lightheadedness and fainting
• Looking very pale
• Feeling very sick
• Severe abdominal pain
• Blood leaks from the fallopian tube
• An unsettled stomach may present as an urge to stool
• Ruptured fallopian tube

A ruptured fallopian tube leads to massive abdominal bleeding and requires immediate medical attention to avoid life-ending consequences.

How can ectopic pregnancy be diagnosed?

In order to diagnose an ectopic pregnancy, the doctor needs to perform a physical examination of the abdomen. This is to locate the area of pain and tenderness. Additional tests are needed to confirm the diagnosis. Some of these tests are:

• Blood testing – this is done to confirm the presence of pregnancy, it is done through an hCG test, and the levels are checked every few days until the fifth or sixth week of pregnancy where an ultrasound can be used to confirm. The blood test can also be done to determine if the patient has anemia or other signs of blood loss.  
• Ultrasound – this can be done in two ways, on the abdomen or transvaginally. The ultrasound uses sound waves to visualize the reproductive tract and organs. It can be used to confirm the presence of an ectopic pregnancy or internal bleeding.

Is there any treatment for ectopic pregnancy?

Ectopic pregnancy is considered a medical emergency and must be resolved; this usually means removing the ectopic embryo. The treatment option to be used is dependent on factors like symptoms experienced, the stage of the pregnancy, and the state of the patient. They include:

Medication 

This is used when ectopic pregnancy is discovered in the early stages, and the bleeding is minor. The situation can be resolved with medication which halts cell growth and dissolves the existing cells. The treatment is confirmed to have worked by subsequent testing of the patient for hCG levels.

Surgery 

This is where a small incision is done on the abdomen, near the navel. A thin tube is then threaded through the incision to visualize the tubal area. This aids in the removal of the ectopic pregnancy, after the removal the fallopian tube is either repaired or removed.

Ectopic pregnancy and IVF

There is an assumption that IVF increases the chances of an ectopic pregnancy occurrence. However, the chances of an ectopic pregnancy are about the same in IVF as in normal pregnancy. A theory of the cause of ectopic pregnancy is that the hydrostatic force generated by the transfer medium during embryo transfer can pull the embryo into the fallopian tube. 

Another theory is that the gravitational pull causes the embryos to enter the hanging tubes. Also, another theory is that the contraction of the uterus causes reflux expulsion of the embryo into the fallopian tubes. Faulty transfer techniques can also lead to an increase in the probability of an ectopic pregnancy occurrence. However, all these are theories, and none have been proven as an actual cause of ectopic pregnancies.

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