An ectopic pregnancy occurs when an embryo implants outside of the uterus. The most common
location is the fallopian tube. People who have had one or more ectopic pregnancies in the past
are at increased risk for another in the future. Can anything be done
to reduce the risk of another ectopic pregnancy? Stay tuned
In humans, the egg is fertilized in the fallopian tube.
The fertilized egg is moved into the uterus by the fallopian tube. A tubal ectopic pregnancy
occurs when the tube has either been damaged or is not functioning properly.
The most common cause for tubal damage is from infection. The most common
infection which causes ectopics is the bacteria chlamydia. Another bacteria which commonly causes
tubal damage, especially in southeast Asia, is tuberculosis. One way to reduce your chance
for an ectopic pregnancy is to avoid getting a tubal infection. If you currently have a pelvic
infection, there may be some benefit to starting effective antibiotic treatment as soon as possible
to limit the amount of tubal damage. If you have already had an infection, it is too late,
the damage to the tubes has already been done. Nothing can be done to reverse it.
Another cause of tubal damage is surgery. For example, people who have had a tubal ligation
and then a tubal reversal are at higher risk for an ectopic pregnancy.
The same is true for surgery to open blocked fallopian tubes..
Surgery is also sometimes used to treat an ectopic pregnancy. I’ll talk more about that later.
There are a number of factors which can cause the fallopian tube to not function correctly. Many of
these are factors you can modify and which will reduce your chances for an ectopic. For example,
smokers are four times more likely to have an ectopic pregnancy. Quitting smoking, therefore,
could reduce your risk for an ectopic. It takes a long time to see the benefit,
however. This study found that the risk for former
smokers took 10 years after quitting to get to the rate of never smokers
Drinking alcohol also increases the risk for an ectopic pregnancy.
10 g of alcohol per day increased the risk by 50%. That’s about 3 and a half ounces of wine.
Stopping or reducing your alcohol use could reduce your risk for an ectopic
One factor that may impact the risk of a repeat ectopic pregnancy
is how the first one was treated. Does the method of treatment matter?
A number of studies have tried to answer this question.
This study looked at people who had one previous ectopic pregnancy. Patients were divided into
three groups. One group had surgery, either to remove the ectopic or to remove the entire tube. A
second group were treated with a medication called methotrexate and a third group was monitored very
closely and eventually their ectopic pregnancies resolved on their own. Doctors call this expectant
management. In this study, all three groups had a fairly low rate for another ectopic
and they were not able to show any significant benefit of one treatment versus another.
This study looked at people who had two previous ectopic pregnancies.
This is a high risk group for having a 3rd ectopic. They discovered that the
expectant management group had a much higher chance for having a 3rd ectopic pregnancy.
About half of the people in this group had another ectopic with their next pregnancy
compared to 18% for the medication group and 13% for the surgery group.
This is important for people who put their faith in con artists like homeopaths. Since
the products they sell have no benefit in treating an ectopic pregnancy, it is the
same as expectant management. It is extremely important that people who take these products
have close monitoring with blood tests and ultrasound under a physician’s care. Some of
these will result in the ectopic rupturing, which is a life threatening condition.
For those that do resolve, the risk for another ectopic is much higher.
Finally, I want to talk about IVF. In people who have had a previous ectopic pregnancy,
conceiving with IVF will reduce the risk for another ectopic. The risk is not zero,
however. Even with IVF, people with previous ectopics are still at greater risk than people
who have never had an ectopic. Choices made during IVF, also affect the risk. For example, having a
frozen embryo transfer lowers the risk for an ectopic by about 85% compared to a fresh transfer.
Transferring a single embryo at a time reduces the risk compared to transferring two or more embryos.
Our InfertilityTV Bottom Line is this. There are things you can do to lower your risk for an
ectopic pregnancy. Stop smoking and drinking alcohol. Avoid getting a pelvic infection
and if you get one, treat it promptly and effectively. If you do get an ectopic pregnancy,
active treatment with surgery or medications is preferable to the
“let things resolve on their own” approach. Finally, frozen embryo transfer with a single
embryo can significantly reduce the risk compared to getting pregnant on your own.