When you’re on the emotional and physical rollercoaster of in-vitro fertilisation (IVF), the last thing you want to hear is the word “complication.”

Unfortunately, for some women undergoing IVF, an ectopic pregnancy can occur. While it’s relatively rare, understanding this risk can help you manage your expectations and spot early warning signs.

This comprehensive guide will cover everything you need to know about ectopic pregnancies during IVF, including how common it is, what causes it, risk factors, symptoms, prevention strategies, and helpful advice from medical experts.

Whether you’re considering IVF or currently navigating the process, this information is designed to reassure and empower you.

An ectopic pregnancy occurs when a fertilised egg implants outside your uterus. Most often, this happens in the fallopian tubes, but it can also occur in other areas such as the cervix, ovaries, or abdominal cavity.

Unfortunately, ectopic pregnancies cannot result in a viable birth and may pose significant health risks to the mother if left untreated.

Dr. Supriya Puranik, a reproductive health specialist, explains, “An ectopic pregnancy is a serious condition, but it can be managed safely with early detection and appropriate care.

Education about the signs and risk factors is crucial, especially for those undergoing IVF.”

The risk of ectopic pregnancy is generally higher with IVF compared to natural conception, although it remains a rare occurrence.

According to various studies, the likelihood of an ectopic pregnancy following IVF ranges between 2% and 5%, compared to about 1%-2% in natural pregnancies.

This elevated risk stems from several factors unique to IVF, including the process of transferring embryos directly into the uterus and any anatomical issues that may have led someone to choose IVF in the first place (like blocked or damaged fallopian tubes).

⇔Why Does IVF Increase the Risk?

One might assume that placing an embryo directly into the uterus eliminates the possibility of it implanting elsewhere, but unfortunately, that’s not always the case. Here’s why ectopic pregnancies can still occur with IVF:

1. Tubal Damage or Dysfunction: Women undergoing IVF often have underlying fertility problems, such as blocked or damaged fallopian tubes, which are already risk factors for ectopic pregnancy.

2. Backward Migration: After embryo transfer, the embryo might migrate back into the fallopian tube and implant there instead of the uterus.
3. Multiple Embryo Transfer: Transferring multiple embryos, which is common in IVF procedures to improve success rates, increases the chances of one implanting outside the uterus.
4. Hormonal Factors: Hormonal medications used during IVF can sometimes affect the movement of the embryo, increasing the risk of abnormal implantation.

Understanding these factors can help manage expectations during IVF and ensure you’re vigilant about monitoring for early signs of ectopic pregnancy.

Certain pre-existing conditions or factors make ectopic pregnancy more likely during IVF treatment. These include:

• Damaged Fallopian Tubes: Conditions like pelvic inflammatory disease (PID), past ectopic pregnancies, or surgeries can cause tubal scarring, increasing the risk.
• Endometriosis: This common fertility issue can distort reproductive anatomy and elevate risks.
• Age Over 35: Advancing maternal age can slightly increase the likelihood of ectopic pregnancies.
• History of Tubal Surgery: Procedures to unblock or remove damaged parts of fallopian tubes may contribute to abnormal implantation pathways.
• Smoking: Smoking is known to damage the fallopian tubes and increase risks of ectopic pregnancy in general.

Dr Puranik adds, “Many patients I see with ectopic pregnancies after IVF have a history of tubal issues or other risk factors. While we can’t always predict when it will happen, understanding individual risks is key to creating a tailored care plan.”

Spotting the symptoms of an ectopic pregnancy early can make all the difference. Here are the most common warning signs:

1. Abdominal Pain: Pain, particularly on one side of your abdomen, can be a red flag. It might feel sharp and sudden or dull and persistent.
2. Vaginal Bleeding: Light or heavy bleeding that doesn’t resemble your usual period may be an indicator.
3. Shoulder Pain: Referred pain in your shoulder can occur due to internal bleeding irritating the diaphragm.
4. Feeling Faint or Dizzy: These symptoms suggest low blood pressure, which may be caused by internal bleeding.
5. Bloating or Gastrointestinal Symptoms: Sudden stomach discomfort can sometimes accompany ectopic pregnancies.

If you experience any of these symptoms, seek immediate medical attention. An ectopic pregnancy can escalate quickly, and delaying care may cause complications.

Doctors use various methods to confirm whether an ectopic pregnancy is present. These may include:

• Blood Tests: Measuring your hCG (human chorionic gonadotropin) levels can help identify abnormal pregnancies.
• Ultrasound Scans: A transvaginal ultrasound is crucial for determining where the embryo has implanted.
• Laparoscopy: Rarely, a minimally invasive surgical procedure might be done to visually examine the fallopian tubes in complex cases.

While ectopic pregnancy isn’t always preventable, there are steps you and your healthcare team can take to reduce the risk during IVF:

1. Thorough Screening: Before starting IVF, ensure that your reproductive system is carefully evaluated. If you have damaged fallopian tubes, your doctor may recommend removing them to lower the risk.
2. Choose Single Embryo Transfer (SET): Transferring one high-quality embryo at a time can reduce the risk of complications like ectopic pregnancy.
3. Closely Monitor Hormones: Work with your fertility specialist to detect and address any hormonal imbalances or irregularities during treatment.
4. Early Blood Tests and Ultrasounds: Once you achieve pregnancy through IVF, close monitoring can catch abnormalities early.
5. Quit Smoking: If you’re a smoker, quitting before starting fertility treatments can improve both your overall fertility and reduce risks associated with ectopic pregnancy.

Ectopic pregnancy is a rare but serious complication of IVF. Understanding its causes, symptoms, and risk factors can help you approach your fertility treatment with realistic expectations and a proactive mindset.

With advancements in IVF technology, improved monitoring practices, and customised care, many women successfully overcome this challenge and go on to have healthy pregnancies.

If you have any concerns about ectopic pregnancy or your IVF treatment plan, speak to your fertility specialist. They’re there to guide, reassure, and ensure you have the best possible support every step of the way.

Remember, complications like ectopic pregnancy are hurdles—not roadblocks. With the right care and preparation, your dream of starting or growing your family is still within reach.

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• About Author

  Dr. Supriya Puranik

  Gynaecologist & IVF Specialist
  
  MMC -072514 (1993)

Dr. Supriya Puranik, a renowned gynaecologist and infertility expert, leads the IVF & Gynaecology department at Sahyadri Hospitals Momstory in Shivaji Nagar, Pune. She is committed to helping couples overcome infertility challenges.