Trying For A Baby / 26 October, 2017 / Julie Price

Is It Harder To Conceive After An Ectopic Pregnancy?

Can an ectopic pregnancy after your chances of conceiving in the future? Consultant Obstetrician and Gynaecologist Julie Price explains what an ectopic pregnancy is, how to identify it, how it is treated and whether it makes trying for another baby more difficult.

What is ectopic pregnancy? How would I be able to tell if I had one?

An ectopic pregnancy means ‘an out of place pregnancy’. It happens when a fertilised ovum (egg) becomes stuck in the fallopian tube, or more rarely in other places in the pelvis or abdomen, and develops there instead of moving down into the uterus (womb).

The symptom of an ectopic pregnancy are:

Pain

One-sided abdominal pain which can be mild or severe. It may begin suddenly and be persistent. Shoulder tip pain is the result of internal bleeding.

Abnormal bleeding

If your period is lighter or heavier than usual or prolonged and not like a normal period then this could indicate an ectopic pregnancy and you should do a pregnancy test.

Collapse

You may be feeling light-headed or faint.  Other signs such as paleness, increasing pulse rate, sickness diarrhoea and falling blood pressure may also be present.

Bladder and bowel problems

If you feel pain when you have your bowels open or pass urine and think you might be pregnant you should go for a check up and mention this.

Pregnancy test

This is usually positive, as the over the counter urine testing kits are very sensitive in detecting the pregnancy hormone Beta HCG.

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Missed period

This usually means you are having a normal pregnancy but if you have any of the above symptoms then you must contact your GP ASAP or Accident & Emergency if your doctor is unavailable.

What are causes and how can I prevent an ectopic pregnancy?

Ectopic pregnancy cannot be prevented as it is due to past tubal damage, rather than present. Any sexually active woman is at risk, however ectopic pregnancies are more likely if you have had:

• Pelvic inflammatory disease e.g. chlamydia
• Endometriosis
• Abdominal surgery such as caesarean section, appendicectomy
• Sterilisation
• A contraceptive coil (IUCD) fitted
• The progesterone only contraceptive pill
• Take the morning after pill
• Fertility treatment e.g. IVF
• A previous ectopic pregnancy

What would happen if I did not know? Could it be fatal?

Ectopic pregnancy is a life threatening condition, which, if not medically managed and treated, can end the life of the mother. 

Is it harder to conceive after an ectopic?

This depends very much on the health of your tubes. The loss of a tube does reduce success rates, but you can still become pregnant and have a successful pregnancy with only one tube intact. Overall 65% of women are pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over 2 years.

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How is an ectopic pregnancy treated?

There are three main types of treatment:

Surgical

Surgical treatment involves performing an operation to remove the ectopic pregnancy under general anaesthesia.  The most likely technique is laparoscopic (keyhole) surgery. Traditional surgery is by laparotomy (opencut on the lower abdomen) and is occasionally used if there is heavy internal bleeding or complications during laparoscopy.

Medical

Medical treatment uses a drug called Methotrexate which stops the pregnancy developing further and the pregnancy is gradually re-absorbed.  It is only suitable if the tube has not ruptured, the pregnancy hormone HCG is low and there is minimal abdominal bleeding.

Expectant Management

Expectant management is defined as close monitoring by the gynaecologist instead of immediate surgery or drug treatment.  More than half of all ectopic pregnancies will end naturally without the need for any treatment. This is appropriate when an ultrasound scan shows a very small ectopic pregnancy with no bleeding and the pregnancy hormone Beta HCG is low.

By Miss Julie Price FRCOG

Consultant Obstetrician and Gynaecologist at The Portland Hospital for Women and Children

The Ectopic Pregnancy Trust: the charity for early pregnancy complications