What are the chances of having another ectopic pregnancy

Getting pregnant after a tubal pregnancy can be difficult and there are risks. Women that have had ectopic pregnancies often have damaged, scarred or blocked tubes.

There are 2 main reasons that fallopian tubes in women that have had ectopics might be abnormal.

• The tube was already damaged. Ectopics are often caused by scarred fallopian tubes which cause the early embryo to get stuck in the tube before it reaches the uterus.
• Sometimes the fallopian tube was normal until the tubal pregnancy. A tubal pregnancy can cause significant damage to the inner lining of the tube.

Ectopic pregnancy occurs when the fertilized embryo implants on a tissue other than the endometrial lining of the uterus. They are almost always in the fallopian tubes.

How to get pregnant after tubal pregnancy

• Wait a few months for the damaged area to heal. Then try on your own – with the understanding that you are at high risk for a repeat tubal pregnancy (see below).
• Or, have in vitro fertilization. We put 1 or 2 embryos into the middle of the uterine cavity with a very low risk for ectopic.

Fertility after ectopic pregnancy – chance for a successful pregnancy after a tubal pregnancy

• Tube sparing surgery for small unruptured ectopics results in open tubes after healing in about 80% of cases.
• The ratio of intrauterine to recurrent tubal pregnancy is about 6:1 but it rises to about 10:1 if the other tube appears normal.

After one ectopic and a tubal sparing surgery:

The subsequent delivery rate is about 55%
• The recurrent ectopic rate is about 15% (so about 20% of pregnancies are ectopics)
• The infertility rate is about 30%

  If the other tube is absent or blocked:

  • The subsequent delivery rate is about 45%
  • The recurrent ectopic rate is about 20% (so about 30% of pregnancies are ectopics)
  • The infertility rate is about 35%

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  After 2 or more ectopics and conservative surgery:

  • The subsequent delivery rate is about 25%
  • The recurrent ectopic rate is about 25% (so about 50% of pregnancies are ectopics).
  • The infertility rate is about 50%

  As a woman has more and more ectopics, the chances for a live birth delivery (without IVF treatment) become less and less.

  ---

  IVF after ectopic pregnancy

  In vitro fertilization, IVF will be the best option for having a successful pregnancy for many women with a history of tubal damage and one or more ectopic pregnancies.

  Our IVF success rates

  • Pregnancy success rates with IVF are excellent in (young) women with tubal problems
  • Tubal pregnancy results from in vitro in only about 3% of cases

What monitoring is needed in a second pregnancy after ectopic pregnancy

• Any pregnancy after an ectopic needs to be carefully monitored in the early stage to confirm the location.
• After the missed menstrual period or positive home pregnancy test, blood hCG levels can be done to evaluate whether they are rising at an appropriate rate.
• By about 5 to 6 weeks of pregnancy transvaginal ultrasound can be done to confirm that there is a gestational sac and yolk sac within the uterine cavity.
• If that is not seen by six weeks, suspicion should be high for another ectopic
• Once the pregnancy is confirmed in the uterus, it can be treated normally
• Pregnancy after tubal removal
• Sometimes women will have both fallopian tubes surgically removed
• This can be due to ectopic pregnancies or other tubal or pelvic problems
• After the tubes are gone the only way to have a baby is with in vitro fertilization
• IVF has high success rates for women without fallopian tubes (or with damaged tubes)

. 1989 Mar-Apr;34(2):102-5.

Affiliations

• PMID: 2565312

Reproductive outcome after multiple ectopic pregnancies

J Uotila et al. Int J Fertil. 1989 Mar-Apr.

Abstract

Seventy-six patients with two or more ectopic pregnancies treated at the Department of Obstetrics and Gynecology, University Central Hospital, Tampere, Finland over a period of 14 years (1972-1985) were retrospectively analyzed. Conservative tubal surgery had originally been performed in 57% of patients with a repeat tubal pregnancy, and in 41% of control patients with a single tubal pregnancy. After two ectopic pregnancies, 53 patients were actively trying to conceive. Of these patients, 25% achieved delivery, 40% had a third ectopic pregnancy, and 35% did not conceive. Ipsilateral tubal pregnancy occurred in 83% after salpingotomy, in 88% after fimbrial evacuation, and in 47% after tubal resection. Conservative surgery was performed in 16 patients with only one tube where an ectopic pregnancy occurred; 25% had a term delivery, 25% had a repeat ectopic pregnancy, and 50% did not conceive. Follow-up of 19 patients after three tubal pregnancies showed that 16% delivered, 26% had a repeat tubal pregnancy, and 58% did not conceive. There was no significant difference between fertility results after salpingectomy and those after conservative surgery.

Similar articles

• [Fertility following tubal pregnancy: comparison of tube-saving surgery and salpingectomy].

  Menton M, Neeser E, Hirsch HA. Menton M, et al. Geburtshilfe Frauenheilkd. 1990 Jan;50(1):29-32. doi: 10.1055/s-2007-1026427. Geburtshilfe Frauenheilkd. 1990. PMID: 2311903 German.

• Reproductive outcome after microsurgical treatment of tubal pregnancy in women with a single fallopian tube.

  Oelsner G, Rabinovitch O, Morad J, Mashiach S, Serr DM. Oelsner G, et al. J Reprod Med. 1986 Jun;31(6):483-6. J Reprod Med. 1986. PMID: 3735260

• [Risk of recurrence and rate of intrauterine pregnancy after endoscopic therapy of extrauterine pregnancies. 10 years experiences with the treatment of 709 extrauterine pregnancies].

  Zöckler R, Dressler F, Raatz D, Börner P. Zöckler R, et al. Geburtshilfe Frauenheilkd. 1995 Jan;55(1):32-6. doi: 10.1055/s-2007-1022770. Geburtshilfe Frauenheilkd. 1995. PMID: 7705596 German.

• Three consecutive recurrent ectopic pregnancies.

  Adelusi B, al-Meshari A, Akande EO, Chowdhury N. Adelusi B, et al. East Afr Med J. 1993 Sep;70(9):592-4. East Afr Med J. 1993. PMID: 8181445 Review.

• [Recurrence after conservative celioscopic treatment of a first ectopic pregnancy].

  Chapron C, Pouly JL, Mage G, Canis M, Wattiez A, Bassil S, Manhes H, Bruhat MA. Chapron C, et al. J Gynecol Obstet Biol Reprod (Paris). 1992;21(1):59-64. J Gynecol Obstet Biol Reprod (Paris). 1992. PMID: 1533407 Review. French.

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