Ectopic Pregnancy After IVF: Is It Possible? Causes, Symptoms, and Risks

IVF offers the much-needed hope to couples who have tried all possible ways to conceive naturally but failed. The procedure helps fertilize an egg outside your womb and involves transferring the resulting embryo back into the womb. Recent advancements in fertility medicines have significantly improved the IVF success rate. 

While the procedure turns out successful for many couples, it does carry risks, some of which can be life-threatening, such as ectopic pregnancy after IVF. Although it’s uncommon, it is possible ble. Knowing your risks and understanding the complications of IVF-related ectopic pregnancy can help you prepare in advance and report unusual symptoms to your fertility specialist early.

What is an Ectopic Pregnancy?

Ideally, pregnancy occurs in the womb. The fertilized egg grows there. An ectopic pregnancy is a life-threatening condition where the embryo grows outside the uterus, in the fallopian tubes, and in rare cases, cervix, abdominal cavity, ovaries, or within the previous C-Section scar.

Did you know 8.38 million cases of ectopic pregnancies were reported in 2021, according to a study? 

Pregnancy growing anywhere other than the uterus cannot be continued, as these places aren’t meant to support a growing baby. So, such pregnancies require termination, preferably as early as possible, to prevent severe maternal complications.

Can Ectopic Pregnancy Happen After IVF?

Yes, it’s possible. Research shows that the risk of ectopic pregnancy after an embryo transfer is less than 5% in healthy individuals, but it can increase to 11% in women with tubal factor infertility. The problem isn’t the IVF itself, but the underlying fertility issues that can increase the risk of an embryo implanting in the wrong places.

It’s natural to think about how ectopic pregnancy can be possible with IVF. After all, fallopian tubes are completely bypassed during the procedure. However, it does carry a relatively increased risk of EP incidences compared to normal pregnancies. The embryo, once transferred to the uterus, can later migrate to the fallopian tubes and other sites. 

Surprisingly, IVF may lower the risk in some patients, especially those with severe tubal damage, as the eggs do not enter the tubes. But that alone doesn’t mean a lowered risk for all patients. Always talk to your healthcare provider about ectopic pregnancy risks before proceeding with IVF.

Causes of Ectopic Pregnancy After IVF

So, what exactly makes an ectopic pregnancy likely after IVF? Here are the contributing factors.

Tubal Damage 

Tubal damage can occur due to scarring from previous abdominal surgery, pelvic inflammatory disease, sexually transmitted infections, a history of ectopic pregnancy, and endometriosis. It’s when the tubes are partially or completely blocked, severely scarred, or too damaged to support natural conception. 

Due to tubal defects, there’s a possibility the embryo might get trapped in the tubes instead of traveling down to the uterus. Even during IVF, the embryo could migrate to one of these tubes and might implant there. 

Embryo Migration

A fertility specialist carefully transfers the embryo into the uterus. However, occasionally, the embryo, instead of settling in the uterine wall for implantation, can travel to the cervix, tubes, or other parts of the reproductive tract. That’s called embryo migration. Although it’s rare, it is an IVF risk factor. This can lead to ectopic pregnancy.

Underlying Fertility Conditions

Sometimes, pre-existing medical conditions that interfere with your normal fertility can also cause complications during IVF. Endometriosis, pelvic infections, and scar tissues are all contributing factors.

Multiple Embryo Transfers

Many clinics strictly adhere to a single embryo transfer because of the risks of multiple births. Still, some fertility centers transfer multiple healthy embryos to increase pregnancy chances. It’s also associated with a small risk of heterotopic pregnancy, where two pregnancies can occur at the same time, one growing inside and another outside the uterus.

Symptoms of Ectopic Pregnancy After IVF

Symptoms of ectopic pregnancy after IVF are similar to those present in people who conceive naturally. The biggest reassuring part is that EP after IVF is, in most cases, caught earlier than usual because these pregnancies are monitored closely and more frequently than normal pregnancies. If you are concerned, watch out for these symptoms:

• Light or heavy vaginal bleeding during pregnancy. It may appear red, pink, or brown.
• Sharp, dull, or cramp-like pain felt in one side of the lower abdomen. It occurs when the tubes start stretching as your pregnancy grows.
• Cramps that feel like menstrual cramps but worsen over time
• Shoulder tip pain
• Ruptured tubes can also cause dizziness, faintness, or weakness because of a drop in blood pressure.

Some of these symptoms are also present in normal pregnancy. For example, light vaginal bleeding can occur during implantation. Still, it’s best to report any unusual symptoms to your fertility care team. 

How is Ectopic Pregnancy Diagnosed?

If you have had IVF, chances are your doctor may recommend early ultrasound scans to confirm pregnancy and its location. This helps diagnose ectopic pregnancy much earlier than normally conceived pregnancies. 

Blood Tests: In normal pregnancies, a pregnancy hormone called Human Chorionic Gonadotropin (HCG) rises steadily in the first few weeks. If the hormone rises too slowly or drops instead of increasing, it can be an early sign of an ectopic pregnancy. It doesn’t necessarily mean ectopic pregnancy, but your fertility specialist will want to rule that out if your blood test shows abnormally rising HCG.

Ultrasound: An abdominal or transvaginal ultrasound can detect an ectopic pregnancy. In a healthy pregnancy, the ultrasound report shows a gestational sac in the uterus. This can be seen as early as 5-6 weeks, given that your HCG levels have reached a certain level.

Physical Examination: Your fertility doctor may also check your abdomen, pelvis, and surrounding structures for tenderness or signs of internal bleeding. It may not be a confirmed diagnostic method for ectopic pregnancy, but it can give important clues.

Treatment Options for Ectopic Pregnancy

Treatment for ectopic pregnancy is determined based on its location and severity. Here’s what’s recommended:

Medication

For early-stage ectopic pregnancy that hasn’t ruptured yet, medication can be advised. Methotrexate is used to stop an embryo’s growth. 

After this injectable shot, your body will absorb the pregnancy tissue, preventing the need for surgery. You may need frequent blood tests and follow-up visits to ensure the pregnancy has stopped continuing.

Surgical Treatment

If there is a large pregnancy tissue that doesn’t respond to medication alone or cause severe symptoms, a surgical procedure may be necessary. 

Surgery might involve removing the ectopic pregnancy, sometimes along with the affected fallopian tube. That’s usually needed if the tube is extensively damaged or is bleeding heavily. The surgeon may recommend a laparoscopic procedure or keyhole surgery to remove the ectopic pregnancy.

When to Seek Immediate Medical Help

Visit a fertility expert immediately if you experience these symptoms:

• Severe abdominal pain
• Heavy bleeding
• Fainting
• Shoulder tip pain

Emotional Impact & Recovery

Ectopic pregnancy can feel devastating, especially for couples who got pregnant after IVF. The fear, anxiety, stress, and grief can all take a toll on your emotional health. While ectopic pregnancy does raise the risk of subsequent ectopic pregnancies, a healthy pregnancy is still possible. What you can do is seek help from parents, your partner, friends, and support groups. Counseling can particularly be helpful for your emotional recovery. 

Can You Get Pregnant After Ectopic Pregnancy?

It’s possible to have a healthy pregnancy in the future, both naturally and with assisted reproductive technology after an ectopic pregnancy. However, the risk of its recurrence is slightly higher in women who have had an ectopic pregnancy before. 

That’s why doctors recommend regular monitoring through ultrasounds and blood tests, especially in the early weeks, to ensure the pregnancy has implanted in the uterus.

How Soon Can You Try Again After an Ectopic Pregnancy?

This depends on your treatment and is very important. If you took methotrexate to terminate an ectopic pregnancy, you may need to wait for at least three months or two menstrual cycles before trying again. Methotrexate is a folate antagonist that interferes with folic acid function in your body. 

Since folate is an important nutrient for fetal growth, you may be advised to avoid trying until the medicine has been completely cleared from your system and you have gotten adequate time to recover the normal folate levels required for a healthy pregnancy. If you have had surgery to end an ectopic pregnancy, you may need to wait 2-3 months before trying again. This can be much longer if you have had the affected tube removed.

FAQs

How common is ectopic pregnancy after IVF?

The risk is less than 5% and is usually around 1-2%, but can vary significantly depending on the individual risk factors and the woman’s medical history.

What are the common symptoms of an ectopic pregnancy after IVF?

Vaginal spotting, bleeding, abdominal pain, and faintness can all be signs of an ectopic pregnancy. 

Can IVF completely prevent ectopic pregnancy?

No, it can minimize the risk for some couples, but it can’t be the definitive way to avoid ectopic pregnancy.

Is ectopic pregnancy dangerous?

Yes, it can be dangerous if not addressed promptly. Tubes can overstretch and rupture if the pregnancy continues to grow in the tubes. This can cause heavy internal bleeding.

Is pregnancy possible after an ectopic pregnancy?

Yes, many women conceive naturally or with IUI, IVF, and other assisted reproductive procedures after an ectopic pregnancy.

How soon can you try IVF again?

It depends on the treatment. Ideally, waiting for 2-3 months is advised to allow your body enough time to heal from the surgery and the blood loss.

Do I need a blood transfusion for ectopic pregnancy surgery?

No, not necessarily. However, if you have suffered significant blood loss, a blood transfusion may be needed to stabilize your condition.