Ectopic Pregnancy and Fertility

An ectopic pregnancy is one in which the fertilized egg implants in a site other than the uterus. The most common place for an ectopic pregnancy to implant is in the fallopian tube; therefore an ectopic pregnancy is sometimes referred to as a tubal pregnancy. The fallopian tube cannot support a growing embryo, and after several weeks the tube may rupture and bleed, resulting in a potentially serious situation.

Ectopic Pregnancy -Illustration courtesy of ASRM

Ectopic pregnancy can be caused by pre-existing tubal damage. This may stem from prior pelvic infection or inflammation, endometriosis, appendicitis, and DES (Diethylstilbestrol) exposure. Prior pelvic or tubal surgery or tubal ligation which has caused scar tissue or adhesions may also be the reason for ectopic pregnancy. Tubes may also be malformed because of birth defects or other anomalous growths.

Symptoms of ectopic pregnancy include missed menstrual period and bleeding during pregnancy. Pain and cramping may be one sided pelvic pain or pain in the shoulder or neck. Pain may come and go and/or cause nausea and vomiting. Dizziness or weakness may accompany symptoms.

An ectopic pregnancy is usually diagnosed by pelvic exam followed by an ultrasound and serial measurements of human chorionic gonadotropin in the blood.

Because and embryo will not survive outside the uterus and because allowing such a pregnancy to further develop is dangerous to the mother, your doctor must intervene. If there has not been rupture of the fallopian tube, Methotrexate injection is the preferred treatment. Methotrexate is very effective in destroying the ectopic tissue and allowing it to be reabsorbed by the body. It may take several weeks to resolve the ectopic pregnancy with the Methotrexate injection. A large number of early ectopic pregnancies can be successfully treated with the injection, leaving the tube open in a majority of women. Patients who have liver and/or kidney disease are generally not candidates for Methotrexate therapy. Other patients that are not candidates for this injection are those who are breastfeeding, those with an active lung disease, and those with active peptic ulcer disease.

In some cases, surgery to remove the pregnancy may be required. Generally, surgery is performed using a laparoscope which is used through small incisions in the belly button and lower abdomen. Surgery with a larger incision, called a laparotomy, may be needed in some cases.

There is still a good chance you can achieve a normal pregnancy after experiencing an ectopic pregnancy. Talk to your physician about your specific circumstances and when you can try again.

Download our pamphlet about the Methotrexate injection


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