Other symptoms include dizziness and fainting, which suggest profound intraabdominal bleeding. In some cases, there is no prior history or risk factors involved but ectopic pregnancy is still observed.
Ectopic pregnancy is generally diagnosed by serial measurements of the pregnancy hormone called beta hCG and a pelvic vaginal ultrasound. Beta hCG hormone levels double every days in the first weeks of a normal pregnancy.
A vaginal pelvic ultrasound is very helpful in differentiating a normal pregnancy from an ectopic pregnancy in most cases. In very early pregnancies, it can be difficult to visualize the pregnancy in the uterus.
If the beta hCG level is above , an intrauterine pregnancy can be seen with vaginal ultrasound. Especially if a yolk sac or a fetal pole is observed, ectopic pregnancy is ruled out.
If there is no gestational sac or there is a gestational sac or pseudosac may look like a normal pregnancy , but there are no other structures yolk sac or fetal pole suggesting a pregnancy in the uterus, ectopic pregnancy is highly suspected or diagnosed.
On ultrasound, presence of blood in the pelvic cavity can be visualized and depending on the amount, it can be diagnostic of bleeding from the end of the tube without rupture or a full blown ruptured ectopic pregnancy. In some cases, the diagnosis can be difficult because there can be blood in the pelvis but the tube may still be intact.
In others, small amounts of blood may be due to a torn tube from the ectopic. For this reason, a historic intervention called culdocentesis withdrawal of blood with a syringe from the pelvic cavity through vaginal approach is no longer performed because the presence of blood does not confirm or rule out a ruptured ectopic pregnancy.
In some cases of early miscarriage, similar symptoms can be observed and complicate the diagnosis and clinical treatment approach. Ectopic pregnancy can be managed expectantly, medically by the use of Methotrexate or surgically through laparoscopy or open abdominal surgery called laparotomy.
Expectant management includes careful monitoring of symptoms, measurement of beta hCG levels and ultrasound examinations. If there is no change in the clinical status and beta hCG levels are steadily decreasing, expectant management is appropriate.
Medical management of ectopic pregnancy includes the administration of a chemotherapeutic agent called Methotrexate MTX intramuscularly in clinically stable patients. MTX destroys rapidly dividing cells, such as those present in an early pregnancy and side effects are limited because of the low dose of medication used.
When a fertilised egg or early embryo implants outside the uterus and starts to grow, it is known as an ectopic pregnancy. The most common place for an ectopic pregnancy is in the fallopian tube the tube which takes the egg from the ovary to the uterus.
Occasionally a pregnancy can become established partly in the uterus and partly in the fallopian tube but that is exceedingly rare. If the tube becomes blocked or the hairs damaged, which can happen following a local infection, an ectopic pregnancy is more likely. Women who have had surgery on their tubes are also at greater risk of ectopic pregnancy.
No, it is still possible that an embryo transferred into the uterus as part of IVF treatment can find its way into a fallopian tube and cause an ectopic pregnancy. If the tubes are damaged which may be the reason you are having IVF in the first place , then an embryo that finds its way into a tube is less likely to get carried back to the uterus naturally.
Once you have a positive pregnancy test, the signs to look out for are unusual pain in your abdomen and vaginal bleeding. A vaginal ultrasound scan can show whether your pregnancy is in the uterus from about 5 to 6 weeks onwards. During the 11 to 14 days when your pregnancy test is positive but it is too early for an ultrasound to confirm exactly where the pregnancy is positioned, your doctor can monitor you for warning signs if you are at risk.
Your doctor may order a blood test every two days to track changes in hCG hormone levels. In a normal pregnancy, the hormone level will normally double between tests. There appears to be an increased rate of ectopic pregnancies after ART when compared to rates in spontaneous pregnancy [ 11 ]. As the number of IVF procedures performed continues to rise, the incidence of ectopic and abdominal ectopic pregnancy will likely also rise.
While there are still relatively few reported cases of abdominal ectopic pregnancies after IVF, our systematic review demonstrates several trends among reported cases. In a larger, more recent study of , ART cycles in the US, among all infertility diagnoses, TFI was the only one significantly associated with increased risk for ectopic pregnancy adjusted relative risk RR 1.
A retrospective study that measured the risk of EP following IVF in women with a previous ectopic demonstrated a fold higher risk of recurrence when compared with women with other causes of infertility. The authors reported that the prevalence of EP was 8.
Odds ratio for developing EP was 8. Interestingly, bilateral salpingectomy was the most common tubal surgery reported in our case review. While the exact mechanism of abdominal ectopic after bilateral salpingectomy remains unclear, many authors have proposed that it may be due to the development of a micro-fistulous tract after salpingectomy.
Uterine perforation during embryo transfer has also been suggested as a mechanism for abdominal ectopic pregnancy, and embryo transfer technique has been related to overall EP risk after IVF. Aspects of the transfer that may increase risk of EP include large volume of transfer media, induction of abnormal uterine contractions, and location of embryo transfer in relation to the uterine fundus [ 9 ]. These factors have all been associated with retrograde flow of both transfer media and the embryo toward the fallopian tubes.
Multiple embryo transfer has always been associated with increased risk of EP with transfer of two or less embryos carrying lower risk than after three or more embryos [ 20 ]. In the setting of multiple embryo transfers, identification of an intrauterine pregnancy often leads to delayed diagnosis of abdominal pregnancy in the absence of clinical symptoms. Among the heterotopic cases, 4 reported a 2 week delay in diagnosis of the abdominal ectopic from the time of suspected ectopic, and 5 cases did not identify the abdominal ectopic until beyond the 12th week of pregnancy.
Unfortunately, this type of delayed diagnosis has the potential to lead to significantly morbid outcomes. In our review, four cases of viable abdominal pregnancies were identified, which is an extremely rare outcome. Three of these cases were identified at 19 weeks or beyond, and all three had attachment of the abdominal placenta to the peritoneal surface of the uterus without involvement of other abdominal organs. Placental attachment to the uterus has previously been associated with viability of abdominal pregnancies [ 21 ], and with a relatively lower risk of bleeding and lower likelihood of fetal growth retardation [ 22 ].
This may be due to the fact that frozen embryo transfer has become widely used only recently, and we may begin to see higher frequency with frozen embryo transfers over time. However, several recent studies indicate that ectopic pregnancy rates are higher for fresh as compared to frozen IVF cycles [ 1 , 6 ]. A limitation of this review is the heterogeneity of reported cases and IVF practices which encompass several decades.
Further research focusing on more homogenous population may help in better characterizing this rare IVF complication. In conclusion, ectopic pregnancy, including abdominal ectopic, is a known risk of IVF. The case reported highlights the diagnostic challenges behind this rare form of ectopic pregnancy, and the need to keep it in the differential in atypical ectopic presentations. Our systematic literature review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers.
Ectopic pregnancy after in vitro fertilization: differences between fresh and frozen-thawed cycles. Fertil Steril. Article PubMed Google Scholar.
Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol. Sites of ectopic pregnancy: a 10 year population-based study of cases.
Hum Reprod. Alto WA. Abdominal pregnancy. Am Fam Physician. Study on the incidence and influences on ectopic pregnancy from embryo transfer of fresh cycles and frozen-thawed cycles. PubMed Google Scholar. Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy? An analysis of more than 30, cycles.
Slightly lower incidence of ectopic pregnancies in frozen embryo transfer cycles versus fresh in vitro fertilization-embryo transfer cycles: a retrospective cohort study. Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of assisted reproduction technology cycles.
Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol. Abdominal pregnancy in the United States: frequency and maternal mortality. Abdominal pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy. Risk factors for ectopic pregnancy after in vitro fertilization treatment.
J Obstet Gynaecol Can. Reduce possible risks from fertility medications by choosing to pursue mini IVF, a cost-effective form of IVF that reduces fertility medications to gently stimulate egg production. If you are experiencing symptoms of an ectopic pregnancy, you should call us right away to schedule an appointment. Timely treatment is critical when it comes to this complication.
You can reach out to us at any one of our Los Angeles area locations, or you can send us a message online for less urgent matters. Consult with your doctor to understand the risks associated with your chosen fertility treatment.
Note: This is not intended to be a substitute for professional medical advice, diagnosis or treatment. Information provided is for general educational purposes only and is subject to change without notice.
Speak to your doctor directly with any questions you may have regarding a medical condition. Any information contained herein does not replace any care plan as determined by a physician. Call us. Call Us. Contact us. Book a consultation. Patient Login. Book a Consultation. Ectopic pregnancy Learn about symptoms of ectopic pregnancy, the diagnosis process, and treatments that are used to correct this rare health risk of IVF and natural conception. What is an ectopic pregnancy?
Symptoms of ectopic pregnancy Ectopic pregnancy usually occurs within the fallopian tube known as a tubal pregnancy.
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