What Are the Risks of Ectopic Pregnancy in IVF and How to Prevent It?

What Is Ectopic Pregnancy In IVF

In a normal pregnancy, the fertilized egg moves from the fallopian tube to the uterus, where it can implant and grow into a fetus. The uterus is the ideal environment for a developing embryo, providing the necessary support and nutrients. However, ectopic pregnancy in IVF has a maximum probability, because sperms are artificially inserted into the fallopian tube cannot mobilize naturally hence, the fertilized egg develops outside the uterus, generally in the fallopian tube (called a tubal pregnancy). This location cannot support the embryo’s development. Therefore, they can lead to severe complications such as a ruptured fallopian tube, significant internal bleeding, and potentially life-threatening conditions or pregnancy loss. Unlike a normal pregnancy, an ectopic pregnancy cannot result in the birth of a viable baby and requires medical intervention.

What Are the Chances of Ectopic Pregnancy during IVF

In IVF and ectopic pregnancy, the chances of ectopic pregnancy are slightly higher than in natural conception. For individuals undergoing assisted reproductive technologies, such as IVF and IUI, the ectopic pregnancy rate is typically between 2% and 5%. In comparison, for those with natural pregnancies, the ectopic pregnancy rate is lower, around 1% to 2%. Research indicates that the likelihood of ectopic pregnancy in IVF cycles ranges from 1.4% to 5.4%. However, this risk varies across different studies regarding in vitro fertilization (IVF) and embryo transfer (ET).

Another finding shows a direct relation between the number of embryos transferred during the reproductive process and the increased risk of ectopic pregnancy. The risk of ectopic pregnancy in IVF increases with the number of embryos transferred. The risk for a single embryo transfer is 1.6% while transferring two embryos raises the risk slightly to 1.7%. The risk further increases to 2.2% with three embryos and reaches 2.5% when four embryos are transferred.

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Top Three Causes of Ectopic Pregnancy During IVF

The leading causes of ectopic pregnancy in IVF include:

• Fallopian Tube Damage: The leading cause of ectopic pregnancy is damage or blockages in the fallopian tubes, preventing the fertilized egg from reaching the uterus.
•  Imbalanced Hormone: Hormonal irregularities can interfere with the egg’s movement through the fallopian tube, increasing the risk of ectopic pregnancy.
• Egg or Sperm Abnormalities: In some cases, problems with either the egg or sperm can cause fertilization issues, heightening the chances of ectopic pregnancy.

How Ectopic Pregnancy in IVF Diagnosed

The major symptoms of ectopic pregnancy include pain in the lower abdomen or pelvis, which can be mild or sharp and may be on one side or all over. Vaginal bleeding that’s different from a regular period, such as being watery and dark brown. Other mild symptoms such as No period, breast tenderness, nausea, vomiting, tiredness, frequent urination, dizziness, fainting, low blood pressure, or discomfort when going to the toilet.

Ectopic pregnancy is commonly identified through blood tests that assess human chorionic gonadotropin (hCG) levels also known as (Beta hCG Test) and ultrasound imaging, both of them are effective tools for early detection. In IVF, the chances of ectopic pregnancy are closely monitored through these methods, particularly by tracking how quickly hCG levels rise.

One important sign is how quickly hCG levels increase, as they should rise by at least 53% over 48 hours in a typical pregnancy. When hCG levels reach this point, successful IVF results should be visible within the uterus. If hCG levels do not rise as expected or surpass this threshold without detecting a pregnancy in the uterus, the patient is at a higher risk of ectopic pregnancy and requires close medical observation.

IVF and Ectopic Pregnancy: Key Risk Factors and Prevention Strategies

Several factors can increase the chances of ectopic pregnancy in IVF, These include:

• Pre-existing conditions such as tubal pregnancy, hormonal imbalance, or uterine issues can cause difficulty in conceiving during IVF.
• Transferring multiple embryos at once.
• Using embryos that are not top quality.
• Advanced maternal age like 40 and older are nearly 3 times more likely to experience an ectopic pregnancy compared to women aged 25-29.
• Women with reduced ovarian reserve are over twice as likely to develop an ectopic pregnancy than those with normal reserves.

Some prevention protocols for ectopic pregnancy are:

• Embryo Transfer Process: During embryo transfer, the fertilized embryos are placed directly into the uterus, reducing the likelihood of ectopic pregnancy compared to methods like intrauterine insemination (IUI) or natural conception. However, with this process, the risk is not entirely eliminated.
• Transferring Multiple Embryos: Transferring more than one embryo raises the risk of ectopic pregnancy. To lower this risk, many fertility clinics now recommend single embryo transfers.

Ways to Prevent Ectopic Pregnancy in IVF

Preventing ectopic pregnancy in IVF involves addressing specific factors that raise the risk, such as:

• Tubal Factor Infertility Management: Surgical procedures to repair or unblock damaged fallopian tubes or opting for In Vitro Tubal Embryo Transfer (IVTET) to bypass damaged tubes can reduce the risk of ectopic pregnancy.
• Timely Treatment of Pelvic Inflammatory Disease (PID): Early diagnosis and antibiotic treatment for PID can prevent tubal damage and reduce the likelihood of an ectopic pregnancy.
• Prevention and Treatment of Sexually Transmitted Infections (STIs): Regular STI screenings, practicing safe sex, and early antibiotic treatment for infections like chlamydia and gonorrhea can help protect the fallopian tubes from damage.
• Quit Smoking: Stop smoking reduces the risk of ectopic pregnancy, as smoking damages the fallopian tubes and impairs egg movement.
• Managing Advanced Maternal Age: Women over 35 should consult doctors for guidance on minimizing risks associated with age-related reproductive changes through early monitoring and interventions.

Managing Ectopic Pregnancy: Surgery or Medication

Patients who are suitable for medication come under the following conditions

• Ectopic pregnancy is detected in early intervention
• No such major symptoms of ectopic pregnancy
• The beta hCG value should be below 3000 mIU/mL

Patients who are strictly advised for the surgery intervention are:

• Patient shows an unstable condition such as unbearable abdominal pain, vomiting, extremely low or no detectable blood pressure, or a loss of consciousness.
• Surgical intervention is also recommended for patients with a history of multiple ectopic pregnancies, as they are at higher risk for complications.

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While IVF aims to ensure proper embryo implantation in the uterus, seldom complications can arise, leading to ectopic pregnancies that require prompt medical intervention. Understanding the risk factors, early diagnosis through hCG level monitoring and ultrasonography, following prevention strategies, and managing underlying conditions are crucial to reducing the likelihood of ectopic pregnancy in IVF.

FAQ:

1.    Is ectopic pregnancy possible after IVF?

Yes, after in vitro fertilization (IVF) ectopic pregnancy can happen.

2.    How common is ectopic pregnancy with IVF?

The risk of ectopic pregnancy after IVF is up to four times higher than after a natural conception. The rate of ectopic pregnancy after IVF is estimated to be between 2.1–8.6%.

3.    Who has a higher chance of ectopic pregnancy?

The risk of an ectopic pregnancy is higher for women who:

• Are over 35 years old
• Have had a previous ectopic pregnancy
• Have had surgery on a fallopian tube
• Have had their fallopian tubes tied
• Have an intrauterine device (IUD)
• Have had infertility problems or taken medicine to stimulate ovulation
• Have a sexually transmitted infection (STI)

4.    How to avoid ectopic pregnancy again?

With the help of proper doctor guidance, you can avoid ectopic pregnancy again.