Ectopic pregnancy after infertility treatment

Abstract

Early pregnancy complications are more common in women who conceive after infertility treatment. Most of these occur before 12 weeks of gestation and include miscarriage, vaginal bleeding, intrauterine hematoma, vanishing twin, and ectopic pregnancy (EP). The incidence of EPs following infertility treatment is much higher compared with that in spontaneous pregnancies. The occurrence of an EP is very distressing to an infertile couple, who has lots of hopes pinned on the treatment outcome, especially because of the cost incurred and the physical and mental trauma both have gone through during the treatment process. The association between infertility and EP is complex, as it can be a consequence of infertility as well as a cause. The two principal risk factors for an EP are genital tract infections and tubal surgeries. Though several etiologies are proposed, but patients with tubal factor infertility are at an increased risk of an EP. Earlier diagnosis of EP helps to improve prognosis and optimize subsequent fertility. It is pivotal to evaluate the likelihood of subsequent occurrence of an EP and be too vigilant when treating. The correct choice of the treatment modality should be made to prevent the recurrence. The early prediction of the pregnancy outcome therefore has great importance for both the couple and clinician. Today with the help of sensitive beta human chorionic gonadotropin (β-hCG) assays and transvaginal sonography, one can diagnose an EP prior to symptoms, and conservative treatment for the preservation of the fallopian tube is possible. Conservative management in the form of expectant and medical management should be considered as a first-line treatment modality, provided that the overall clinical picture suggests that it is safe to do so. If not, laparoscopic management of EPs appears to be the favored approach of management as compared to laparotomy.

Risk factors for ectopic pregnancy among pregnant women attending a tertiary healthcare facility in Accra, Ghana

“…The present study found that women with a history of infertility were six times more likely to develop ectopic pregnancy. It has been postulated that, in cases of infertility due to tubal pathologies, when a pregnancy occurs it may implant in the fallopian tube . Because tubal factor has been shown to be a significant contributor to infertility in Ghana, this might explain the present association of ectopic pregnancy with infertility.…”

Risk factors for recurrent ectopic pregnancy: a case–control study

“…Tubal damage can disturb the passage of the zygote through the fallopian tube and into the uterine cavity, and thus predisposes women to another EP . Furthermore, women with infertility tend to receive infertility work‐up and surgical treatment, which may also increase their risk for EP . Thus, the association between a history of infertility and REP could be due to a common underlying tubal factor (i.e.…”

“…15,16 Furthermore, women with infertility tend to receive infertility work-up and surgical treatment, which may also increase their risk for EP. 8,17 Thus, the association between a history of infertility and REP could be due to a common underlying tubal factor (i.e. a mere association) or the tubal damage caused by infertility treatment could, in turn, have caused REP (i.e.…”

Live Monochorionic Adnexal Twin Ectopic Pregnancy

“…1,2 This downward trend may reflect the decreased incidence of pelvic inflammatory disease, a common predisposing factor for EP. 4 As a general rule, anything that impedes the progression of the ovum through the fallopian tube raises the risk of EP. 3 In vitro fertilization results in 2.2 cases of EP of every 100 successful procedures, regardless of the type of assisted reproductive technology used.…”