Ectopic Pregnancy and Infertility

Medical Emergency

An ectopic pregnancy is a medical emergency in which a fertilized egg implants itself outside of the uterus, most often in the fallopian tubes. The embryo in such a pregnancy must be removed to save the mother's life. At any rate, there is no chance that the embryo can live in its chosen environment.

Tube-Saving Surgery

There may be no choice but to sacrifice the entire fallopian tube, but if you have a choice, choose a procedure in which the embryo is removed through an incision in the tube. This provides you with the highest chance of having a viable pregnancy in the future. If this is not possible, you may be able to have only a part of the tube removed with the stump left open rather than sutured closed. This means an egg might still be able to travel down the tube into the uterus.

*If you must have both tubes removed or sutured shut, the only way you will be able to conceive is via IVF.

Some statistics on future fertility after an ectopic pregnancy:

*Careful surgery in the case of small, unruptured ectopic pregnancies can preserve the function of the fallopian tubes more than 80% of the time.

*Normal, intrauterine pregnancies follow ectopic pregnancies at a ratio of 6:1, but if one tube is unaffected the ratio rises to around 10:1.

*The subsequent delivery rate after one ectopic pregnancy and conservative tube-sparing surgery is 55-60%, the recurrence of tubal pregnancies is about 15%, and the rate of infertility is 25-30%.

*If the second tube is nonexistent or blocked, the subsequent rate of delivery is from 45-50%, the recurrence of tubal pregnancies is about 20%, and the infertility rate is from 30-35%.

*After 2 or more tubal pregnancies and conservative surgeries the subsequent delivery rate is around 30%, recurrent ectopic pregnancies at 20-30%, with the infertility rate at 40-50%.

*The greater the number of recurrent ectopic pregnancies, the less likely it is that a woman will deliver a baby without fertility treatment.

*An ectopic pregnancy is as likely to occur in a tube that was saved during surgery as in the unaffected tube.

*Salpingostomy, the saving of a tube, and salpingectomy, the removal of a tube, in cases where there is no history of infertility and the second tube is normal give similar delivery rates.

*In a case where the other tube is diseased and there is a history of female infertility, the salpingostomy gives a higher ratio in favor of delivery: 76% vs. 44% according to one study, but also comes with a higher risk of recurrent ectopic pregnancy.

Make sure that your doctor knows of your wish to become pregnant before he operates, if at all possible.