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Ectopic pregnancy

An ectopic pregnancy is any pregnancy that implants outside the uterus. During a normal pregnancy, an egg becomes fertilized by sperm inside the Fallopian tube. The fertilized egg travels down through the Fallopian tube and into the uterus, where it implants on the inside wall.

In most cases, an ectopic pregnancy takes place in a Fallopian tube where a fertilized egg becomes trapped and implants there. Although rarer, an ectopic pregnancy can also occur in other places such as on an ovary, within the cervix, or in the abdomen.

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What is an ectopic pregnancy?

An ectopic pregnancy is one in which the embryo (a fertilized egg) does not implant in the uterus as it is supposed to but finds its way to surrounding areas and organs. Though an ectopic pregnancy can occur in the abdomen, ovary or cervix, about 95 percent of them occur in one of the fallopian tubes.

The embryo begins to implant at a certain time after it is created through fertilization. If it has been prevented from entering the uterus, it will implant where it is and try to grow as if it were in the uterus. This is a serious condition that can threaten the life of the woman if her fallopian tube ruptures and leads to massive internal bleeding.

Another term for an egg implanting in the fallopian tubes is a tubal pregnancy. Ectopic pregnancies are rare and occur in an estimated 20 out of every 1,000 pregnancies, or about 2 percent of the time.

What causes an ectopic pregnancy?

Ectopic pregnancies are typically caused by damage to the fallopian tube or by an abnormally shaped tube that does not allow the embryo to make its way from the fallopian tube where it was fertilized into the uterus. Although there is usually no full explanation for why an ectopic pregnancy occurs, there are risk factors that put certain women at a higher risk of ectopic pregnancy. These risk factors include:

  • Having already had an ectopic pregnancy.
  • Infection and inflammation – the fallopian tubes can become damaged and prone to ectopic pregnancies by infections such as pelvic inflammatory disease (PID), gonorrhea or chlamydia.
  • Endometriosis.
  • The embryo implantation step of in vitro fertilization (IVF) may increase some women’s risk.
  • Previous abdominal surgery or fallopian tube surgery.
  • Smoking cigarettes.
  • Getting pregnant while using an intrauterine device (IUD).

Symptoms of an ectopic pregnancy

If you have any of the following symptoms of an ectopic pregnancy, call your doctor right away:

  • Irregular bleeding after a missed period.
  • Lower abdominal pain.
  • Lower back pain.

An ectopic pregnancy can become a serious, life-threatening medical emergency if it’s not diagnosed and treated early. Your Fallopian tube can rupture from the growing embryo, resulting in severe pain, uncontrolled internal bleeding, and shock.

How an ectopic pregnancy affects fertility

An ectopic pregnancy can damage your Fallopian tube, which may reduce your chances for future normal pregnancies. Additionally, people who have had an ectopic pregnancy are at increased risk for a future ectopic pregnancy. Your doctor will discuss treatment options with you that can often increase your chance for a healthy pregnancy.

Diagnosing an ectopic pregnancy

Your medical history and a pelvic exam are helpful in diagnosing ectopic pregnancy. Additionally, you may need one or more of the following tests:

  • hCG (human chorionic gonadotropin): A blood test that confirms pregnancy by measuring the amount of hCG (a hormone produced by pregnancy) in your blood; often, we repeat this test every 2 days.
  • Ultrasound: A scan that uses high-frequency sound waves to visually confirm a pregnancy.

Treatment for ectopic pregnancy

Your treatment will depend on how early your physician discovers the ectopic pregnancy. If you’re in a lot of pain and have heavy internal bleeding, you will likely need emergency surgery to stop the bleeding. The surgery may involve either removing the embryo from your tube or removing the segment of the tube containing the embryo.

If a physician discovers the ectopic pregnancy early before the embryo has grown large enough to rupture your Fallopian tube, an injection of a medication called methotrexate may be an option. Methotrexate prevents the rapid division of cells in early pregnancy, thereby ending the pregnancy.

Take control of your fertility journey

An ectopic pregnancy doesn’t have to stand in the way of your dreams of parenthood. At RSC, we’re committed to helping you understand your condition, explore your options, and take confident steps forward.

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At the Reproductive Science Center of the San Francisco Bay Area (RSC), we believe that our team is the heart of our success. Since 1983, we have built a legacy of excellence and compassion in the fertility industry, serving patients from across the U.S. and around the world. Our work goes far beyond clinical procedures – we help create families and bring hope to those we serve every day.

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Thank goodness you’re pregnant, but you’ll want to adhere to a healthy pregnancy diet to improve your chances of a successful birth and a healthy child

Eating a healthy, balanced diet is important for everyone, but it becomes even more crucial when you’re pregnant. Your body is not only providing nutrients for your health, but also for the growing baby inside of you. The food you eat, which is turned into nutrients during digestion, will play a vital role in your baby’s development and overall health.

First, enhance your chances of getting pregnant with a fertility diet

If you’re planning to get pregnant, it’s important to start paying attention to your diet even before you conceive. This so-called fertility diet will help ensure that you’re getting all the necessary nutrients for a healthy pregnancy. Make an appointment with your doctor or nurse to discuss how your diet needs to change to support a healthy pregnancy.

Do take prenatal vitamins during pregnancy

One important change to make is to start taking prenatal vitamins during pregnancy. They help make sure that you and your baby are getting all the necessary nutrients. Look for a vitamin that contains folic acid, iron, and calcium. Folic acid is essential for the early development of the baby’s brain and spinal cord.

Establishing your pregnancy diet plan

So, what should you eat during pregnancy? The best diet for you and your baby will include lots of fresh fruits, vegetables, and whole grains. You should also include good protein sources like fish, dried beans or peas, and meat. I recommend eating some low-fat dairy products, as well.

If you do not eat dairy foods, you will need to get calcium from other sources. These foods include tofu, sunflower seeds, edamame, kale, broccoli, and other non-dairy items.

Low mercury fish

Fish is a great source of protein and omega-3 fatty acids, which are important for your baby’s brain development. However, it’s important that your pregnancy diet includes low-mercury fish. Salmon, shrimp, pollock, catfish, and canned light tuna are all good choices, as long as you don’t eat too much of them. Bluefish, grouper, halibut, mahi-mahi, and yellowfin tuna are also good options but limit them to one serving per week.

Make food safety part of your pregnancy diet

Pregnant women should be extra careful about avoiding germs in their food during pregnancy. Make sure to wash your hands well with soap and water before handling food. Fully cook fish, chicken, beef, eggs, and other meats. Rinse fresh fruits and vegetables under lots of running water before you eat them. And be sure to wash your hands and anything that touches raw meat or fish with hot soapy water when you’re done preparing food.

Foods to avoid when pregnant

While it’s important to focus on getting enough of the right nutrients in a pregnancy diet, it’s equally important to know certain foods to avoid when pregnant that could harm your baby. For example, some cheeses made from unpasteurized milk or raw or undercooked meat can contain harmful bacteria that could lead to an infection and potentially a miscarriage. You should also avoid high-mercury fish such as shark, swordfish, king mackerel, marlin, and tilefish. These can harm your baby’s brain development.

Alcohol should be avoided completely, as even small amounts could harm your baby. Limit caffeine to one or two cups of coffee per day, and avoid sugary drinks, such as soda and sports drinks. Additionally, taking too much vitamin A (more than 3,000 micrograms or 10,000 international units a day) can lead to birth defects in your baby.

Pregnancy diet = a healthy pregnancy

In summary, eating a healthy, balanced diet is crucial for a healthy pregnancy. Focus on getting plenty of fruits, vegetables, whole grains, and lean protein sources. Avoid foods that could harm your baby and take prenatal vitamins to ensure you’re getting all the necessary nutrients.

Finally, make sure to speak with your doctor or nurse about any concerns you may have about your diet during pregnancy.

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This blog is an update. It reflects new recommendations from the American Society of Reproductive Medicine.

Recurrent pregnancy loss (RPL) has been defined as the loss of 2-3 or more consecutive pregnancies in the first or early second trimester of pregnancy. Other terms for RPL include recurrent spontaneous abortion, miscarriage, or habitual abortion. It is estimated that fewer than 5% of women will experience 2 consecutive losses and less than 1% will experience 3 or more. The majority of pregnancy loss occurs before 10 weeks of pregnancy. The rate of miscarriage increases with maternal age, especially after age 35. In women over 40, miscarriage rates approach 50%

Recurrent pregnancy loss is a distressing problem as frequently the cause(s) are unknown. Even when a detailed evaluation is completed, a definite cause is established in no more than 50% of couples. There are also many unproven hypotheses and poorly designed clinical studies, resulting in various treatments for RPL, many of which are without proven benefit.

Immunologic causes of RPL (often referred to as Alloimmune) continue to remain controversial and largely unproven. It has been theorized that there may be a group of women in whom their immune system recognizes pregnancy and rejects it. Immunotherapy has been proposed to reduce the risk of rejection of pregnancy and improve the opportunity for a successful pregnancy. The results of published medical studies are conflicting. The best available studies do not indicate that Immunotherapy is any more successful than no treatment. One must consider the costs and possible side effects of current utilized therapies in light of the lack of scientific evidence of effectiveness.

A very well-done and updated Committee Opinion from the American Society of Reproductive Medicine entitled “Evaluation and treatment of recurrent pregnancy Loss: a committee opinion” was just released in the November edition of Fertility and Sterility. (Fertil Steril 2012; 98:1103-11). The committee recommends that the evaluation for PRL can proceed after 2 consecutive clinical pregnancy losses. Psychological counseling and support should be offered to each couple.

The evaluation of RPL includes:

• Assessment of lifestyle variables

• Chromosome Analysis of the couple

• Chromosomal analysis of products of conception

• Sonohysterogram, Hysterosalpingiogram (HSG) and/or Hysteroscopy to screen for uterine abnormalities

• Screening for Thyroid and Prolactin abnormalities

• Screening for Lupus Anticoagulant, Anticardiolipin Antibodies and anti-β1-Glycoprotein I.

• Women with persistent moderate-to-high antiphospholipid antibodies can be treated with low-dose Aspirin and unfractionated Heparin.

The treatment of RPL should be based on the above evaluation as well as the couple’s unique history. Treatment of recognized factors such as uterine abnormalities and hormonal imbalances will increase the chance of a successful pregnancy. If all testing is normal, the chances of a favorable outcome are good. In studies of women with unexplained pregnancy loss where no active medical intervention is used, successful pregnancies occur in 50- 65% of cases.

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Ectopic pregnancy (a pregnancy outside the womb and in the wrong place, such as the fallopian tube or ovary) is still a life-threatening complication. While in vitro fertilization (IVF) is recommended for women at risk of an ectopic pregnancy, especially if they’ve already had more than one ectopic pregnancy, it is not a 100 percent guarantee that a woman will not have an ectopic pregnancy.

Why? As many of my patients ask.

Although in IVF the embryo is placed in the uterus, generally 1.8 cm from the top, the waves of uterine contractions can propel the embryo backward through the fallopian tubes before it actually implants. This means there are still approximately 12-24 hours in which the embryo can move before implantation begins. It has also been surmised that damaged tubes can suck the embryos back into them due to pressure differentials between the uterus and the tube.

So you will find it reassuring to note that recent statistics on ectopic pregnancies (also called tubal pregnancies) after embryo transfer are on the decrease. It declined from 20 to 12 per 1,000 assisted reproductive cases over the last 12 years in the United Kingdom. It now occurs in less than 2 percent of natural (spontaneous) pregnancies and 1.4 percent of IVF and IUI pregnancies.

But this risk can be subdivided even more, providing reassurance for those without tubal disease. There is now known to be a 3 percent risk if a patient has tubal infertility and more than one embryo is transferred, but only 0.8 percent if the patient has male factor infertility and only one embryo is transferred. The statistics are similar in the U.S. showing a decline in ectopic pregnancies with IVF from 2 to 1.6 percent and a reduction in risk from 2.5 percent, if four embryos were transferred, down to 1.6 percent if only one embryo was transferred, regardless of the embryo stage.

The most common causes of tubal factor infertility include sexually transmitted infections with chlamydia, abdominal surgery, endometriosis, and smoking.

Lowering the total number of embryos transferred and transferring at the blastocyst stage (day 5) are thought to be the reasons for the decrease. Reproductive Science Center has long been a strong advocate of elective single embryo transfer (eSET) and leads the network in helping patients achieve high success rates while transferring fewer embryos. RSC has also been performing blastocyst transfers for the majority of our patients for over 10 years, giving us very low ectopic pregnancy rates.

Early detection of an ectopic pregnancy is critical. So, serial monitoring of human chorionic gonadotropin (hCG) levels and early ultrasounds at six weeks estimated gestational age (two weeks after finding out you are pregnant) can help to manage ectopic pregnancies safely 95-98 percent of the time, avoiding the need for surgery.

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The staff at the Reproductive Science Center (RSC) understands that the decision to seek fertility treatment can be difficult. For a couple considering fertility treatment, it is important to ask the right questions about success rates, costs, medical services, and financial options. Also, consider your relationship with, and trust in, your physician.

Our advice to patients considering fertility clinics is to be certain they understand all aspects of their decision, and to make certain they receive understandable answers to any questions they may have. Understanding these issues before beginning treatment can save time, energy, frustration, and money. It may also increase your chances of achieving a successful pregnancy.

1. What factors should be considered when choosing a treatment program?

  • Success rates
  • Full range of procedures performed
  • Treatment flexibility and customization
  • IVF program stability over time, with an established “good track record”
  • Financial options, including insurance participation and financing
  • Staff accessibility and response

2. Is it possible to evaluate clinics objectively?

Interpreting statistics of fertility programs requires patience and care. Individual assisted reproductive technology (ART) programs do not use a standard format for reporting their success rates in advertisements and promotional literature, making comparison among clinics difficult. The Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) publish clinic-specific data on most of the ART programs in the U.S. Each clinic reports its annual outcome data to SART in a standardized format.

The SART report is comprehensive and provides valuable information about each clinic, including the number of cycles performed, pregnancy rates by age (with or without male factors), miscarriage rates, and average patient age.

You may be able to see trends or patterns that will help you understand the quality, stability, and experience of the programs you are considering, especially if evaluated over time. The SART reports are available online on a clinic-by-clinic basis.

We encourage you to visit the American Society for Reproductive Medicine (ASRM) for information on objective criteria.

3. How do I evaluate clinics based on current statistics?

While recent advances in fertility treatment are improving patients’ chances for success, it can also mean that the most recently published statistics available from CDC/SART may not reflect your actual odds. Ask the clinics you are considering for current statistics. Be sure to ask for documentation on the statistics, as well as for statistics for your age range and infertility diagnosis.

Since beginning an IVF program, RSC has published a comprehensive statistical analysis. of all ART cycles performed in its center and outcomes. We strongly encourage anyone considering advanced fertility treatments to obtain the same information from each clinic they are considering. View our most recent success rates.

4. How important are the statistics?

Couples with normal fertility have a 20-to-25-percent chance of conception each month if they have intercourse at the proper time of the cycle. Therefore a fertile couple has at least a 93 percent chance of achieving pregnancy within a year.

To help you understand how important success-rate statistics are, we’ll compare two theoretical clinics, Clinic A with a 30-percent delivery rate per cycle and Clinic B with a 12-percent delivery rate. From the chart below, you can see that the average couple undergoing IVF can expect:

  • Clinic A (30 percent delivery rate): a 65 percent chance of delivery after 3 cycles
  • Clinic B (12 percent delivery rate): a 31 percent chance of delivery after 3 cycles
Clinic A:
30 % Delivery
Rate		Clinic B:
12% Delivery
Rate
# of Couples# of Deliveries# of Couples# of Deliveries
Cycle 11003010012
Cycle 270218810
Cycle 34914789
Total
Deliveries		6531

You may also notice that you have nearly the same odds of success in one cycle at Clinic A as you have with three cycles at Clinic B. So, even if Clinic A’s fees are higher than Clinic B’s, you may save money with treatment at Clinic A.

5. How do I know that the fertility center I am considering offers a full range of services?

First, ask a lot of questions and listen carefully. Some centers specialize in one form of treatment, and all patients receive that form of treatment; unfortunately, other, more effective treatments may be overlooked. At RSC, we offer a full range of fertility treatments, and each patient undergoes a comprehensive assessment to ensure that all options are considered.

Secondly, we encourage patients to ask about all possible treatments, including surgery, intrauterine insemination (IUI), in vitro fertilization (IVF), egg donation, embryo freezing, and a full range of embryology services, including intracytoplasmic sperm injection (ICSI), embryo hatching, and preimplantation genetic testing (PGT).

6. Does it matter how long a program has been in existence? Isn’t newer better?

At RSC, we believe one of our strengths is our stability and longevity. Our physicians have been working together for almost 10 years, and we have worked with the same embryology laboratory director for over 20 years.

We recommend that anyone considering fertility treatment ask each clinic under consideration about stability and years of experience of the physicians and the embryology staff. Infertility treatment, particularly IVF, requires a great deal of timing, coordination and communication between doctors and embryologists. The longer teams have worked together, the more effective they are in assuring a well-executed treatment plan.

7. How much does treatment cost?

The costs for infertility treatments vary widely among clinics. The best way to assess your ultimate cost is to ask each clinic for a copy of its fee schedule. It is important to determine if there are any additional fees not included in the fee schedule such as hospital charges, drug costs, and testing.

At RSC, we recognize that cost is an important factor when selecting an ART program. Our financial options page provides information related to our refund and discount programs, as well as financing options.

In the San Francisco Bay Area, the costs for one cycle of IVF range from $14,000 to $19,000, plus medications.

The cost of medications is a significant portion of the total IVF expense, and can vary. RSC has developed a relationship with a pharmacy offering competitive prices and the convenience of shipping to your home. There is the added benefit of verifying your insurance coverage for medications.

8. Will my medical insurance cover infertility treatment?

Approximately one-half of insurers provide limited coverage for intrauterine insemination services. RSC participates in many local physician groups that represent the many commercial health plans in Northern California.

It is not highly likely that your insurance plan will provide coverage for in vitro fertilization, although some of the initial diagnostic examinations, and the medications, may be covered. In most cases, you will be covered for pregnancy resulting from fertility treatment. There are a few insurance plans that do cover IVF services.

Insurance companies usually have hundreds of plans to offer employers, each with different benefits. Contact your insurance provider and ask them what your insurance plan benefits are for infertility treatment. Our practice can investigate insurance benefits for you. We can also provide you with the necessary forms so that you may submit claims for reimbursement by your insurance company.

You may wish to consult ASRM’s website for information regarding state infertility insurance laws.

9. What other financial matters should I be considering?

When choosing an ART program, look for flexibility and evidence of programs designed in response to patients’ needs. The Reproductive Science Center has many financial options for patients, including a refund program, a discount program, and financing options that cover medication costs. See our financial options page for additional information, or contact one of our financial counselors at (925) 867-1800.

10. Who will be on my fertility treatment team, and how will I know how I am progressing?

Communication is a vital element in successful fertility treatment. The physicians at RSC are joined by a highly qualified team of nurse case managers, working collaboratively to coordinate your care. All of the physicians in our center may be involved in your care, along with IVF nurse case managers, operating room nurses, and embryologists.

At RSC, we have one of the most experienced teams around. Every IVF patient is assigned a nurse case manager, who will provide an overview of IVF, assist in communications, provide instructions, and make certain that any questions you may have are addressed.

We encourage individuals considering several clinics to ask about the availability of nurse case managers, and methods of care coordination and communication.

11. What other online resources are available for evaluating a fertility program?

The ASRM has a helpful publication “Selecting an ART Program” – a consumer’s guide to evaluating a fertility clinic, including a review of how success rate claims are calculated by providers.


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