Ectopic Pregnancy After IVF – What You Must Know (Q&A with Dr Malpani)
Patient: Dr. Malpani, I’m worried. I’ve heard about ectopic pregnancies, and I’m scared it could happen to me. What exactly is an ectopic pregnancy?
Dr. Malpani: That’s an important question. An ectopic pregnancy happens when the embryo implants outside the uterus, instead of inside it. Most commonly, it settles in the fallopian tube. That’s why it’s often called a tubal pregnancy. In rare cases, it can also implant in the ovary, cervix, or even the abdomen.
Patient: But how does that even happen? Isn’t the embryo supposed to go into the uterus?
Dr. Malpani: Absolutely. Normally, the embryo is formed in the fallopian tube and then moves into the uterus, where it implants. But sometimes, the tube is damaged—maybe due to a past infection or surgery. The tiny hair-like cilia that help move the embryo along might not work properly. If the embryo gets stuck, it may implant right there in the tube.
Patient: How common is this? Should I be very worried?
Dr. Malpani: It’s not extremely common—ectopic pregnancies occur in about 1 out of every 100 pregnancies. But if you've had tubal infections, previous ectopics, or certain fertility treatments, the risk goes up. It’s also slightly higher after IVF, because the embryo can sometimes move back into the tube after transfer.
Patient: Oh! I didn’t know that could happen after IVF. So how would I know if I had an ectopic pregnancy?
Dr. Malpani: In the early stages, it may feel like a normal pregnancy—missed period, sore breasts, nausea. But one of the first signs could be abnormal vaginal bleeding, which can be mistaken for a period. You might also feel pain on one side of your lower abdomen or feel light-headed. If the tube ruptures, the pain becomes severe and may be accompanied by fainting or shock. That’s a medical emergency.
Patient: That sounds really serious. How is it diagnosed?
Dr. Malpani: We use two tools: blood tests for hCG and vaginal ultrasound. If your hCG level is over 1000 mIU/ml and we don’t see a pregnancy sac in the uterus, it raises concern for an ectopic. Sometimes we can directly see the ectopic sac in the tube on ultrasound. But early on, it can be tricky, and we have to interpret hCG trends and scan results together.
Patient: What if the doctor misses it during the scan?
Dr. Malpani: Sadly, it happens. Many sonographers aren’t trained to spot early ectopics. That’s why you must ask your doctor to rule it out, especially if you have pain or bleeding. Remember—the eye only sees what the mind knows. If the possibility isn’t considered, it may be missed until the tube ruptures.
Patient: If I do have an ectopic pregnancy, what’s the treatment?
Dr. Malpani: If we catch it early and your hCG levels are low, we may watch and wait, as sometimes the body absorbs the pregnancy on its own. If not, we can give you methotrexate, a medicine that stops the pregnancy from growing. In some cases, especially if there’s bleeding or rupture, surgery may be necessary. If the tube is damaged, we may have to remove it.
Patient: Is surgery always the only option?
Dr. Malpani: Not always. If the ectopic hasn't ruptured, we may be able to treat it with injections into the pregnancy sac under ultrasound guidance. For early cases, laparoscopic surgery lets us remove the pregnancy and sometimes save the tube. But if the tube has burst, emergency surgery becomes essential to stop internal bleeding.
Patient: If I lose a tube, can I still get pregnant?
Dr. Malpani: Yes, absolutely. Many women have healthy pregnancies with just one tube. But there’s a risk the other tube might also be damaged, especially if the first ectopic was due to tubal disease. About 60% of women go on to have a normal pregnancy. If pregnancy doesn’t happen within a year, we may recommend tests or IVF.
Patient: Does having one ectopic mean I’ll have it again?
Dr. Malpani: Unfortunately, the risk does go up. That’s why early monitoring is critical in your next pregnancy. We’ll track your hCG levels and do an early scan to confirm the embryo is in the uterus. But don’t lose hope—many women with a past ectopic go on to have healthy babies with the right care and close follow-up.
Dr. Malpani: If you’re pregnant and worried about ectopic pregnancy, register at www.hcgexpert.in. We’ll help monitor your pregnancy closely so we can catch any issues early. Remember: early diagnosis can save your tube, your health—and your future fertility.