My beta HCG was only 75. After a year of fertility treatments, I knew this number, which detects the amount of pregnancy hormone in the blood, should’ve been higher after my first embryo transfer 12 days prior, but I trusted the team at my fertility clinic and tried to stay positive. But as the days went on and my beta plateaued instead of multiplied, I knew something was off. I just didn’t know yet that what I was experiencing was an ectopic pregnancy.
Of all the things I worried about during my IVF journey, an ectopic pregnancy was not on the list. Part of the idea of IVF, I thought, is that the doctor places the embryo right into the uterus, giving it a better chance of implanting and growing appropriately. But actually, no. I was told that just like with natural conception, where the fertilized egg travels down the tube and hopefully implants itself into the uterus, my one perfect embryo, the one that took me one year and three egg retrievals to get, swam around like a fish for a bit before setting into, in my case, my right fallopian tube. My very wanted pregnancy after two previous losses was not viable before it even had a real chance.
Turns out that IVF is a risk factor for ectopic pregnancies (it’s a measly 1-2% chance, go figure), as is age (I’m in that dreaded category of “geriatric pregnancy” at age 37), and having had a previous ectopic pregnancy, among other things.
But now that I’m more than a year out from this experience and have lived to see the other side (only a little bit dramatic to say that I survived, considering it can be life-threatening), I’ve learned quite a bit about ectopic pregnancy, its treatment options, and more.
What’s an Ectopic Pregnancy?
Medically speaking, an ectopic pregnancy1 is when the fetal tissue (or the embryo) implants somewhere outside the uterine lining—most commonly in one of the fallopian tubes, which is why it’s also sometimes referred to as a “tubal pregnancy.” But in rarer cases, the embryo embeds into the cervix, ovaries, a scar from a previous C-section, or somewhere in the abdominal cavity.
About 1 in 50 pregnancies are ectopic, which means they’re relatively rare. But ectopic pregnancies cannot survive and they can become extremely dangerous if not treated; once diagnosed, they must be monitored very closely and treated immediately.
As I learned, it can be difficult to get a definitive diagnosis very early on. In my case, despite my oscillating HCG numbers, my reproductive endocrinologist (RE) was not convinced at first my pregnancy was ectopic. The terms “chemical pregnancy” and “pregnancy of unknown location” were each thrown around in conversation like ping pong balls, and I even underwent a dilation and curettage (D&C) to confirm the pregnancy wasn’t in my uterus. A few days after that procedure, with my HCG level still hovering around 1,000, I got confirmation via ultrasound that the pregnancy was ectopic, and that my hard-earned embryo was stuck in my right tube. It was a relief to finally get a diagnosis, but terrifying nonetheless.
What Are the Symptoms of an Ectopic Pregnancy?
Symptoms for ectopic pregnancy can vary depending on how “far along” you are in the pregnancy. The good thing about seeing an RE for fertility treatment, like I was, is the monitoring is way more frequent than it would be for a patient who conceived without assisted reproductive technology. Because mine was found so early, my only real symptom was the lower-than-usual beta HCG.
But for many other women, physical symptoms are the first indication something is wrong; common ectopic pregnancy symptoms2 include:
pain on one side where the embryo implanted
irregular vaginal bleeding
upset stomach
dizziness
shoulder pain, which can indicate internal bleeding
How Is an Ectopic Pregnancy Diagnosed?
Only a doctor who conducts a transvaginal ultrasound can diagnose an ectopic pregnancy3 , and the ectopic can only be confirmed once the gestational sac is large enough to be visible on an ultrasound—typically between 6-10 weeks gestation.
The risk is that if your embryo grows large enough, it can cause the fallopian tube to rupture. Ectopic pregnancy rupture leads to excessive bleeding and complications, which is why it’s considered the most common life-threatening emergency in early pregnancy4 . Ideally, you’ll be diagnosed and treated for an ectopic pregnancy before it ruptures, as I thankfully was.
Ectopic pregnancy treatment
There are two main types of treatment for ectopic pregnancy, one medicinal and one surgical.
Methotrexate
If your ectopic pregnancy is diagnosed before it ruptures, the most common course of treatment is methotrexate. This injectable medication5 works by stopping the embryo’s cells from growing, which should end the pregnancy and therefore bring the HCG back down to zero within about a month.
Methotrexate can be administered only by a physician, either as a one-dose shot in the butt or two doses separated by a few days or a week.
Methotrexate has about an 80 percent success rate for ectopics, according to studies 6 . One big caveat with the drug, though, is that once it's administered, you can’t try to get pregnant or do another egg retrieval for three months until it’s out of your system. Lucky me, I was in the 20 percent of women whose ectopic wasn’t cured by two doses, which meant I had a week-long bout of nausea and a mandatory three-month halt on trying to conceive, all for naught.
Laparoscopic surgery
In cases where methotrexate doesn’t work or there’s been a rupture, surgery to remove the embryo is the only other option. I was told by my team that I could wait it out before surgery, but with each passing day, the risk of rupture became greater as the embryo grew. So finally, after about six weeks since that first pregnancy test, I opted for a laparoscopic unilateral salpingectomy, which in human speak means I got my right tube removed through three tiny laparoscopic incisions.
My right tube was gone, and my HCG was negative at last. The recovery from the surgery was like a mini C-section—not easy by any means, but I was relieved to be done with this chapter and ready to move on with my journey to baby number two (once the three months since the first shot was up).
How Can You Move Forward After an Ectopic Pregnancy?
Getting over the emotional and physical toll of an ectopic pregnancy wasn’t easy for me. And according to Tekla Barrett, licensed marriage and family therapist (LMFT) who specializes in infertility and pregnancy loss, a loss is a loss, meaning any baby loss is sad and takes time to recover from.
On a positive note, she says, the chances of having another ectopic pregnancy are slim, and you will likely go on to have a baby even if you lost a tube (you still have another tube if you’re conceiving naturally, while IVF bypasses the tubes entirely). Here are some tips on how to move on (when you’re ready, of course):
Don’t rush through your grief. It’s natural to want to get pregnant again ASAP, but Barrett says we need to let ourselves feel, internalize our grief, and not suppress our feelings as much as possible. And it’s ok to cry! If you're having trouble doing this on your own, find a therapist who specializes in baby loss and/or an online support group (many therapists like Barrett offer them for free) that can make you feel less isolated.
Find a supportive provider. If you plan to get pregnant again, make sure you find an ob-gyn or RE who makes you feel heard. “Nothing is worse than having a loss and then your doctor being dismissive,” Barrett notes.
Communicate with your partner. If you have a significant other, it’s important to understand that they’re grieving too, but the way they show emotion might be different from how you do (I don’t think my husband cried once after the ectopic, TBH). The two of you are in this together.
Pass the time wisely. When I had a mandated three-month break from fertility treatment, I purposely made good use of my time—I started a new workout routine, did a ton of research, and booked consults to figure out where I wanted to continue my IVF treatment. Self-care does wonders too. Meditation has benefits when TTC and pregnant, Barrett notes, or try acupuncture, yoga, or exercises such as breathing into a bamboo straw. “When we’re panting or crying, our cortisol levels are in fight or flight mode,” she says. “Breathing into an object like a straw forces you to slow down and stay present.”
Avoid your triggers. Barrett says this can mean saying no to a friend’s baby shower during your waiting period or avoiding Google rabbit holes as best you can. “When you notice yourself doing it, literally just put your computer down or say out loud, “Stop doing this!”
Envision the future. Barrett tells her clients to make a vision board of themselves holding a healthy baby, but if that seems too intense for right now, commemorate the pregnancy somehow—plant a tree, light a candle, or purchase a piece of jewelry to honor the baby.
If you’re experiencing an ectopic pregnancy, please know that you are not alone. Barrett’s biggest takeaway: “Be gentle with yourself. It’s not your fault.”
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