Ectopic pregnancy with IVF: causes, symptoms, likelihood, sequence of actions

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

After several years of unsuccessful attempts to get pregnant, many spouses turn to IVF specialists for help. In Russia, problems with conception occur in 15-20% of the population. For them, this method becomes a real way out of a difficult situation. This medical procedure has its advantages, disadvantages, as well as the preparation period. In some cases, an ectopic pregnancy occurs with IVF.

Let's try to figure out what it is and how to avoid such a pathology.

What is IVF

If a woman has not been able to get pregnant for a year or a little more, then she is diagnosed with infertility. She needs to see a specialist so that he can identify the cause and prescribe treatment. Quite often, infertility is associated with a hormonal background, so doctors prescribe drugs to normalize it.

If the problem is related to obstructionfallopian tubes, adhesions and other serious reasons, you can only become a mother with the help of IVF. This method of pregnancy is also called artificial insemination and in vitro conception.

IVF procedure involves the fertilization of an egg outside the female body. And only after some time (2-3 days) several ready-made embryos are planted in the uterus and wait until they attach to its walls. Let's try to figure out if there can be an ectopic pregnancy during IVF.

Is this possible?

In artificial conception, a fertilized egg is placed in the uterus, where it is attached to its walls. It would seem that this approach excludes incorrect implantation. But why then are there cases of ectopic pregnancy during IVF? Before implantation, the egg can move in different directions and, with different pathologies, attach to the fallopian tubes, cervix, or other places. Even if the fallopian tubes are missing, improper implantation is possible (although this is rare).

Because IVF transfers multiple fertilized eggs, it is possible for one embryo to attach to the uterine wall and the other in the wrong place. This phenomenon is called heterotopic pregnancy, which will be discussed below.

What is this pathology

In a normal pregnancy, the embryo attaches to the walls of the uterus, and in an ectopic pregnancy, to other surfaces. It can enter the fallopian tube, cervix, appendages, and even into the abdominal cavity. If one or both tubes are missing, implantation to its end segment is possible. The probability of an ectopic pregnancy with IVF is a maximum of 10%. In the presence of chronic diseases of the small pelvis, it increases.

To avoid he alth problems, it is necessary to identify the pathology in time and eliminate possible negative consequences.

Varieties of pathology

Specialists divide ectopic pregnancy into several types depending on the place of attachment of the egg.

It can be implanted in the following locations:

1. In the area of the removed fallopian tube.
2. Inside one of the pipes. Such a pregnancy can rupture the tube as the fetus grows.
3. In the area of the cervix. Rare, and so the embryo can develop for quite a long time.
4. On the ovaries. Often seen in IVF as a result of ovulation hyperstimulation.
5. In the abdomen. Very dangerous for a woman's life, can lead to tissue necrosis, sepsis, peritonitis.

In most cases (8 out of 10) the fetus is attached to the fallopian tube, much less often it happens in the peritoneum. The main danger of improper implantation is trauma and rupture of the organ, as well as internal bleeding. If nothing is done, then everything can end in death.

Heterotopic pregnancy

Are there cases when an ectopic pregnancy with IVF is possible? If several embryos were transferred into the uterine cavity, then the following result is possible: one fetus will attach to the wall of the uterus, and the other in the wrong place. Probability of heterotopic pregnancy– 1-3% (applies only to artificial insemination).

This pathology can be detected in the first trimester using ultrasound. Doctors begin to assume it if the patient complains of abdominal pain (uterine bleeding may not be). The picture of manifestations can be confused by an increase in the concentration of beta-hCG in a woman's blood. Heterotopic pregnancy can result in the birth of a he althy baby if it was attached to the wall of the uterus. In this case, the misplaced fetus must be removed.

Reasons

Before dealing with the symptoms of ectopic pregnancy after IVF, let's try to find out the causes of the pathology. Most often, women with poor endometrium, to which the embryo is attached, are prone to this.

This may be related to:

• Insufficient or improper preparation for fertilization.
• Infectious diseases of the uterus and appendages (ureaplasmosis, chlamydia, trichomoniasis, etc.).
• Chronic endometritis.
• Adhesion processes.
• Hormonal failure.
• The presence of polyps or fibroids.
• Stimulation of ovulation with the drug "Klostilbegit" (which reduces the growth rate of the endometrium).
• Insufficient thickness and structure of the endometrium.
• Ovarian hyperstimulation. In response to hormone therapy, they increase in size, move and damage the fallopian tubes. Inside they have villi that start to work incorrectly: they move the fetus from the uterus to the ovaries.
• Abnormalities in the organs of the smallpelvis.
• Failure to comply with the requirements of the doctor associated with reduced physical activity and stressful situations.

It should be remembered that some diseases can occur without any symptoms. If left untreated, they can lead to female infertility.

Symptoms

There are no specific signs of an ectopic pregnancy after IVF. Manifestations of improper fixation of the fetus make themselves felt as the development and growth of the fetus. As a result, the walls of the organ in which implantation occurred are compressed. There may be regular increasing pain in the abdomen (often on one side). It happens that a woman associates the appearance of pain with uterine distension and goes to the doctor late. In the end, everything can end in serious complications.

Another sign of an ectopic pregnancy in IVF is spotting. They can be associated not only with improper attachment of the fetus, but also with anomalies in its development, the threat of miscarriage.

In the early stages, problems with implantation may present with the following symptoms:

• dizzy;
• drawing pains in the abdomen;
• fainting;
• nauseous;
• low pressure;
• bleeding;
• feeling of heaviness in the perineum.

Diagnosis

After the artificial insemination procedure, doctors monitor the condition of the woman and the course of pregnancy.

Without fail, they prescribe the following procedures:

• Ultrasound for a period of 2-3 weeks (the place of fixation of the embryo will be visible);
• examination by a gynecologist (an experienced doctor will be able to suspect a pathology).

If an ectopic pregnancy is detected after IVF, the woman must be urgently taken to the hospital. In the early stages, hormonal drugs are prescribed that reduce the growth of the fetus (so that it does not break the organ). Specialists try to save the fallopian tube (if the fetus is attached to it), and if necessary, it is removed. In order for the next pregnancy to be normal, it is necessary to restore the body (at least six months).

How to recognize by tests and ultrasound

At the moment when the embryo is fixed, the chorion (future placenta) begins to secrete the hormone - hCG. With the increase of the term, its level will increase. It is on hCG that any express test reacts, even if the fetus is fixed in the wrong place.

Specialists may suspect an ectopic pregnancy during IVF if a small amount of the hormone is present in the blood. Each period corresponds to a certain amount of hCG. And if it does not grow with the fetus, then there are some pathologies.

Doctors diagnose an ectopic pregnancy based on the following criteria:

1. HCG should double every 2 days. If this does not happen, suspicions arise. You should be aware that the results of the analyzes can only be evaluated in dynamics.
2. When an ultrasound is performed, a fetal egg is not detected in the uterus. In the earliest stages, it may not be visible with the help ofultrasound, so do not get upset ahead of time. The study should be carried out approximately one month after the replanting of embryos.

Medication assistance

Unfortunately, ectopic pregnancy with IVF happens, and it will not work. Therefore, doctors send a woman to remove the fetal egg. This can be done medically or surgically. Medical termination of pregnancy is carried out only in the early stages with the help of hormonal drugs.

Specialists can prescribe "Mifepristone" or "Methotrexate" - they do not allow the embryo to develop. As a result, an artificial miscarriage occurs, after which the woman is carefully examined and rehabilitation therapy is prescribed. This technique negatively affects the hormonal background and the condition of the mucous membrane. It cannot be used in heterotopic pregnancy.

Surgery

Surgical removal of the fetus is performed by laparotomy or laparoscopy. Laparotomy involves opening the anterior abdominal wall and is rarely used (when there is a threat to the woman's life or the necessary equipment is not available in the hospital).

Ectopic pregnancy after IVF can be terminated by laparoscopy. This intervention is carried out using miniature instruments and optical magnification. A small puncture is made in the area of the abdominal wall, from which in the future there will be practically notraces. With the help of laparoscopy, it is possible to save the fallopian tube if the fetus is attached to it. For long periods, doctors remove it, especially if there is a threat of rupture. The duration of such an operation is 45-60 minutes.

Recovery period

If the organ in which the fetus was implanted has been preserved, then improper attachment of the embryo may be repeated. To prevent this from happening, it is necessary to carry out restorative therapy. It should be remembered that a woman should not become pregnant for the next six months, otherwise you can cause irreparable harm to he alth.

Before surgery, it is necessary to examine and prepare the pregnant woman. After that, the woman is monitored, medicines are administered through a dropper, and antibacterial treatment is carried out. Doctors advise the patient to be active (move more and walk in the open air).

In order to restore the body as much as possible, postoperative recovery should be started in the first 12 hours. This is due to the fact that adhesions begin to form at this time. You can avoid their appearance using laser radiation or a magnetic field (quite effective methods).

Also after an ectopic pregnancy with IVF, women are advised:

• use contraception for the next six months;
• make hydroturbation, in which drugs are injected into the fallopian tubes;
• keep active and avoid stress.

When can I get pregnant again

Before the eventartificial insemination doctors carry out the collection of eggs. One part of them is fertilized, and the other part is frozen (cryopreservation). It is also possible to freeze fertilized cells, i.e. embryos. If IVF ended with an ectopic pregnancy, then the procedure is repeated after at least 6 months.

Sometimes women try not to get pregnant for a longer period. If frozen embryos or eggs are preserved, then no additional puncture or ovarian stimulation is required. Repeat IVF is also carried out under full control: after cell transfer, the level of hCG is regularly measured and ultrasound is performed. If doctors have even the slightest suspicion, they will conduct a full diagnosis and treatment.

According to reviews, ectopic pregnancy after IVF can be avoided. A woman should be less stressed after the procedure, avoid stress and physical exertion. At first, it is necessary to lie down so that the ovum implants normally.

Unfortunately, ectopic attachment of the embryo can occur during IVF, but do not despair. The next attempt will definitely end with a long-awaited pregnancy and the birth of a he althy baby. It is very important to carefully prepare for the procedure and follow all the requirements of the doctors.