Ectopic pregnancy in the overwhelming majority of cases occurs during conception naturally, since with IVF (in vitro fertilization), embryos are transferred directly into the uterine cavity. However, in rare cases, for a number of reasons, they can move to another part of the organ, which leads to an ectopic pregnancy. What factors provoke the development of such a pathology in IVF? How can you avoid it? We will talk about this in our article.
Development mechanism
The fusion of male and female germ cells occurs most often in the fallopian tube, from where the zygote moves into the uterine cavity. If for some reason it does not reach the endometrium, then an ectopic pregnancy develops. This process is typical for natural conception.
Can this happen with IVF? First you need to find out what this procedure is. In vitro fertilization differs from natural fertilization in that it does not take place in the mother's body, but in the laboratory. Unfortunately, there is no 100% guarantee that after this procedure, a woman will definitely become a mother.
The physical condition of the future father and mother, the endocrine balance of the woman's body, as well as her attitude, have a decisive influence on the success of the manipulation. In addition, an important role in this matter is played by the choice of a specialist who will perform this manipulation. It is also necessary to take into account a number of features of preparation for the procedure and exactly follow the step-by-step algorithm of actions.
Since with IVF fertilization occurs outside the mother's body, and after that the embryo is transplanted into the uterus, it may seem that an ectopic pregnancy will not occur in this case. However, this opinion is wrong. Until the moment when the fertilized egg is implanted into the lining of the uterus, it "floats" and can be fixed in other parts of the organ, for example, in the fallopian tubes, ovaries or cervix. Outside the body of the uterus, the embryo is viable until a certain point (as long as it has room to grow), so it is not possible to maintain this pregnancy.
With IVF, a heterotopic pregnancy can occur, which is characterized by the development of embryos in the uterine cavity and in the tube at the same time. This is due to the fact that during artificial insemination, several embryos are transferred into the uterus at once in order to increase the chances of a successful outcome. But at the same time, the transferred embryos, before being introduced into the endometrium, wander in the uterine cavity, and one of them may leave its limits.
In this case, it is possible to maintain only a normal pregnancy, while the surgeon will face a difficult task: to remove the fallopian tube with the embryo and not harm a normal pregnancy.
According to specialists in the field of reproductive health, the likelihood of developing an ectopic pregnancy after IVF is approximately 3-10%. If a woman who is forced to use the IVF procedure has already removed the fallopian tubes, this does not exclude the possibility of developing an ectopic pregnancy. This is due to the fact that during the operation the tubes are not completely excised, and there is always a small area near the entrance to the uterus. The embryo has the ability to implant at the border of the uterus and the remaining segment or in another part, for example, on the cervix.
Classification
Ectopic pregnancy is divided into several types according to the localization of the embryo.
- Pipe type. It occurs in 95-97% of patients diagnosed with an ectopic pregnancy. This type is characterized by the implantation of a zygote into the cavity of one of the fallopian tubes. The development of the embryo occurs until the moment of its rupture.
- Ovarian type. This type of ectopic pregnancy can be attributed to extremely rare clinical cases, since it occurs only in 1-2%. Ovarian pregnancy is a consequence of the implantation of an embryo into the structure of the ovary.
- Abdominal type. This type of ectopic pregnancy can also be classified as rarely diagnosed. This pathology is characterized by the ingress of a fertilized egg into the abdominal cavity.
- Interlinking type. It is characterized by the attachment of a fertilized egg in the space between the large ligaments of the uterus. If the interstellar pregnancy was not terminated in the early stages of gestation, then its development can take up to about 20 weeks.
- Cervical type. It is caused by the implantation of the embryo into the cervical region. Until a certain point, such a pregnancy does not have any objective symptoms. However, in the later stages, vaginal discharge with an admixture of blood may occur, especially after intercourse.
- Interstitial type. It is characterized by implantation and development of the embryo in the interstitium of the fallopian tubes. If such a pregnancy is not interrupted at the initial stages of development, then it can develop up to 4 months.
Each of these types of ectopic pregnancy is considered an extremely dangerous condition that can cause rupture of the fallopian tube, ovary and other organic structures, as well as provoke severe bleeding.
Etiology
The most common causes of pregnancy outside the uterine cavity after IVF can be the following factors:
- non-compliance with bed rest after the artificial insemination procedure and other doctor's recommendations;
- trauma to the fallopian tubes by hyperstimulation;
- artificial termination of pregnancy and diagnostic curettage in anamnesis;
- the presence of inflammatory diseases of the appendages and uterus;
- chronic endometriosis;
- use of an IUD (intrauterine device);
- stress.
As you can see, there are quite common conditions among the factors predisposing to the development of ectopic pregnancy. Therefore, during the IVF procedure, careful medical supervision of the patient by the antenatal clinic staff is required.
Diagnostics
A woman after an IVF procedure listens carefully to her feelings. If she begins to feel weak, dizzy, nauseous, or any painful sensation in the lower abdomen, this could indicate an ectopic pregnancy. When examined by a gynecologist, it is possible to identify this pathology in the case of intense pain in the abdomen and a significant increase in the uterus.
In order to prevent rupture of the tubes and the development of massive internal bleeding, it is necessary to immediately seek help from specialists when such symptoms appear. After the IVF procedure, the woman is constantly under the supervision of a doctor, so do not hesitate to talk about all the unusual sensations.
With an ectopic pregnancy, a blood test for the concentration of the hormones progesterone and hCG will be reduced by almost half compared with the indicators typical for a normal pregnancy. It must be taken every two days to make an accurate diagnosis.
Very often, doctors resort to surgical laparoscopy in the presence of threatening signs. This is a diagnostic procedure that is performed through small incisions in the anterior abdominal wall using special optical instruments. It allows you to make a diagnosis as accurately and quickly as possible. With this manipulation, you can visualize the abdominal organs, assess their condition, remove the existing adhesions and the embryo from the fallopian tube. In case of rupture of tubes and massive internal bleeding, laparoscopy is not used, and doctors perform abdominal surgery.
Therapies
For the treatment of ectopic pregnancy, the surgical method is mainly used. With this diagnosis, it is also possible to use elements of conservative treatment: drugs are prescribed that inhibit the growth of the ovum and embryo. Drug therapy is not popular as it is done with toxic drugs. After such treatment, serious complications can appear.
The type of surgical treatment is determined only by the attending physician, depending on the specific case. He also decides whether to remove the fallopian tube or keep it. If it is possible to do without a complete excision of the tube, then the surgeon will carefully open it and take out the embryo from there.
Currently, the so-called access method is widely used, thanks to which it is possible to save the fallopian tube in the presence of a tubal pregnancy. In this case, only the ovum itself is removed.
Various surgical techniques can be used for this purpose. However, this manipulation has a significant drawback: after it is carried out, there is a threat of recurrence of an ectopic pregnancy during IVF. Therefore, in the overwhelming majority of cases, the ovum is removed along with the fallopian tube so that such situations do not arise in the future.
If the embryo develops in the abdominal cavity, then it is definitely impossible to do without surgical removal. This type of ectopic pregnancy is extremely rare (in 0.02% of cases), and usually occurs as a result of an incorrectly performed embryo transfer procedure. There are entire forums devoted to discussing this problem. On them, women share real feedback on the treatment of ectopic pregnancy.
Rehabilitation
If all the organs after the operation were restored, then no one will give a guarantee that an ectopic pregnancy will not occur with repeated embryo replanting. Therefore, it is extremely important to complete a full course of therapy and rehabilitation. After surgery, subsequent protocols should be postponed for at least 6 months.
After the operation, the woman should spend more time outdoors and move. For six months, sexual relations should only be with the use of contraceptives. Immediately after the operation, the patient is prescribed procedures to restore reproductive function, for example, hydroturbation. During this procedure, special preparations are injected into the fallopian tubes, which have a regenerating effect and accelerate the regeneration of damaged tissues. If there are adhesions in the pipes, they can be removed using laser resurfacing.
Prevention
It is quite possible to avoid an ectopic pregnancy if you strictly follow the doctor's recommendations. This is especially true of bed rest immediately after embryo transfer.
Two weeks after the embryo transfer, it is necessary to pass an analysis for the content of hCG (a hormone produced by the placenta). The growth of this indicator is a sign of the onset of pregnancy, therefore, after 10 days, an ultrasound examination should be done, which will determine where the embryo is located.
It so happens that during an ultrasound scan, the doctor can see a fertilized egg in the uterine cavity already at 3-4 weeks of gestation (in case of uterine pregnancy). In the absence of an embryo in the uterine cavity at a certain time after the transfer of the ovum, a positive pregnancy test, an increase in the concentration of hCG in the blood, the appearance of bloody vaginal discharge and the presence of pain in the lower abdomen, an ectopic pregnancy can be assumed with a high degree of probability.
IVF is a rather complex procedure that requires a responsible approach both from the specialists who carry out all the manipulations and from the woman who wants to feel all the delights of motherhood. That is why careful monitoring of the patient's physiological parameters is of great importance.
If a woman complains of the appearance of symptoms indicating the possible development of an ectopic pregnancy, and the doctor, in turn, upon an objective examination, reveals signs confirming the presence of this pathology, then the question of hospitalization of the patient and a comprehensive examination is raised.
In such a situation, delay in contacting a doctor can be very dangerous, since an ectopic pregnancy is fraught with the likelihood of rupture of the fallopian tube, which is a very serious condition that, if timely assistance is not provided, can be fatal.
A specialist tells about the reasons for the appearance of an ectopic pregnancy with IVF in the following video.
