Ectopic Pregnancy after Embryo Transfer

An ectopic pregnancy after embryo transfer occurs when a fertilized egg implants outside the uterus, typically in the fallopian tube instead of the uterine lining.

Ectopic pregnancies are rare, but can be a major concern for women undergoing assisted reproduction treatments such as embryo transfer.

If you believe you may be experiencing an ectopic pregnancy or have concerns after frozen embryo transfer, seek medical attention.

In this article, we will discuss what an ectopic pregnancy is, why it occurs, the signs and symptoms of ectopic pregnancy after embryo transfer, and how it is diagnosed and treated, with particular focus on surrogates undergoing assisted reproductive technology (ART).

Learn more about pregnancy as a surrogate here, or fill out this simple form to get help if you are considering becoming a surrogate.

What Is an Ectopic Pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most often in a fallopian tube, although it can also occur in the ovaries or cervix. Since the fertilized egg cannot develop properly outside of the uterus, the pregnancy is not viable and can be life-threatening if left untreated.

In a normal pregnancy, the embryo implants in the uterine lining, where it can grow and develop into a fetus.

However, in an ectopic pregnancy, the embryo grows in an abnormal location, which can cause the fallopian tube (or other tissue) to rupture. This can result in severe bleeding and can endanger the woman’s health.

How Likely Is an Ectopic Pregnancy After Embryo Transfer?

The risk of ectopic pregnancy in a typical IVF cycle is about 1-2%. While ectopic pregnancy after embryo transfer is rare, it is a potential complication that can arise during assisted reproduction procedures like in vitro fertilization (IVF) or frozen embryo transfer.

Ectopic pregnancies after assisted reproduction treatments can be more common than in natural conceptions, due to factors such as the use of fertility medications, the condition of the fallopian tubes, and previous reproductive surgeries. The implantation process may also be affected by the embryo’s ability to attach in the correct location.

Why Do Ectopic Pregnancies Happen After Embryo Transfer?

There are several medical factors and conditions that may contribute to the occurrence of an ectopic pregnancy, particularly after assisted reproduction treatments like embryo transfer:

• Damaged or Blocked Fallopian Tubes: Prior surgeries, infections, or conditions like pelvic inflammatory disease (PID) can cause scarring or blockage of the fallopian tubes, which increases the risk of an ectopic pregnancy. If an embryo is transferred and fails to implant properly in the uterus, it may end up in the fallopian tube or elsewhere.
• Fertility Treatments: IVF and frozen embryo transfer involve manipulating the reproductive system, which can increase the risk of ectopic pregnancy. Factors such as hormone stimulation, the number of embryos transferred, and the quality of the embryos can influence implantation.
• Endometriosis: This condition, in which tissue similar to the uterine lining grows outside the uterus, can also increase the risk of an ectopic pregnancy by affecting how the embryo moves and implants.
• Age: Women over 35 may be at a higher risk for ectopic pregnancies, particularly after ART procedures.
• Previous Ectopic Pregnancy: A history of an ectopic pregnancy is one of the strongest predictors for future ectopic pregnancies. Women who have had this complication are at a higher risk during subsequent pregnancies, including those achieved through IVF.[SP1] 

Symptoms of Ectopic Pregnancy After Embryo Transfer

Recognizing the signs and symptoms of ectopic pregnancy after embryo transfer is crucial for early detection and intervention. Common symptoms may include:

• Pelvic pain or discomfort: This is often one-sided and may begin as mild cramping but can escalate to sharp, intense pain as the pregnancy grows.
• Irregular bleeding or spotting: Light bleeding or spotting may occur, but it may become heavier or more prolonged as the pregnancy progresses.
• Shoulder pain: This can be a sign that the ectopic pregnancy has caused internal bleeding that is irritating the diaphragm.
• Dizziness or fainting: This could indicate that the ectopic pregnancy has caused internal bleeding, leading to a drop in blood pressure.
• Painful urination or bowel movements: This can occur if the pregnancy is located near the cervix or intestines.[SP2] 

It’s important for surrogates and individuals undergoing ART to be vigilant and report any unusual symptoms to their doctor as soon as possible.

Diagnosis of Ectopic Pregnancy

If an ectopic pregnancy is suspected, a doctor will typically perform a combination of tests to confirm the diagnosis. These include:

• Blood tests (hCG levels): Human chorionic gonadotropin (hCG) is a hormone produced during pregnancy. In an ectopic pregnancy, hCG levels may rise more slowly than they would in a normal pregnancy.
• Ultrasound: A transvaginal ultrasound is commonly used to locate the pregnancy and check for signs of an ectopic pregnancy. In many cases, an ectopic pregnancy can be visualized in the fallopian tube or other areas outside the uterus.
• Pelvic exam: A pelvic exam may help to identify tenderness or masses that suggest an ectopic pregnancy.

Treatment Options for Ectopic Pregnancy

Treatment for an ectopic pregnancy is crucial to prevent complications like internal bleeding, infection, and damage to reproductive organs. The treatment approach depends on the location of the ectopic pregnancy, its size, and the overall health of the patient.

• Medication: In early cases of ectopic pregnancy, the drug methotrexate may be used to stop the growth of the pregnancy and allow the body to absorb it naturally. This is typically used when the ectopic pregnancy is detected early and is not causing severe symptoms.
• Surgical Intervention: If the ectopic pregnancy is more advanced or there is a risk of rupture, surgery may be necessary. A laparoscopy (minimally invasive surgery) is often performed to remove the pregnancy and any affected tissue. In some cases, a more invasive procedure may be required.
• Monitoring: In certain situations, the ectopic pregnancy may resolve on its own without intervention, but close monitoring is necessary to ensure the health and safety of the surrogate.

Treatment for an Ectopic Pregnancy After Embryo Transfer

If you are a surrogate undergoing assisted reproduction treatments, you will receive careful medical monitoring throughout the process, including after embryo transfer.

Any signs of complications, such as ectopic pregnancy, are taken seriously, and immediate steps should be taken to protect your health.

Surrogates are usually given frequent ultrasounds and blood tests to track hormone levels and embryo development. If an ectopic pregnancy is diagnosed, the surrogate will receive a tailored treatment plan to address the condition safely.

The Emotional Impact of Ectopic Pregnancy After Embryo Transfer

An ectopic pregnancy is not only physically challenging, but it can also take an emotional toll on surrogates. The stress of an unexpected pregnancy complication, the uncertainty of the diagnosis, and the potential loss of the pregnancy can cause feelings of grief, anxiety, and isolation. You should seek emotional support to help cope with these challenges.

Resources may include:

• Counseling: Professional therapists or counselors who specialize in reproductive health can offer emotional support and coping strategies.
• Support groups: Connecting with other surrogates who have experienced ectopic pregnancies or other pregnancy complications can provide valuable emotional support and solidarity.
• Partner and family support: It’s essential for surrogates to lean on their partners, families, or trusted friends for emotional care during difficult times.

An ectopic pregnancy after embryo transfer is rare, but your concerns should be taken seriously. With appropriate care, the chances of a healthy future pregnancy can remain intact.

Learn more about pregnancy as a surrogate here, or fill out this simple form to get help if you are considering becoming a surrogate.

Frequently Asked Questions

Can ectopic pregnancy happen after embryo transfer?

Yes, an ectopic pregnancy can occur after embryo transfer, although it is relatively rare.

During assisted reproductive technologies like in vitro fertilization (IVF) or frozen embryo transfer (FET), the embryo is transferred directly into the uterus. However, there is still a small risk that the embryo may implant outside the uterus, most commonly in the fallopian tube.

What are the early signs of ectopic pregnancy after IVF?

The early signs of an ectopic pregnancy after IVF may be similar to those of a typical pregnancy but can include more concerning symptoms. Common early signs include:

• Pelvic pain or discomfort: Often sharp or cramp-like pain on one side of the abdomen.
• Vaginal spotting or bleeding: This bleeding may be mistaken for implantation bleeding.
• Shoulder pain: This can occur if the ectopic pregnancy causes internal bleeding that irritates the diaphragm.
• Dizziness or fainting: A sign of internal bleeding, which can lead to a drop in blood pressure.
• Painful urination or bowel movements: If the pregnancy is near the cervix or intestines, it can cause pain during these activities.

It’s important for anyone undergoing IVF or embryo transfer to be vigilant about these symptoms and consult a healthcare provider immediately if they occur.

What are the chances of ectopic pregnancy with embryo transfer?

The chances of an ectopic pregnancy after embryo transfer are relatively low but not zero. In general, the incidence of ectopic pregnancy in IVF patients is estimated to be around 1-2%. This is higher than the risk in natural pregnancies, which is about 1%. The risk may be influenced by several factors, such as:

• Previous ectopic pregnancies: A history of an ectopic pregnancy increases the risk of recurrence.
• Tubal issues: Women with blocked or damaged fallopian tubes (due to prior infections, surgeries, or conditions like endometriosis) are at higher risk for ectopic pregnancy.
• Age: Older women may have a slightly higher risk of ectopic pregnancies after ART.
• Number of embryos transferred: Transferring more than one embryo may increase the risk of an ectopic pregnancy.