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 in a year or a little more the woman has not managed to become pregnant, then she is diagnosed with infertility. She needs to consult a specialist so that he identifies the cause and prescribes treatment. Quite often, infertility is associated with a hormonal background, so doctors prescribe drugs to normalize it.
If the problem is related to obstruction of the fallopian tubes, commissures, and other serious reasons, you can become a mother only with the help of IVF. This method of pregnancy is also called in vitro fertilization and conception.
IVF 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 whether there can be an ectopic pregnancy with IVF.
Is this possible?
In an artificial conception, a fertilized egg is placed in the uterus, where it attaches to its walls. It would seem that this approach eliminates improper implantation. But why then are cases of ectopic pregnancy with IVF? Until the moment of implantation, the egg can move in different directions and, with different pathologies, attach to the fallopian tubes, neck, or other places. Even if the fallopian tubes are absent, improper implantation is possible (although this is rare).
Since IVF implants several fertilized eggs, one embryo may 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 normal pregnancy, the fetus attaches to the walls of the uterus, and in ectopic, to other surfaces. It can get into the fallopian tube, neck, appendages, and even into the abdominal cavity. If one or both pipes is missing, implantation to its final segment is possible. The probability of an ectopic pregnancy with IVF is a maximum of 10%. In the presence of chronic pelvic diseases, it rises.
To avoid health problems, it is necessary to identify the pathology in time and eliminate the possible negative consequences.
Varieties of pathology
Specialists subdivide an ectopic pregnancy into several types, depending on where the egg is attached.
It can be implanted in the following places:
- In the area of the removed fallopian tube.
- Inside one of the pipes. Such a pregnancy can break the tube as the fetus grows.
- In the cervical region. It is rare, and so the embryo can develop for quite some time.
- On the ovaries. Often found in IVF as a result of ovulation hyperstimulation.
- In the abdominal cavity. 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 this occurs 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 be fatal.
Heterotopic pregnancy
Are there cases when an ectopic pregnancy with IVF is possible? If several embryos were transferred to the uterine cavity, then this result is possible: one fetus will attach to the uterine wall, and the other in the wrong place. The probability of a heterotopic pregnancy is 1-3% (applies only to artificial insemination).
This pathology can be detected in the first trimester using ultrasound. Doctors begin to suggest it if the patient complains of abdominal pain (there may be no uterine bleeding). The picture of manifestations may be confused by an increase in the concentration of beta-hCG in the blood of a woman. A heterotopic pregnancy may result in the birth of a healthy baby if it was attached to the wall of the uterus. In this case, the incorrectly located fetus must be removed.
Causes
Before dealing with the symptoms of an ectopic pregnancy after IVF, we will try to find out the causes of the pathology. Most often, women with poor endometrium are exposed to this, to which the embryo is attached.
This may be due to:
- Inadequate or improper preparation for fertilization.
- Infectious diseases of the uterus and appendages (ureaplasmosis, chlamydia, trichomoniasis, etc.).
- Chronic endometritis.
- Adhesive processes.
- Hormonal failure.
- The presence of polyps or fibroids.
- Stimulation of ovulation with the drug "Klostilbegit" (reducing the growth rate of the endometrium).
- Insufficient thickness and structure of the endometrium.
- Hyperstimulation of the ovaries. In response to hormone therapy, they increase in size, are displaced and damage the fallopian tubes. Inside them there are villi that begin to work incorrectly: they move the fetus from the uterus to the ovaries.
- Anomalies in the pelvic organs.
- Failure to comply with the requirements of a doctor related to a decrease in 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 particular signs of an ectopic pregnancy after IVF. Manifestations of improper fixation of the fetus make themselves felt as the fetus develops and grows. As a result, the walls of the organ in which the implantation is compressed are compressed. Regular, increasing pains in the abdomen may appear (often on the one hand). It happens that a woman associates the appearance of pain with a uterine distension and later consults a doctor. In the end, everything can end in serious complications.
Another sign of ectopic pregnancy with IVF is spotting. They can be associated not only with improper attachment of the fetus, but also with abnormalities of its development, the threat of miscarriage.
In the early stages, problems with implantation may manifest the following symptoms:
- dizziness
- drawing pains in the abdomen;
- fainting state;
- nausea
- reduced pressure;
- bleeding
- a feeling of heaviness in the perineum.
Diagnostics
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 embryo fixation will be visible);
- examination of a gynecologist (an experienced doctor will be able to suspect a pathology).
If an ectopic pregnancy after IVF is detected, 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 rupture the organ). Specialists try to save the fallopian tube (if the fetus is attached to it), and if necessary, remove it. In order for the next pregnancy to be normal, it is necessary to restore the body (at least six months).
How to recognize by analysis and ultrasound
At that moment, when the embryo is fixed, the chorion (future placenta) begins to secrete the hormone - hCG. With an increase in the term, its level will increase. Any express test responds to hCG, even if the fetus has fixed in the wrong place.
Specialists may suspect an ectopic pregnancy with 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 any pathologies.
Doctors diagnose an ectopic pregnancy by the following criteria:
- HCG should double every 2 days. If this does not happen, suspicions arise. You should be aware that analysis results can only be evaluated in dynamics.
- An ultrasound scan does not show a fetal egg in the uterus. At the earliest dates, it may not be visible with the help of ultrasound, so do not get upset ahead of time. The study should be about a month after replanting the embryos.
Medical assistance
Unfortunately, ectopic pregnancy with IVF happens, and it will not work out. 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 may prescribe Mifepristone or Methotrexate - they prevent the embryo from developing. As a result, an artificial miscarriage occurs, after which the woman is carefully examined and prescribed rehabilitation therapy. This technique negatively affects the hormonal background and the condition of the mucous membrane. It cannot be used in a heterotopic pregnancy.
Surgical intervention
Surgical removal of the fetus is performed using 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 there is no necessary equipment in the hospital).
An ectopic pregnancy after IVF can be terminated by laparoscopy. This intervention is carried out using miniature instruments and optical zoom. A small puncture is made in the abdominal wall, from which in the future there will be practically no trace. Using laparoscopy, you can save the fallopian tube if the fetus has attached to it. For longer periods, doctors remove it, especially if there is a risk of rupture. The duration of such an operation is 45-60 minutes.
Recovery period
If the organ into which the fetus was implanted was preserved, then the embryo may not be attached correctly. To prevent this, it is necessary to carry out rehabilitation therapy. It should be remembered that a woman should not become pregnant for the next six months, otherwise it can cause irreparable harm to health.
Before surgery, examination and preparation of the pregnant woman is necessary. After him, a woman is observed, drugs are administered through a dropper, antibacterial treatment is carried out. Doctors advise the patient to be active (move more and walk outdoors).
To restore the body as much as possible, postoperative recovery should be started in the first 12 hours. This is because 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;
- maintain physical activity and avoid stress.
When can I get pregnant again?
Before carrying out artificial insemination, doctors carry out the collection of eggs. One part is fertilized, and the other is frozen (cryopreservation). It is also possible to freeze fertilized cells, i.e. embryos. If IVF has ended with an ectopic pregnancy, then the procedure is repeated at least 6 months later.
Sometimes women try not to get pregnant for a longer period. If frozen embryos or eggs are preserved, then additional puncture or ovarian stimulation is not needed. Repeated 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 at least slight suspicions, they will conduct a complete diagnosis and treatment.
According to reviews, ectopic pregnancy after IVF can be avoided. A woman should strain less after the procedure, avoid stress and physical exertion. At first, it is necessary to lie down so that the fetal egg is normally implanted.
Unfortunately, with IVF, an ectopic attachment of the embryo can occur, but do not despair. The next attempt will necessarily end with the long-awaited pregnancy and the birth of a healthy baby. It is very important to carefully prepare for the procedure and comply with all the requirements of doctors.