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The major benefit of early diagnosis is that with early treatment it is possible to save the tube, and thus preserve fertility and increase the chances of a normal pregnancy in the future. If the ectopic pregnancy is very early and the HCG levels are low, one can choose to simply wait and watch. Often, the HCG levels will fall, meaning that the pregnancy is being reabsorbed by the body on its own and no treatment is needed. Medical treatment is also possible. Such treatment involves the use of the anti-cancer drug, methotrexate, which acts on the rapidly dividing cells of the tubal pregnancy and kills them, thus preventing the pregnancy from growing further.
Ultrasound guided treatment is also useful for treating tubal pregnancies which have not ruptured. This treatment involves the injection of toxic chemicals (potassium chloride) into the tubal pregnancy under ultrasound guidance. These kill the pregnancy, allowing the body to reabsorb it.
Surgical treatment for early tubal pregnancies can be done through the laparoscope as well; with salpingotomy, the pregnancy can be selectively removed and the tube saved.
If the tube has ruptured, and blood has collected in the abdomen, then emergency surgery is needed. In these cases the tube is often so badly damaged that it has to be removed entirely. When this occurs, a couple not only mourns the loss of a pregnancy, but also the possible loss or reduction in their fertility. This sense of loss is accompanied by the discomfort and anxiety of having had an emergency operation.
What about the chances of getting pregnant after an ectopic pregnancy? Because tubal disease usually damages both sides, the chances of being infertile are increased. Also, the risk of a repeat ectopic pregnancy are increased even if the other tube seems normal. However, about 60% of women who have had a tubal pregnancy the first time will have a normal pregnancy the next time without further treatment. Early testing during pregnancy to rule out a repeat ectopic pregnancy is essential!
If pregnancy does not occur within about a year of trying, then treatment is needed. Treatment options for fertility will depend upon the kind of surgery done for the ectopic pregnancy and upon the condition of the other tube. Often, a second look laparoscopy is needed to assess tubal status. Options may include: ovulation induction; tubal surgery; laparoscopic surgery; and even IVF.
Having faced an unsuccessful outcome the first time makes getting pregnant very stressful, especially if the tubal pregnancy ended in a rupture. However, with the right treatment, chances of having a baby are quite good after all, the fact that a pregnancy occurred even though it was an ectopic means that the eggs and sperm are in good working order!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
