Ectopic pregnancy risk and fertility after an ectopic pregnancy

Having one ectopic pregnancy increases your risk of having another ectopic pregnancy. When an ectopic pregnancy grows in a fallopian tube, it damages the surrounding tubal tissue, making it more likely that a fertilized egg will lodge there in the future. But early detection and treatment can minimize the damaging effects of an ectopic pregnancy. If you have surgery for an ectopic pregnancy, scar tissue from that surgery also raises your risk of another ectopic pregnancy.¹

Having a uterine pregnancy after an ectopic is a good sign that you have a low risk of having another ectopic pregnancy later on.

Future fertility

Your future fertility and your risk of having another ectopic pregnancy will be affected by your own combination of risk factors. These can include smoking, use of assisted reproductive technology (ART) to get pregnant, and how much fallopian tube damage you have.

Early detection is the key to avoiding new tube damage. If the embryo has no heartbeat, your pregnancy hormone (hCG) is low enough, and you are not bleeding, you can choose methotrexate treatment instead of surgery. Generally, avoiding surgery gives you a better chance of preserving your fertility.

As long as you have one healthy fallopian tube, salpingostomy (small tubal slit) and salpingectomy (part of tube removed) have about the same effect on your future fertility. But if your other tube is damaged, your doctor may try to do a salpingostomy. This may improve your chances of getting pregnant in the future.²

If you become pregnant and are at high risk for ectopic pregnancy, you will be closely monitored. Health professionals do not always agree about which risk factors are serious enough to watch closely. But research suggests that risk is serious enough if you have had a tubal surgery or an ectopic pregnancy before, were exposed to the chemical DES (diethylstilbestrol) before birth, have known fallopian tube problems, or have a pregnancy with an intrauterine device (IUD) in place.³

Citations

1. Cunningham FG, et al. (2005). Ectopic pregnancy. In Williams Obstetrics, 22nd ed., pp. 253–272. New York: McGraw-Hill.

2. Farquhar CM (2005). Ectopic pregnancy. Lancet, 366: 583–591.

3. Speroff L, Fritz MA (2005). Ectopic pregnancy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1275–1302. Philadelphia: Lippincott Williams and Wilkins.