A common cause of female infertility is a blockage of the fallopian tubes, which can prevent sperm from meeting and fertilizing an egg. Blocked fallopian tubes can also cause ectopic pregnancy, in which a fertilized egg is unable to move to the uterus for implantation and starts to grow within the tiny fallopian tube, ovary or abdominal cavity.
There are several possible causes of fallopian blockage. Fortunately, there are also several treatment options.
Listen as Alan Martinez, MD explains ectopic pregnancy and the steps necessary to help insure future pregnancies.
Ectopic Pregnancy
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 12/26/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): In most pregnancies, the fertilized egg travels through the fallopian tube to the womb, and if the movement of the eggs is blocked for some reason or slowed through the tubes, it can lead to an ectopic pregnancy. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. What is an ectopic pregnancy?
Dr. Alan Martinez (Guest): Well, thank you for having me. I appreciate it. So, an ectopic pregnancy, as you’ve alluded to in your intro, is a pregnancy that is located outside of the cavity of the uterus where a woman would normally carry a baby to full term. So, it can actually be any location outside of the uterus. So, commonly, it is in the fallopian tubes. It can also be at the end of the fallopian tube; it can be outside in the actual pelvic cavity. It can be on the ovary. It can be in the abdomen. And so, it’s any pregnancy that is located outside of the cavity itself.
Melanie: Who is at risk for ectopic pregnancy?
Dr. Martinez: Well, so the ectopic pregnancy patients that are the most at risk, are those with fallopian tubes that are not functioning properly. They’ve been damaged maybe through a previous undiagnosed pelvic infection or previous treated pelvic infection. There are some sexually transmitted infections that characteristically damage the fallopian tubes, and those that have prior infections and/or possible procedures, surgeries or scarring, any sort of damage to the fallopian tubes, those are the patients that are at the highest risk of having ectopic pregnancies.
Melanie: So, are there some symptoms, Dr. Martinez, something that would signal to a woman that’s just recently become pregnant that this is what’s going on?
Dr. Martinez: Yes. Oftentimes, the ectopic pregnancies are diagnosed early during a pregnancy, and that would be either when a person has--shortly after they’ve missed a period or possibly they could have abnormal bleeding. So, vaginal bleeding can be a sign. And, in some situations, they can actually have pelvic pain. So, either the left or the right side near the ovaries of the fallopian tubes, the patient may start to have some cramping or pain, and that could be a signal that there is a pregnancy located within the fallopian tube itself.
Melanie: Is this very dangerous, and can a woman maintain a pregnancy that’s ectopic?
Dr. Martinez: So, it’s not recommended to allow a pregnancy to continue that is ectopic because it just is not a safe environment. So, ectopic pregnancies have the potential to bleed, to rupture out of the fallopian tube most commonly, and it can create a situation where a patient may have a large amount of bleeding within the fallopian tube and the abdomen that can lead to a surgical emergency. It can lead to nausea, vomiting, fever, chills and, at that point, it becomes an emergency and then we have to take out the pregnancy tissue and repair any sort of bleeding that’s occurring. So, it’s not recommended to continue an ectopic pregnancy. With that being said, in some developing countries, occasionally, patients will actually present with an advanced ectopic pregnancy or an abdominal pregnancy later on in gestation. But, overall, especially in women in the United States that are receiving early prenatal care, it usually is discovered either through bloodwork and the levels not rising appropriately of the pregnancy hormone, and/or ultrasound showing that there’s a lack of a pregnancy in the uterus, that these are diagnosed early enough to where they can be addressed and we can avoid the emergency situation.
Melanie: So, then, what do you do to treat, and you mentioned surgery a little bit, what does this involve now for the woman?
Dr. Martinez: So, in an ectopic pregnancy, depending upon the level of the hormones, if the pregnancy hormone, the hCG, is of a lower level; if a pregnancy that is located most commonly within the tube is of a certain size and a lack of a heartbeat and those kind of signs, then the patient may actually be a candidate for medical therapy over surgical therapy. So, there are medications out there. Methotrexate is a medication that stops any dividing cells and it can help counteract the growth of the pregnancy, and sometimes patients can be managed medically. In other cases, depending if there’s bleeding, if the patient is symptomatic or the hormone levels are high or the size of the ectopic is larger, then surgical intervention would be needed. And, in most cases, we do a minimal surgery called a “laparoscopy” which is small incision in the belly button and maybe a couple of places in the abdominal cavity, and we can take out the ectopic pregnancy. In some cases, the tube can be salvaged if it’s not damaged, but in other cases, it may be recommended that the fallopian tube be removed so as not to put the patient at risk for another ectopic pregnancy in the future.
Melanie: And, that was going to be my next question. If you have had ectopic pregnancy, are you then at risk, if you try and get pregnant again, for that to happen again? Is pregnancy possible after surgery as well?
Dr. Martinez: So, it is possible depending upon the situation. A woman has two fallopian tubes so, in general, there’s just one ectopic at a time. If the fallopian tube that’s affected with the ectopic, if it is damaged, it’s recommended to either remove the tube or to block the tube so that no pregnancy can potentially happen in that tube again. With that being said, if the other tube remains open and it’s of a normal contour, a normal shape and it’s not diseased, it’s a healthy tube, then the patient can potentially get pregnant from that tube. In some cases, if there’s tubal damage to both of the tubes through a prior infection, then both of the tubes may be recommended to be removed at which time that would involve assisted reproductive techniques, specifically in vitro fertilization which bypasses the tubes and allows a physician such as myself to go and get the eggs from the ovaries and not utilize the tubes to get pregnant.
Melanie: So, in in vitro fertilization, you avoid the tubes altogether, so ectopic pregnancy is pretty low risk when you’re doing IVF?
Dr. Martinez: Yes. IVF does bypass the tubes and it allows us to not rely on the tubes but to place an embryo directly into the uterus. So, in most cases, women that do have damaged fallopian tubes, both of them, then it may be recommended that they undergo IVF as their preferred route to conceive.
Melanie: Such interesting information, Dr. Martinez. So, wrap it up for us a little bit about ectopic pregnancy--what you tell women that either have discovered that this is going on or are at risk for ectopic pregnancy. What do you tell them and why should they come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: First of all, if a woman misses her period and she suspects that she’s pregnant, taken that home pregnancy test and it’s positive, then my recommendation is to make sure that you proceed with establishing care with an obstetrician gynecologist at your earliest convenience because there are a couple of tests, either laboratory testing and/or ultrasound testing which will confirm the location of that pregnancy which will allow you to identify a potential ectopic pregnancy early on. If there is an ectopic pregnancy, you may have symptoms--bleeding, pain. You want to be very aware of those things and also contact your doctor if you think you might be at risk of being pregnant because early intervention will keep you the most healthy. From the point of our practice, the Reproductive Science Center of New Jersey, we specialize in infertility and all of a woman’s health surrounding the reproduction and infertility. We specialize in early pregnancy loss and we try to provide an environment that is both supportive and personalized to help our patients in the most comfortable setting and to take care of them as we would take care of a member of our family.
Melanie: Thank you so much, Dr. Martinez, for being with us today. You're listening to Fertility Talk with Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That's www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): In most pregnancies, the fertilized egg travels through the fallopian tube to the womb, and if the movement of the eggs is blocked for some reason or slowed through the tubes, it can lead to an ectopic pregnancy. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. What is an ectopic pregnancy?
Dr. Alan Martinez (Guest): Well, thank you for having me. I appreciate it. So, an ectopic pregnancy, as you’ve alluded to in your intro, is a pregnancy that is located outside of the cavity of the uterus where a woman would normally carry a baby to full term. So, it can actually be any location outside of the uterus. So, commonly, it is in the fallopian tubes. It can also be at the end of the fallopian tube; it can be outside in the actual pelvic cavity. It can be on the ovary. It can be in the abdomen. And so, it’s any pregnancy that is located outside of the cavity itself.
Melanie: Who is at risk for ectopic pregnancy?
Dr. Martinez: Well, so the ectopic pregnancy patients that are the most at risk, are those with fallopian tubes that are not functioning properly. They’ve been damaged maybe through a previous undiagnosed pelvic infection or previous treated pelvic infection. There are some sexually transmitted infections that characteristically damage the fallopian tubes, and those that have prior infections and/or possible procedures, surgeries or scarring, any sort of damage to the fallopian tubes, those are the patients that are at the highest risk of having ectopic pregnancies.
Melanie: So, are there some symptoms, Dr. Martinez, something that would signal to a woman that’s just recently become pregnant that this is what’s going on?
Dr. Martinez: Yes. Oftentimes, the ectopic pregnancies are diagnosed early during a pregnancy, and that would be either when a person has--shortly after they’ve missed a period or possibly they could have abnormal bleeding. So, vaginal bleeding can be a sign. And, in some situations, they can actually have pelvic pain. So, either the left or the right side near the ovaries of the fallopian tubes, the patient may start to have some cramping or pain, and that could be a signal that there is a pregnancy located within the fallopian tube itself.
Melanie: Is this very dangerous, and can a woman maintain a pregnancy that’s ectopic?
Dr. Martinez: So, it’s not recommended to allow a pregnancy to continue that is ectopic because it just is not a safe environment. So, ectopic pregnancies have the potential to bleed, to rupture out of the fallopian tube most commonly, and it can create a situation where a patient may have a large amount of bleeding within the fallopian tube and the abdomen that can lead to a surgical emergency. It can lead to nausea, vomiting, fever, chills and, at that point, it becomes an emergency and then we have to take out the pregnancy tissue and repair any sort of bleeding that’s occurring. So, it’s not recommended to continue an ectopic pregnancy. With that being said, in some developing countries, occasionally, patients will actually present with an advanced ectopic pregnancy or an abdominal pregnancy later on in gestation. But, overall, especially in women in the United States that are receiving early prenatal care, it usually is discovered either through bloodwork and the levels not rising appropriately of the pregnancy hormone, and/or ultrasound showing that there’s a lack of a pregnancy in the uterus, that these are diagnosed early enough to where they can be addressed and we can avoid the emergency situation.
Melanie: So, then, what do you do to treat, and you mentioned surgery a little bit, what does this involve now for the woman?
Dr. Martinez: So, in an ectopic pregnancy, depending upon the level of the hormones, if the pregnancy hormone, the hCG, is of a lower level; if a pregnancy that is located most commonly within the tube is of a certain size and a lack of a heartbeat and those kind of signs, then the patient may actually be a candidate for medical therapy over surgical therapy. So, there are medications out there. Methotrexate is a medication that stops any dividing cells and it can help counteract the growth of the pregnancy, and sometimes patients can be managed medically. In other cases, depending if there’s bleeding, if the patient is symptomatic or the hormone levels are high or the size of the ectopic is larger, then surgical intervention would be needed. And, in most cases, we do a minimal surgery called a “laparoscopy” which is small incision in the belly button and maybe a couple of places in the abdominal cavity, and we can take out the ectopic pregnancy. In some cases, the tube can be salvaged if it’s not damaged, but in other cases, it may be recommended that the fallopian tube be removed so as not to put the patient at risk for another ectopic pregnancy in the future.
Melanie: And, that was going to be my next question. If you have had ectopic pregnancy, are you then at risk, if you try and get pregnant again, for that to happen again? Is pregnancy possible after surgery as well?
Dr. Martinez: So, it is possible depending upon the situation. A woman has two fallopian tubes so, in general, there’s just one ectopic at a time. If the fallopian tube that’s affected with the ectopic, if it is damaged, it’s recommended to either remove the tube or to block the tube so that no pregnancy can potentially happen in that tube again. With that being said, if the other tube remains open and it’s of a normal contour, a normal shape and it’s not diseased, it’s a healthy tube, then the patient can potentially get pregnant from that tube. In some cases, if there’s tubal damage to both of the tubes through a prior infection, then both of the tubes may be recommended to be removed at which time that would involve assisted reproductive techniques, specifically in vitro fertilization which bypasses the tubes and allows a physician such as myself to go and get the eggs from the ovaries and not utilize the tubes to get pregnant.
Melanie: So, in in vitro fertilization, you avoid the tubes altogether, so ectopic pregnancy is pretty low risk when you’re doing IVF?
Dr. Martinez: Yes. IVF does bypass the tubes and it allows us to not rely on the tubes but to place an embryo directly into the uterus. So, in most cases, women that do have damaged fallopian tubes, both of them, then it may be recommended that they undergo IVF as their preferred route to conceive.
Melanie: Such interesting information, Dr. Martinez. So, wrap it up for us a little bit about ectopic pregnancy--what you tell women that either have discovered that this is going on or are at risk for ectopic pregnancy. What do you tell them and why should they come to the Reproductive Science Center of New Jersey for their care?
Dr. Martinez: First of all, if a woman misses her period and she suspects that she’s pregnant, taken that home pregnancy test and it’s positive, then my recommendation is to make sure that you proceed with establishing care with an obstetrician gynecologist at your earliest convenience because there are a couple of tests, either laboratory testing and/or ultrasound testing which will confirm the location of that pregnancy which will allow you to identify a potential ectopic pregnancy early on. If there is an ectopic pregnancy, you may have symptoms--bleeding, pain. You want to be very aware of those things and also contact your doctor if you think you might be at risk of being pregnant because early intervention will keep you the most healthy. From the point of our practice, the Reproductive Science Center of New Jersey, we specialize in infertility and all of a woman’s health surrounding the reproduction and infertility. We specialize in early pregnancy loss and we try to provide an environment that is both supportive and personalized to help our patients in the most comfortable setting and to take care of them as we would take care of a member of our family.
Melanie: Thank you so much, Dr. Martinez, for being with us today. You're listening to Fertility Talk with Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That's www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.