This is an emotional time and some women are desperate to try to conceive again after an ectopic pregnancy whereas others are frightened and feel they need more time to emotionally and physically recover. Everyone grieves differently and there is no right or wrong decision when choosing to wait or try again quickly for another baby.
It is likely you have been advised to wait for three months or two full menstrual cycles (periods), whichever is the soonest, before trying to conceive. The bleed that occurs in the first week or so of treatment for an ectopic pregnancy is not your first period. It is the bleed that occurs in response to falling hormones associated with the lost pregnancy.
Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over 2 years. Your chance of conceiving depends very much on the health of your tubes.
Below is a list of common questions that we are asked about trying to conceive. Please click on any of the questions below that interest you and they will expand into a detailed answer. If there are any questions that you don’t see the answers to here, you may find them on our ectopic pregnancy discussion forums or you could email us at firstname.lastname@example.org.
Why must I wait for 3 months before trying to conceive?
While there is no clear, researched evidence on how long a woman should wait to try to conceive after having treatment for ectopic pregnancy, we and other medical professionals advise you wait for at least three months or two full menstrual cycles (periods) before trying to conceive for both physical and emotional reasons.
Physically, this timeframe is to allow your cycle to return and for there to be a clear Last Menstrual Period (LMP) date to be able to date a new pregnancy from. The LMP date is what is used to decide when to scan a pregnancy; information that is invaluable in ensuring you are not suffering from another ectopic pregnancy.
The first proper period you have after an ectopic pregnancy is likely to be heavier than usual and the second more like your usual period. A normal period would suggest you are hormonally ready to be able to try to conceive. Having two periods can also give an idea of menstrual cycle length, which may be different for a few months after your ectopic before settling back into its usual rhythm.
This wait allows the internal inflammation and bruising from the ectopic and any associated treatment to heal.
In addition to the physical aspects of ectopic pregnancy, many women also feel an intense emotional impact. Taking time before trying to conceive again enables the necessary process of grief to surface and be worked through. The emotional recovery that is often needed can be significant and many underestimate this aspect. Some studies suggest that women who conceive immediately after treatment for ectopic pregnancy are more at risk of suffering a subsequent ectopic and, as painful as it is to think about, the incidence of miscarriage (which is not linked to ectopic pregnancy) is 1 in 5 pregnancies, so taking that extra bit of time enables you some emotional recovery to feel strong enough to face whatever is coming next should there be further bad news.
If you have had either one or two injections of Methotrexate you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive.
This is because the Methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The Methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs, and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as cleft lip and palate, or even spina bifida or other neural tube defects.
The NHS Choices website has more information on vitamins, supplements and nutrition during pregnancy.
When will I ovulate again?
Before you get your first period after your ectopic pregnancy you will have to ovulate so when you get your period this will be an indicator that you are ovulating again. It is perfectly possible to ovulate within 14 days after surgical treatment and almost as soon after Methotrexate treatment, so it is important to be aware that it is possible to become pregnant without having a proper period first, if you are not using some form of contraception.
Have I only got half of my fertility?
When a person has only one fallopian tube they are still able to get pregnant from an egg at the opposite ovary as an egg from one ovary can travel down the tube on the other side. Conservative estimates suggest that an egg produced on the tubeless side manages to descend the remaining tube around 15 to 20% of the time. This means that rather than your fertility being halved it has been affected by around 30% or, looking at it another way, it means we have around a 70% opportunity of conception with each menstrual (period) cycle.
Is it true that I ovulate on alternate sides each month?
We naturally assume that we will ovulate from alternative ovaries each month (left ovary, right ovary, left, right etc.) This is not true and varies from woman to woman. Some women will ovulate from the same side each month with an occasional ovulation from the other side, while others will ovulate randomly from side to side.
Both ovaries compete each month to produce an egg and usually the one that is ‘pulling ahead in the race’ continues while the other one gives up (but not always – sometimes women will ovulate from both ovaries in one cycle or twice from one ovary but these are rare events that explain how we get non-identical twins naturally). It depends on which ovary contains the egg that is at the right stage of development at the point in time where the woman is due to ovulate and is nothing to do with a set pattern.
The side we ovulate from does not strictly matter as an egg from one ovary can travel down the tube on the other side.
How can an egg get down the only tube I have when it’s produced on the other side where I have no tube?
The fallopian tubes and uterus are lined with little receptor cells that, at the point of ovulation, are sent a chemical signal that ‘switches’ them on and they emit a signal that attracts a similar receptor in the egg and in the sperm to come and meet in the same place, i.e. the fallopian tube. The fallopian tubes are not attached to the ovaries and, also at the point of ovulation, some very delicate structures called the fimbriae on the end of the fallopian tube begin to move gently creating a slight vacuum to suck the egg toward the end of the tube it is nearest to (like lots of little fingers waving and drawing the egg towards it).
This means that, if you have only one fallopian tube, then there is only one set of receptors working and one set of fimbriae creating a vacuum and so the egg is much more likely to find its way to that tube, whichever ovary it is produced from.
Conservative estimates suggest that an egg produced on the tubeless side manages to descend the remaining tube around 15 to 20% of the time. This means that rather than your fertility being halved, it is more the case that the opportunity to conceive has been affected by around 30%. Or looking at it another way, it means we have around a 70% opportunity of conception with each menstrual cycle.
How can I tell if I’m ovulating?
For most women, the menstrual cycle lasts about 28 days and ovulation usually happens 10 to 16 days before the start of your next period. When you’re ovulating, you’re at your most fertile so it is the best time of the month to have sex. Physical signs of ovulation include:
- increase in vaginal discharge. This changes from white, creamy or non-existent to clear, stretchy and slippery when you ovulate;
- breast tenderness;
- mild abdominal pain;
- slightly increased body temperature;
- increased sex drive.
What exactly do ovulation kits predict?
An ovulation predictor kit measures Luteinising Hormone (LH). A surge in LH leads to ovulation within the next 12 hours. The egg does not always get released from the ovary in spite of a surge but it is a very good marker. A positive pregnancy test around 14 days after you think ovulation occurred is the only way of establishing that it actually did.
Urinary ovulation predictor kits are used typically daily around the time ovulation may be expected. A conversion from a negative to a positive reading would suggest that ovulation is about to occur within 24–48 hours, giving women two days to engage in sexual intercourse or artificial insemination with the intentions of conceiving.
As sperm can stay viable in the woman for several days, LH tests are not recommended for contraception, as the LH surge typically occurs after the beginning of the fertile window.
Can my Home Pregnancy Test (HPT) tell me if I am ovulating and can my Ovulation Predictor Kit (OPK) tell me if I am pregnant?
The DNA that makes up the strands for hCG, which is the hormone associated with pregnancy, is only one strand different to the luteinising hormone (LH) which detects ovulation. Both hormones, at a molecular level, are nearly identical. hCG has a beta sub-unit, meaning that it has an extra molecular twist. This means that it is possible for an OPK to detect pregnancy, although this is not always reliable. It is not, however, possible to use an HPT to detect ovulation.
Does drinking alcohol affect fertility?
In women, alcohol affects fertility by disrupting the delicate balance of the menstrual cycle. Clinical research data published in the British Medical Journal (BMJ) suggests that women, who drank socially, 1-5 drinks per week, were at a greater risk of decreased fertility when compared to women who remained abstinent. These findings underscore the importance of remaining abstinent while attempting to conceive.
The NHS standards watchdog, the National Institute for Health and Clinical Excellence (NICE) looks at the available evidence on the best way of treating or managing a condition and makes recommendations based on this evidence. Doctors, nurses and other healthcare professionals in the NHS are expected to follow NICE’s clinical guidelines. Current NICE guidance states:
“Pregnant women and women planning a pregnancy should be advised to avoid drinking alcohol in the first 3 months of pregnancy if possible because it may be associated with an increased risk of miscarriage.”
Research also suggests that alcohol disrupts the hormonal imbalance of the female reproductive system, leading to menstrual irregularities, and even anovulatory cycles (menstrual cycles where ovulation fails to occur). These changes can drastically decrease a woman’s chance of becoming pregnant and thus affect fertility.
Is there anything I can do to improve my chances next time?
Not really, but if you have a history of abdominal pain which persists after the ectopic, then you should see your GP to make sure you do not have a persistent infection that might contribute to a future ectopic pregnancy. Having regular sexual intercourse is a good way to approach future conception.
I have read a lot about alternative therapies and supplements, do these work?
The EPT is a charity that has the backing of many medical specialists and prides itself in providing accurate, research based medical information. Whilst we understand that many people are interested in the use of alternative and complementary therapies, we do not endorse these on our site. We therefore remind you that, should you wish to make use of these therapies, you exercise caution and also avoid recommending them to other users of the EPT forums. Many complementary medicines are quite powerful and can have harmful side effects if misused. They may also interact with medicines that you may already be taking, or intend to take. Please remember that “natural” does not always mean safe – indeed some of the medicines that are prescribed today (including some controlled drugs) are derived from natural products. Many “natural” or “herbal” preparations can interfere with prescribed medicines or even make an existing condition or illness worse.
Buying medicines on the internet is far from safe and you can never be 100% sure that they do what they say they do, or contain exactly what they say they do. Lastly, there are many unscrupulous people out there who are quite happy to make money from vulnerable groups of people like ourselves, making claims that cannot be substantiated about products and services they aim to supply to you, so do be aware of this and only seek guidance and or alternative treatment from appropriately qualified and registered individuals.
What tests, treatments or investigations can be done to make sure this won’t happen again?
Sadly, there are no tests or investigations that can be done to assure you that you will not experience an ectopic pregnancy again. Ectopic pregnancy occurs because of some underlying damage to a fallopian tube and the cause of this damage may never be established. Doctors would usually want you to wait to try again for three months, after which, your doctor will probably encourage you to try again for 12 months if you are less than 35 or 6 months if you are over 35. Only if you do not conceive within those times would they then consider further tests and investigations. The exception to this might be if the surgeon saw something during the surgical procedure to resolve your ectopic pregnancy that they felt warranted further investigation more quickly.
The one test that you could undertake in the meantime, if you feel that you may have ongoing problems of pelvic infection, is a Chlamydia test. Chlamydia is usually symptomless. Testing for this and taking antibiotic treatment if required might help to reduce the risk of a future ectopic pregnancy.
I have been referred for a Hysterosalpingogram (HSG) test, what is it?
A Hysterosalpingography (HIS-tur-oh-sal-ping-GOG-ru-fee) HSG test is a valuable test if you have been trying to conceive for a year and are not pregnant if you are under the age of 35, or six months if you are over the age of 35. You should visit your health care provider to discuss this.
(HSG) is a very safe procedure to investigate the shape of the uterine cavity and the shape and patency (the state of not being blocked or obstructed) of the fallopian tubes. The test is an x-ray of the uterus and the fallopian tubes. The doctors inject a special radiographic dye into the uterine cavity through the vagina and cervix which shows up on the x-ray. They then watch to see if the dye moves freely through the uterus and fallopian tubes to look for a block that may be causing fertility problems.
If the fallopian tubes are open, the special dye will fill the tubes and spill out into the abdominal cavity. If the fallopian tubes are full or partially blocked the dye will not flow freely and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal) can also be determined. The test is not 100% accurate as the fallopian tubes can go into spasm during the test and can appear blocked even though this isn’t the case. The test can also not determine what the internal villi of the tube look like.
The HSG can be painful, so analgesics (pain relief) may be administered before and/or after the procedure to reduce pain. Many doctors will also prescribe an antibiotic, such as Azithromycin, prior to the procedure to reduce the small risk of an infection. The medical professionals prescribe the antibiotics taking the viewpoint that prevention is better than cure and it is better to prevent an infection in your fallopian tubes rather than cure it.
Many women feel emotionally conflicted between wanting the peace of mind of answers versus the fear of catching an infection that could potentially do harm when they have a HSG test.
There is only a 1% chance of getting an infection from a HSG test and, of that 1% chance of infection, only 20% of the 1% who get an infection would need hospitalisation… This means that you have a 99.8% chance of not damaging your fallopian tube and a 0.2% chance of damage.
It would be likely that you would know if you got an infection through symptoms like abnormal vaginal discharge, painful menstrual periods, painful or uncomfortable sexual intercourse, abdominal pain affecting both sides, frequent urination, spotting between periods, pain during ovulation, fever, and/or lower back pain.
People are able to try to conceive again during their next menstrual cycle after a HSG test, unless medical professionals suggest a longer wait time. It has been claimed that pregnancy rates are increased in a cycle when an HSG has been performed.
My doctor says it is too early to have a Hysterosalpingogram (HSG) test, why?
Doctors prefer not to use a HSG test unless they really need to because it is not a 100% accurate test. For example, if the fallopian tubes go into spasm during the test they can appear blocked even though this isn’t the case. The test can also not determine what the internal villi of the tube look like. Furthermore, it is an invasive test and there is a very small (1%) chance that it can cause infection of the fallopian tubes hence their preference to only perform the test when it is unquestionably required.
When an ectopic pregnancy is treated, the remaining tube is typically examined externally and the doctors would usually have told you if they had seen any problems with it at that time. If you would like peace of mind about this you could ask for a post-operative follow up appointment to ask whether they had looked at the condition of your fallopian tubes during the operation.
The examination is a pretty good indicator about the condition of your remaining tube(s) because it looks at:
- The fimbriae – The fallopian tubes are not attached to the ovaries and, at the point of ovulation, some very delicate structures called the fimbriae begin to move gently creating a slight vacuum to suck the egg toward the end of the tube it is nearest to (like lots of little fingers waving and drawing the egg towards it).
- Whether there are any adhesions (scar tissue).
- Whether there is any thickening of the tube.
- The shape of the tube.
What is selective salpingography?
Selective salpingography is a fairly new procedure and not available in every centre but is well documented as having good success rates. It is normally done under mild sedation with pain relief.
During a HSG test, a small diameter flexible catheter is threaded inside the HSG catheter and, with the help of the x-ray machine, can be directed right into the opening of the fallopian tube. Once this is done, dye can be introduced directly into the fallopian tube. With this technique, it is possible to demonstrate a normal, patent fallopian tube whose opening may be in spasm. Fallopian tubes with an obstruction can also be opened by the higher pressures which can be achieved with selective salpingography.
- Assisted Conception
What is Clomid?
Clomiphene or Clomid is an extremely powerful, oral (taken by mouth), medication that is often prescribed to help those trying to get pregnant if their menstrual (period) cycle is so irregular that they can’t be sure when they are ovulating. The Clomid would produce a regular cycle to allow for timed intercourse or intrauterine insemination. The medication works by blocking estrogen receptors in the brain, stimulating them to release Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH). These are the naturally occurring ovarian stimulants that prompt ovulation in a normal cycle.
Typically you will take one to three tablets a day for five days early in your cycle. During this time, some women will notice hot flashes, moodiness, or sleep pattern changes but most patients notice no symptoms at all. Ovulation will typically occur 7-8 days following completion of the Clomid treatment. Because the ovaries are stimulated there may be some bloating, or discomfort with intercourse.
The chance of multiple ovulations is slightly higher with Clomid than with a normal menstrual cycle. The chance of twins resulting from Clomid is 6-8%. There is no increased risk of higher order multiples (triplets, etc).
Rarely women will have hyperstimulation of the ovaries as a result of Clomid use. In this case the ovaries become enlarged with multiple follicles. Other rare side effects include visual changes, reversible hair thinning, dizziness, or hives. Patients with currently existent large ovarian cysts or liver disease should not use Clomid.
Am I able to get pregnant with no fallopian tubes?
If your fallopian tubes were removed or both have been deemed completely blocked, it is still possible to get pregnant with IVF because it bypasses the fallopian tube and the embryos are placed directly into the uterus.
In 2010, the percentage of IVF treatments that resulted in a live birth (the success rate) was:
- 32.2% for women under 35
- 27.7% for women aged 35-37
- 20.8% for women aged 38-39
- 13.6% for women aged 40-42
- 5% for women aged 43-44
- 1.9% for women aged over 44
What is the NHS criteria for being eligible for IVF?
The NHS Choices website summarises that, in 2013, the National Institute for Health and Care Excellence (NICE) published new guidelines about who should have access to IVF treatment on the NHS in England and Wales.
According to the guidelines, women aged under 40 should be offered three cycles of IVF treatment on the NHS if they have been trying to get pregnant through regular unprotected intercourse for two years, or have not been able to get pregnant after 12 cycles of artificial insemination (directly inserting sperm into the womb). The guideline also states that if tests show IVF is the only treatment likely to help you get pregnant, you should be referred for IVF straight away. If you turn 40 during treatment, the current cycle will be completed, but further cycles should not be offered.
For women aged 40 to 42, the guidelines also say women should be offered one cycle of IVF on the NHS if they have been trying to get pregnant through regular unprotected intercourse for two years, or have not been able to get pregnant after 12 cycles of artificial insemination; They have never had IVF treatment before; They show no evidence of a shortage of eggs and they have been informed of the additional implications of IVF and pregnancy at this age. Again, if tests show IVF is the only treatment likely to help you get pregnant, you should be referred for IVF straight away.
The reality is somewhat different to this guideline though and NHS trusts across England and Wales offer different levels of service. The provision of IVF treatment varies across the country and often depends on local policies.
Priority is often given to couples who don’t already have children and this can sometimes be hard when you don’t have a baby but you are told you aren’t eligible because your partner has a child from a previous relationship. Sometimes people are also told they must lose weight in order to be eligible for IVF as this increases the likelihood of successful treatment.
How do I research private IVF clinics?
If you’re not eligible for NHS funding or you decide to pay for IVF, you can approach a private fertility clinic directly, although some clinics ask for a referral by your GP. On average, one cycle of IVF costs about £5000. However, this varies from clinic to clinic and there may be additional costs for medicines, consultations and tests.
The Human Fertilisation and Embryology Authority is the UK’s independent regulator that oversees fertility treatment, licenses and inspects fertility clinics and presents success rates for every licensed clinic. The success rates presented show the number of treatments carried out by a clinic in a particular year and the number of pregnancies or live births that were born as a result. The majority of clinics’ success rates are around the national average.
You can research clinics local to you and their success rates through HFEA’s Choose a Fertility Clinic Search.
If you’re thinking about having IVF abroad, there are a number of issues you need to consider, including your safety and the standards of care you’ll receive. The HFEA licenses and regulates clinics in the UK only. Clinics in other countries may or may not be regulated to local standards and regulations. Read about the issues and risks associated with fertility treatment abroad on the HFEA website.
I am not eligible for IVF on the NHS but cannot afford it, what can I do?
Egg-sharing is an IVF treatment that brings together women having conventional IVF with those unable to produce their own eggs. The woman who shares/donates some of her eggs receives free conventional IVF treatment, involving ovarian stimulation, egg collection and embryo transfer but half the eggs collected are then randomly allocated to the other lady, whose uterus is prepared for embryo transfer with hormone therapy. The recipient of the donated/shared eggs allocated eggs are fertilised with her partner’s or a donor’s sperm and are transferred as in conventional IVF.
This diagram borrowed from the London Women’s Clinic website helps to explain the process. Please note we have not researched this clinic so the use of the diagram is not an endorsement.
Results suggest that neither woman is statistically more likely to do better than the other but it is important to consider how you may feel if you got told by letter that the sharers IVF treatment had been successful and yours had not. You would also need to consider that your name would be accessible to that child when they were 18. For some this would be emotionally too tough to deal with whereas, for others, it would feel like giving someone else the gift of a child, understanding how the desperate need for having a baby feels. Neither feelings are right or wrong.
To become an egg-sharer, you would also need to meet certain criteria specified by the individual clinic established through a guideline by the UK’s regulatory body, the Human Fertilisation and Embryology Authority (HFEA). You can read more about these guidelines by clicking here.
What is the risk of ectopic pregnancy with IVF?
It is, sadly, still possible to have an ectopic when having IVF treatment. The incidence of ectopic pregnancy through IVF varies greatly according to what you read and from clinic to clinic but sits at about 10% in the UK. This is a higher statistic than would occur through naturally conceiving. However, the statistic given for the likelihood of a second ectopic after a first through IVF does not increase. This means that the risk of a second ectopic pregnancy after a first is 10% in the UK, whether through IVF or natural conception.
In IVF, a fertilised egg is replaced in the uterus and spends several days floating around before implantation. During this time it is possible to float into the fallopian tubes, the stump of tubes or the interstitial area of the uterus. No one can be sure why this happens but there is an unproved hypothesis that if the egg is encouraged along the tube by specialised cells that literally attract it on its journey from the ovary to the uterus then this could work in reverse and, if the fertilised egg is introduced in to the uterus first, these specialised cells can attract the egg toward them causing it to ascend the tube rather than descend it.
- Pregnancy Tests
I feel pregnant but my home pregnancy test is negative, why is this?
There can be a number of reasons for this:
- As the hormones in our bodies change in the later stages of the menstrual cycle, a special cyst called the corpus luteum cyst stimulates an ovary to produce progesterone. Progesterone has many actions on the body but, along with the other changes in your body, it can leave you feeling bloated, with tender breasts and sometimes feeling headachy and nauseated (sick). These can sometimes be interpreted as the feelings you might get in early pregnancy and can leave you feeling disappointed when a period arrives a few days late.
- Sometimes women ovulate later in their cycle than day 14. This might especially be the case if you normally have cycles which are longer than 28 days. If you ovulate later in the cycle, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
- Sometimes it can take longer than the average 6 to 7 days for the egg to travel along the fallopian tube and implant. Where this happens, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
- The test may be from a faulty batch.
My home pregnancy test was negative to begin with but now seems to be positive, what should I do?
Home pregnancy tests must be read within the time frame specified in the individual instructions on each pack. These times vary a little but any result which appears after 10 minutes cannot be relied upon to be an accurate result. It is not unheard of for people to do a test which is negative, leave it on the bathroom window sill until sometime later, and then when they look at it again a new line has appeared in the test window. This is invariably an evaporation line and not a positive result.
To get an accurate result, it is essential you follow the instructions on the Home Pregnancy Test pack. You should preferably test with the first urine of the day and in urine which has been in your bladder for at least four hours. Finally, you should always read the test result within the time frame clearly stated on the test pack’s instructions.
My home pregnancy test is positive but my doctors test is negative, why is this?
- If the test is done in the surgery using a reagent stick, just like the home pregnancy test you have already done, there is the possibility that the test the doctor is using is not as sensitive as your home pregnancy test.
- Sometimes women ovulate later in their cycle than day 14. This might especially be the case if you normally have cycles which are longer than 28 days. If you ovulate later in the cycle, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a pregnancy test detects.
- Sometimes it can take longer than the average 6 to 7 days for the egg to travel along the fallopian tube and implant. Where this happens, the egg may not have implanted for as long as necessary to produce the hCG hormone which is what a home pregnancy test detects.
- The test may be from a faulty batch.