Can you have an ectopic pregnancy with ICSI

Ectopic pregnancy refers to a condition wherein an embryo gets implanted outside the uterus, usually in one of the fallopian tubes. Such cases happen in approximately 1% of all pregnancies, although traditionally their incidence is thought to be significantly higher in pregnancies resulting from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments.

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Among several risk factors proposed, abnormalities in the fallopian tubes (an indication for IVF), transfer of multiple embryos, the treatment technique itself are the most common factors listed. Multiple statistical analyses conducted across countries have indicated tubal infertility to be the most common cause of ectopic pregnancy, followed by transfer of multiple embryos. Other risk factors include smoking, previous history of ectopic pregnancies, older age while conceiving, endometrosis, pelvic inflammatory disease and so on.

Though IVF/ICSI treatments are often used to help overcome tubal problems – after all, it bypasses the fallopian tubes, ironically, they also slightly increase the risk of an ectopic pregnancy. This is because if the embryo is placed too high in the womb there is a greater chance it can drift off course. Most of it depends on the embryo transfer process. Research has shown that extended embryo culture, such as blastocyst transfer, has shown to significantly reduce the risk of EP, while frozen-thawed embryo transfer (T-ET) has shown no effect on the risk of EP following IVF/ICS. Hence one should always insist on the most experienced doctor for conducting one’s embryo transfer. Rarest of rare cases have also seen bilateral tubal ectopic pregnancy following ICSI, however the odds of this happening is again 1/200,000.

Fertility medication prescribed to stimulate ovulation can also be one of the risk factors and one should always get a specialist’s opinion before starting such courses of medication.

However, it is not that bad a worry for mothers who have dealt with ectopic pregnancy. Most women who have had an ectopic pregnancy retain the ability to pregnant again naturally, even after removal of a fallopian tube. Research facts reveal that 65% of affected women go on to have a successful pregnancy within a period of 18 months. However, in some cases assisted fertility treatment is advisable.

Ectopic pregnancy does not have any specific symptoms to distinguish from other gestational discomforts. However, a vaginal ultrasound may reveal the position of the fetus on the fallopian tube, and confirmatory blood tests to check the levels of human chorionic gonadotrophin, hCG, which tends to be lower and its levels increase at a slower pace in an ectopic pregnancy than in a normal pregnancy, can be done twice in 48 hours.

Symptoms indicative of severe ectopic pregnancy pain include,

  • stomach pain, usually low down on one side
  • vaginal bleeding different from a normal period, like stopping and starting or very dark brown in colour, or a watery brown discharge
  • discomfort when going to the toilet
  • pain in the tip of the shoulder – caused as a result of some internal bleeding
  • sudden, sharp and intense stomach pain
  • feeling very sick
  • suddenly becoming dizzy
  • fainting
  • very pale skin

One should immediately seek expert help when faced with such a situation.

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