How does an embryo get into the tube? After the egg leaves the ovary, it gets picked up by the tube, and after intercourse or insemination, fertilization takes place midway down the tube. The new embryo then needs to get through the rest of the tube into the uterus. If it stays in the tube, there’s your ectopic. Compared to the uterus, the tube is probably a sub-standard implantation zone. It is probable that there are many embryos that get stuck in the tube but don’t divide further, so they may be ectopic, but they dissolve away and no one knows they even existed.
Aren’t some women prone to ectopics? Yes they are, and these are women who have some sort of tubal scarring. The tube is a muscular tube about the length and diameter of a pen that has one end attached to the uterus and the open end hanging around near the ovary. This open end needs to be free: it shouldn’t be attached to anything, this way it can move to pick up the egg. Now we don’t know if it moves towards the egg and actively picks it up, but we know that tubal freedom is a plus. If there is some scar tissue on the outside of the tube, holding the tube down, it can’t move well. This may prevent the tube from getting the egg, but if not, it may cause the embryo to get stuck inside the tube. There is a second type of tubal scarring, and this involves the cells on the inside of the tube. These cells are large and lush and have microscopic hairs (cilia) that help sweep the egg and embryo towards the uterus. These cells may become damaged, usually from infection or endometriosis. If the sweeping can’t occur, ectopics can.
I had an ectopic, but my tubes are normal? Yes, even though some women are at higher risk, most ectopics occur in women with normal tubes. It’s just a numbers game: the vast majority of women trying to conceive have normal tubes, so even though their rate of ectopic is low, they have the majority of ectopics.
I had one ectopic, will I get another? You might. In medicine, the biggest risk factor for getting something bad is having it once before. If you get pregnant without IVF, odds are it’s in the uterus, but you really need to be watched for an ectopic.
How do ectopics occur with IVF, I though IVF bypasses the tubes? Embryos that are placed in the uterus can somehow move into the tubes. It may happen all the time, but the embryos flow back to the uterus. If they get up into a damaged tube, they will have more trouble getting back down. A few more next time, and please read disclaimer 5/07/06.
During my first two IVFs I expressed concern to my RE after transfer that I might dislodge the embryos if I were to walk around, commence normal activities, etc. The RE said, "Your uterus is like a peanut butter sandwich. They're not going anywhere."
ReplyDeleteOkay. But if this is true, then how does one explain the ectopics that routinely occur after IVF transfers? Clearly movement of the embros is possible. And if they're being places in the fundus, a great deal of movement is occurring for them to be able to get into the proximal or medial portions of the tubes.
Logic dictates that if the embryos can move into the fallopian tubes, against gravity and through unmolested layers of uterine lining (that should be like a "peanut butter sandwich") that they can also move down the uterus and thru the cervix. My thinking here is that the uterine lining has been disturbed with the transfer cathetar thereby creating a small channel which might also inadvertently assist with this movement. This specific area of uterine lining has been disturbed. Gravity could also be argued to assist in movement in this direction as well.
What do you think of this? Do you think that movement is possible in either direction, with the latter resulting in a loss of embryos via the cervix?
PS, What do you think of embryo glue? Could this help to prevent ectopics?
ReplyDeleteDr. Liccardi,
ReplyDeleteThanks for this wonderfully informative blog. It has helped me quite a bit towards understanding my fertility issues.
I and my husband have been trying to conceive for the past one year. We recently underwent tests and everything looks pretty normal except for two things: 1) My husband's semen has low motility (38%), though his count (59 million) and his morphology are good.
My HSG revealed two blocked tubes. Upon reviewing the XRays, my GYN thinks that my right tube has distal occlusion and nothing can be said for sure about my left tube (The HSG was inconclusive about the left side - the dye went through up to a certain point and not further - indicating a possible infundibular spasm).
I am getting two different sets of opinion online and from my converstaions. One recommends going for IVF as tubal repair is not very successful.
The other says that tubal repair can work in cases of mild tubal disease.
I read your other post about tubal repair and success rates. What is you general opinion about surgery for distal tubal occlusion?
Should I go with a surgeon that specializes in tubal repair or just go to the RE my GYN has recommended, understanding that the RE may perform very few tubal surgeries, if any, every year?
Thanks for your help.
Dr Licciardi,
ReplyDeleteI just discovered this fantastic blog, looking for some info about clomid negative effects on endometrium. I just failed to get pregnant on my first IUI and my doctor said my endometrium being a little thin could be the cause of the failed implant (I took clomid for one month last april and apparently it takes 3 months to get it out of one's sistem).
You had a great idea in writing this blog, since infertility is affecting a huge deal of persons even here in Europe and serious infos are still difficult to get.
Great job!
This is a great blog. Can you talk a little about why fertilization may not occur, even if ovulation occured with Clomid, HSG and a timely IUI was conducted.
ReplyDeleteDr Licardi,
ReplyDeleteI have been diagnosed with PCOS. I took 50mg of Clomid on days 4-8, ovulated my first cycle. I am currently on my second cycle and my RE just cancelled this cycle. He is said i am over responding to the clomid and produced 4 mature follicles and the chance of getting pregnant with an iui, given the fact that i am 26, and my husbands sperm count is very high, is extremely high. He said he does not want me to have quads. He is cutting the clomid to 25mg the next cycle. Does this sound right?
I have an ectopic pregnancy and got my methotrexate shot 4 days ago and waiting to see if it is working. This was after my 1st IVF which went so smoothly and then ended in this nightmare. I would like to know if you get an ectopic from IVF, is it likely this will happen to me again if I do another IVF?
ReplyDeleteThanks for the help.
Since you do not have a topic in mind for your next issue, would you consider addressing fibroids and their impact on IVF and Infertility?
ReplyDeleteI am 20 years old and I found out I was pregnant in August of 2009. 8 weeks into my pregnacy my doctors found that the pregnancy was a ectopic pregnancy. They rushed me to emergency surgery to remove the baby along with my right tube. My boyfriend and I was heart broken after the loss of our child. We both decided that we didnt want to try again after the loss of the child, till about 3 months ago when we decided that we wanted a child. We have been trying and trying for the last three months and it just seems as it is not working. People keep telling me to give it sometime but I just dont understand it. The first time we ever not used protection I got pregnant, now it seems as I cant get pregnant. It has made me really depressed here lately and wanted to get thur this. I didnt know what kind of questions to ask my OBGYN concerning why I cant get pregnant? So I decided to write about it and see what kind of feed back I can get. Thanks for all the help
ReplyDeletei have done 3 IUI cycles, all with clomid. just as we were about to start injectionables (and try IUI one more time before moving on to IVF), I got pregnant. Sadly, it was ectopic. My HCG was 6,000 and my doctor gave me methotrexate. I know we have to wait until my HCG goes to zero, but after that, can we try to concieve again?
ReplyDeleteEleanor,
ReplyDeleteWhile clomid helps a lot of people, we wasted one year with clomid. It was clearly thinning uterine lining. When we used Femara can see the difference in thickness of lining. Ofcourse, it took injecables for us to conceive.
I have had 4 ectopic pregnancies and now I am going to try iui what do u think the success rate will be this will be my first treatment? Scared but very eager to have a child.
ReplyDelete