August 21, 2014

Fertility after an ectopic pregnancy

Hi
I found this site when i was searching google site for my questions.This
site is wonderful with good information.I too want to ask some questions.I
will explain my situations.
This is a very lengthy mail.Please make time to read this and answer my
questions.I will be very thankful to u.

I am 26.I am trying to get pregnant since 3 years.I have regular periods
for 32-35 days.
It never changed since my 14th year.only 2 or 3 times it got delayed for
about 10 days.other than that nothing much difference.

After our marriage,we tried for 8 months for pregnancy without any
medication.After tht we consulted our doctor,as i am having regular periods
she asked me to have clomid tablet from 3rd day to 7th day and progesterone
tablet from 18th day to 28 th  day.I tried this for 3 months.There was no
use.During this cycles we didnt have ultrasound test.
For the next cycle I again started taking clomid from 3rd day for 5 days
and i went to ultrasound examination on the 12th day.
The details are
Right Ovary Follicle : 1.2 cms
Left Ovary Follicle :1.9cms
Endometrium Thickness : 0.8cms

on th 14 th day I again went and have the following observation
Right Ovary Follicle : 1.2 cms
Left Ovary Follicle :2.5cms
Endometrium Thickness : 1.0cms

on that day my doc asked me to have pubergyn injection and i again went on
16 th day for ultrasound
Right Ovary Follicle : 1.0 cms
Left Ovary Follicle :Ruptured
Endometrium Thickness : 1.1cms
POD : minimal

For this cycle i got pregnancy but it was an Ectopic Pregnancy.I had severe
pain on my 45th day and found that it was tubal pregnancy and immidaiately
laprotomy surgery was performed and got aborted.

During this surgery my doctor observed some thing and told me that I have
only left tube connected to the uterus.My right tube is not connected to the
uterus.Adding to this I have another small uterus attaching to the right
tube.This was the observation.

After this for 3 months i didnt think of getting pregnant.After 6 months we
again started the same treatment by taking clomid for 5 days and went to
ultrasound on the 12th day.
Then Right Ovary follicle was 1.1 cm
On the 14 th day it is 2.4 cm
Then again I had the same pubergyn injection .This time I got positive
result for pregnancy in the urine test.But in the ultrasound we didnt find
anything.
After 50 days i got my periods and my doctor said me tht it should be
biochemical pregnancy.

After this again we had 3 months gap and we moved to new place.So here we
started our treatment again.

After all basic tests  and SSG
again my new doctor suggested me to have the same treatment
In SSG she observed left tube is open and so no problem.
so in the february i again started taking clomid for 5 days and went to
ultrasound on the 12th day
My doc told me good follicle was on the right side which measures 12.6mm
Endometrium Thickness was 6.73mm
My doc asked me to do the LH test and take the injection pregnyl when it
comes positive.
But i didnt get positive LH test So she advised to have the injection on my
15 th day.
But at last the result is negative and again I got my periods on 34th day.

Again in the March cycle I continued this treatment hoping tht this time my
left follicle may mature.But our thought was wrong.This time again one right
follicle was good measuring about 19.3mm.But my doc told me this time
endometrium thickness is not upto the level it is only4.5 mm.So she advised
me to have progesterone tablets for 10 days after the injection on my 12th
day.

But this time also my pregnancy test is negative.
This is my whole story.

My Questions are:

1.As i got Ectopic Pregnancy once will i be able to have normal pregnancy
again?
2.In my case will egg releases only if i take that injection? Without that
is it not possible??
3.Even if I take that injection i think my chances of getting pregnant is
good only if my left follicle gets matured. Am I right?
4.My doc is asking to try one more cycle of clomid and then start the
injections treatment.Shall I do that or shall I start injections treatment
in this cycle itself?
5.I am very depressed thinking about this all the time I have a big doubt
that will I become pregnant and have a baby?
6.Please suggest me which treatment is better based on ur opinion in my
case.

Thanks in advance but please reply me.

MADHAVI
Helsinki, Finland

Dear Madhavi,

Thank you for sharing your story. Your doubt and disappointment are understandable. However, in my judgment, based only on what you have revealed, your chances of ever having a baby are quite good.

I will summarize what you’ve revealed to us so far, but bear in mind there are some key bits of information that you either left out completely or for which you have been vague. Email is not the optimal form of communication for this, but let’s try our best.

When I work on seeing the big picture for someone’s fertility, I focus on three areas which most of the regular readers already know and those are SPERM, EGGS and ANATOMY. You mention nothing of your husband’s sperm, but with the two pregnancies you have described, we might assume that the sperm is OK. Your eggs have produced two pregnancies (even if they were an ectopic and a biochemical), so that is promising. Your age is even more promising. This brings us to your big problem — your anatomy. From what you said, your HSG showed that your left tube was open. Can we assume you mean that your right tube is absent or blocked then? If, so that leaves you with a realistic chance of getting pregnant ONLY IF you ovulate from the good side.

Now going back to the ovulation issue, your periods are not every 28 days on your own. The fact that naturally, they are every 32-35 days means you will have fewer ovulations per year than average. Also, half of your ovulations are essentially wasted because they will be on the right side where the tube is blocked / absent / disconnected. We don’t know for sure whether or not you ovulate on your own. We do know that you have ovulated at least twice using a combination of Clomid and hCG (Pregnyl and Pubergen are both hCG. Just different brands). Your descriptions of your ultrasound findings are very good. It seems everything went as expected with respect to the sizes of the follicles.

Now let’s look at your specific questions:
1.As i got Ectopic Pregnancy once will i be able to have normal pregnancy
again?
A woman who has at least one open tube can usually still have a normal pregnancy. Most pregnancies that occur are normal rather than ectopic. This is true even for women who already had an ectopic.
2.In my case will egg releases only if i take that injection? Without that
is it not possible??
This question is not answerable, because I have no way of knowing, without doing further monitoring whether you can release an egg on your own or not. I would venture to guess that you CAN ovulate on your own without the trigger injection, but the chances of ovulation are MORE CONSISTENT if you take the injection. In other words, some months you might and some months you might not. But it is not that important anymore. Remember that the best questions to ask focus on WHAT DECISIONS TO MAKE, which is what we will discuss shortly.
3.Even if I take that injection i think my chances of getting pregnant is
good only if my left follicle gets matured. Am I right?
As I said earlier, if your right tube is truly blocked or missing, then the chances of pregnancy are terrible UNLESS you have ovulation on the good side (the left side), so I would agree with you there.
4.My doc is asking to try one more cycle of clomid and then start the
injections treatment.Shall I do that or shall I start injections treatment
in this cycle itself?
This is the type of question I find most practical. You have many choices. You can try naturally, on your own. You can try Clomid again. You can move up to taking injectables. With each advancement, costs go up, but chances also go up. So the choice is individualized depending on the balance between how great your sense of urgency vs how great is your preference to save money. I always thought medical care was free in Scandinavia. Isn’t it? If so, have you considered just going on to IVF?
5.I am very depressed thinking about this all the time I have a big doubt
that will I become pregnant and have a baby?
Your feelings are very normal. However, don’t forget that with IVF, your chances of getting pregnant should be very very high.
6.Please suggest me which treatment is better based on ur opinion in my
case.

This is best discussed with your doctor. I still have incompletely information. Some things that would be considered in making the decision are as follows:
What exactly does the HSG film show? Is the uterine cavity normal? Is it confirmed that the left tube is open and the right tube is not? How brisk is the spillage from the left side. Is it just a small trickle? Or is there a large amount of dye spillage?
What other ovuations problems might you have? Do you have a healthy BMI (below 25)?
How much will it cost you to do IVF? How much will it cost you to do IUI?

For most couples in your situation, I would probably offer at least one aggressive IUI cycle with injectable stimulation, trying to get 2 or 3 eggs to grow on the good side. (It doesn’t matter how many grow on the bad side). Then, if there is still no pregnancy, I would give serious consideration to going on to IVF. Your age is on your side and gives you many options. If you were 40, I’d probably suggest IVF sooner than later.

Thanks for sharing your story. We all wish you the best. Feel free to give us an update on your progress!

  • Mersia

    Hello, i believe that i have also have a fertility problem and i would be thankful if you could give me some advise. on 5 December 2007 i found out that i was pregnant for the very first time after trying with me husband for 8 months without any medical help. after going for my first -second and third ulta-sound scan my doctor has revealed to me that the embryo was not growing and that he had to abort the embryo on the 14 january, the diagnosis was that the products of conception showed implantation failure (type II), which my doctor claimed that it is the commonest cause of reccurent pregnancy failures.they suggested a treatment for the next pregnancy … aspirin + heparin. after two months i tried again to get pregnant ( using ovulation kits) after consulting my doctor that i was healthy. my doctor suggested that as soon as i was ovulating i was to start taking aspirin 75mg and duphaston daily. on 23 April i found out i was pregnant for the second time, but i was seeing blood and with the first ultra-sound scan we couldn’t see the embryo again. so , my doctor suggested i should take progesteron because my hcg levels were rising, since we checked it twice a week. on the 16 May my doctor confirmed that i had an ectopic pregnancy and that it should be treated immediatly with laboroscopy, before the operation he suggested that it should be best if he remove my left tube. My questions are if i still can have a normal pregnancy , what examinations should i do before trying again, when should i try again., and most importantly was my doctor correct to remove my left tube since the ectopic pregnancy was detected early. Thank you in advance. i am looking forward your reply.

  • http://shakthi_j@ymail.com sakthi

    i am sakthi i have got married one year but baby s not click. now i am taking treatment .i am used fst iui .now i am waitng for a result.

  • liby biju

    hi,i am 26yr old.i was marrid in 2008 nd aftr tat i got an ectopic pregnancy,so salphinjectomy was done on the rt tube.then i tried to concieve i didnt gt pregnant.nd i also developed hypothyroidsm,nd nw my mensus are very irregular tat is i always hv to tk medicines to get a period.i am realy fed up eating medicines,nd then last aftr my hcg examinatn my reports told me tat my left tube was blocked.so i underwent a diagnostic laproscopy,nd then my doctr started wid inj pubergen 50000 nd my follicer study was done then my follicles ruptred bt til date i didnt concieve.nd frm may tis is september til ny i did gt my periods also.wat to do i am worried.nw wat to do.wil i get pregnant.

  • kiki

    Hei yall, im feeling what your’ll feeling, i had an ectopic in 2008 and my periodz have been regular but i have not had any luck with falling preganant, its so devastating when i get my periodz after tryin so hard, i want to fall preg naturally without any medication,because this may cause an ectopic again,and i can’t go through it again,my fiancè and i are devastated. Since my periods are regular,do i stand a chance to fall pregnant naturally? Please help.

    Looking forward 2 your response

  • IVF-MD

    Kiki, do you know what your tubes are like after the ectopic? Are they still open or are they blocked?

  • mylan

    hi! i feel also what u felt.. I’m 23 yrs.old and I got my tubal pregnancy last April 2011. The doctor remove my left fallopian tube. I only have my right tube now..after 2 months of normal period Im quite worried of not getting pregnant anymore and the risk of having an ectopic again but with the grace of God and prayers I am now 8 weeks pregnant after I got married to my husband. Still praying for a good health of my baby and me.

  • http://zmds sangster

    hi am 39yre and had my first prego 15 years ago.in 2011 october 17th i tested positive but with low hcg.a week later i stared felling terible pain from the sides.on 7th Nov 2011 it reputured and i was operated on.now am thinking of having twins cos i only have one son.my question is can i take clomodi without hving the same tubal preggo?if so when can i start taking it cos i cant wait or plize help me if there is any thing i can do to have it double