Confused - tubal abortion / milking Fallopian tube!?

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Hi ladies,

I was wondering whether anyone knows anything about tubal abortions or “milking” of Fallopian tubes.

I was diagnosed with an ectopic pregnancy and was treated with MTX. Unfortunately, a week later I suffered awful pain in my stomach and shoulder which led to me having surgery that night due to internal-bleeding/free fluid.

Before I went in for surgery I stressed to the surgeon that I do not want to be at risk of an ectopic again. I would rather he took the tube and it took me longer to conceive than he leave a damaged tube that puts me at risk of an ectopic again (if that is even how it works!!) I explained that as I have a daughter already, that when trying for a second, the most important thing to me is that I not put my life at risk again by ending up in surgery again.

However, the day after the surgery the surgeon hugged me and explained how happy he was that he had saved the tube.

Everything was different than they had thought on the ultrasound. I had actually suffered a tubal abortion so most of it had come out of the end of the tube already so they had to just clean the area out and they managed to squeeze the remaining tissue etc out of the end of the tube. This does sound much less invasive than removing a tube or cutting the tube but what is really upsetting me is that he later said my risk of a future ectopic was “high”. I was exhausted and didn’t clarify this any further. But now I’m home and googling (dangerous!!) I’ve found some sites say future pregnancies can be very successful after milking tissue from the tube but some say the risk of a future ectopic is high. It doesn’t seem like what I suffered or how I was treated is common at all.

I feel devastated every time I read the word “high”. What does “high” mean!? The 10-20% for most pregnancies after ectopics or is it worse as my surgeon operated in this way?

Why would it leave the tube if my risk was high?

I really don’t understand and I know no one can really give me the answers but if anyone knows anything or even how on the NHS I can speak to my surgeon again or have questions answered, that would be great.

Thank you all so much x

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Hi, I’m so sorry for your loss, it sounds like you’ve been through a horrible time.

I had a tubal abortion which was milked out. The surgeon said there was minimal damage. Mine is a little different because it was my second ectopic and my other tube had been removed 8 weeks previously.

But I’m absolutely delighted to say that despite all that I’m now 10 weeks pregnant and everything is looking good. Baby developing beautifully in the uterus :slight_smile: This obviously wouldn’t have been possible if that tube had been removed, or perhaps I would have had a third ectopic if the surgeon had needed to cut the tube to remove the ectopic.

It must be hard to wake up and hear that the surgeon didn’t remove the tube when this is what you were expecting, but I’m sure they had your best interests and future fertility in mind. Unfortunately you will have an increased risk of further ectopic, but you’d have this even if they removed your tube instead of milking it. After my first ectopic I was told my other tube looked completely fine, but I still had a second ectopic. I had a follow up appointment with my surgeon a few weeks after surgery, did they offer this to you?

Have you had a follow up hcg blood test? Sadly after they milked my tube they actually left a small amount of pregnancy tissue behind (I was told this happens 20% of the time when the surgeon saves the tube) and I had to have follow up methotrexate.

FT

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Hi Fertility-tales,

Thank you so much for replying to me.

It makes me SO SO happy to hear you are pregnant and all is going well. You deserve all the happiness in the world after going through your experience.

I think I’m my mind I thought, no tube, no more risk. So when he said he had milked my tube and my future risk was high, I couldn’t understand why he left it. But to be honest, I really do not understand the medical side of it all. I’ve not been offered a follow up appointment with the surgeon or gynaecologists but will be going back for more bloods as after surgery they dropped 4,700 to 300 then to 30, so I will keep going back for bloods until the level is 5 or below. I had previously had methertraxate so that may have helped after surgery by already being in my system. The only thing I’ve found is that I’m a bit anaemic now and I’m still getting random stabs of pain - which does make me panic a little.

When looking online I found a lot of studies that showed women who had the milking method or tubal abortions all went on to have healthy pregnancies as it was minimal damage but then seen one that said it’s not common and future risk of ectopic is high, which devastated me again. I just don’t know what they mean by “high”. I would of thought I had minimal damage as most of the tissue was already out so they just had to milk the tube to get out the remaining tissue which was loose and not attached to the tube so I don’t understand why he said high. He also didn’t mention anything about previous damage in my tubes so would like to guess there is none? But maybe he just didn’t say? It was literally a 5 min chat at most.

As I have so many questions and haven’t been offered a follow up, I think I might pay privately for a consultation with a specialist who could perhaps explain things to me.

The surgeon I had was a lovely, older man who hugged me and signed me off work for a long time out of kindness for my recovery so I am trying to keep faith that he really did make the best choices for me. He knew my wishes were to most importantly, get home safe to my daughter and secondly, not have future risk of ectopic as I would love her to have a sibling. My sister is my best friend so that’s what breaks my heart the most about this.

I wish you all the best for your pregnancy, enjoy every second of it. With my daughter I loved pregnancy yoga and hypnobirthing especially, I started that at 12 weeks and found the bonding part amazing! X

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Thank you for your kind words! We’re so happy about this pregnancy and feel so incredibly lucky. I must admit that I have really high anxiety that something will go wrong. I was feeling really really sick and exhausted between weeks 5 and 10, but I’m starting to feel better. I’m really hoping this is normal as I’m coming to the end of my first trimester, and not because something has gone wrong. But I’m hoping that the 12 week scan will reassure me.

My surgeon told me that while I had a very high risk of a third ectopic (50%) that a tubal abortion was the best outcome because it meant minimal damage and less risk than if they’d had to cut the tube.

But I know you’re worried that the risk is higher than if they’d just removed the tube. I really don’t think that’s true, but it sounds like you need to chat to an expert about it. After my second ectopic I actually emailed the surgeon’s secretary and asked for the surgical notes, which they sent through no questions asked. This was really helpful because post surgery I was also told I had endometriosis, but they didn’t tell me what stage it was. But I was able to see this in the surgical notes. Could this be an option?

We also paid for a private consultation as we couldn’t decide whether to go for IVF to reduce our chance of a third ectopic (Stuart Lavery at Harley Street). He was brilliant and really knowledgeable about ectopics. He helped us interpret the surgical notes.

Could you ask your GP for a follow up appointment with the surgeon? Or maybe email the surgeon’s secretary directly to ask? They really should give you a follow up, it sounds like you are searching round for the answers yourself and you’d really benefit from a gynaecologist to give you these answers.

The chance of you having a little brother or sister for your baby is excellent. I really hope it happens for you!

FT xxx

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Dear Rose1986,

I am so sorry to hear of your ectopic pregnancy and loss and the worrying time you are going through.

Studies suggest that the chances of successful pregnancy are not significantly different between treatment methods ie whether having a tube removed or methotrexate or expectant management. From what I understand, the chance of a successful pregnancy is determined much more by the health of the opposite tube.

The chances of a further ectopic after a first in UK is 10%. So that’s 90% chance of the embryo being in right place next time.

While generally it is possible to conceive after an ectopic pregnancy, the amount of time it takes varies from couple to couple. Factors include age, general health, reproductive health and how often you have sex, among other things. It may be comforting to know that 65% of women are successfully pregnant within 18 months of experiencing an ectopic pregnancy and some studies suggest this rises to around 85% after two years.

Importantly early scans avail. As soon as you know you are pregnant, contact your local EPU to inform them and book in for an early scan at around six weeks. Remind them of your previous ectopic pregnancy. This self refer route is the best route in our view. Hopefully you will have some comfort to know you are under the radar of medical professionals right away.

As a gentle reminder following methotrexate injection, 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 hare lip, cleft palate, or even spina bifida or other NT defects. This is why the “wait” and then taking folic acid for 12 weeks before trying to conceive is so important.

Making the decision to begin trying to conceive is an emotional rollercoaster compounded by our sad loss. Again, you are not alone. We here emotional support whenever you need us. There is a specific Preparing for your next pregnancy board you can look at too whenever feel ready.

Sending much love,

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Further information is available at www.ectopic.org.uk

Email us at ept@ectopic.org.uk.

Our helpline is 020 7733 2653 (available Monday to Friday 10am - 4pm).

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team.

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Hi EPT Host 20 and Fertility Tales,

I’m so sorry, I have only just read your replies. I am awful at getting the hang of this - not even sure if I am replying correctly haha.

Thank you so much for the words of advice.

I have seen a fertility nurse and a surgeon now, both through the NHS. It wasn’t the surgeon who did my surgery but he answered all questions. He reassured me that the best choice was made and that the “milking” method was the least invasive so much more positive now.

It’s interesting what you mentioned about endometriosis as I’ve ovulated twice since surgery now and both times has been more painful and I’ve had nausea and dizziness. I was wondering if this meant endometriosis but am I right in thinking they would of seen this during surgery if I had it?

@fertility-tales, hoping all is going well with you now that we are a month down the line! Xx