Hi Corinneck,
You raise some great questions.
With regard to your question ‘why would people who had had one or more than one natural EP would be advised to go IVF (this advice was more to minimise the risk of another EP rather than just to get pregnant.) Surely if the stats say there is an increase in the likelihood of another EP after a first - whether via IVF or not - then there is no advantage?’
There is an advantage to going the IVF route depending on an individual’s diagnosis. The 10% chance of a subsequent ectopic pregnancy naturally is an average evened out by people whose contralateral fallopian tube is considered clear. When people are advised to go for IVF having had two ectopic pregnancies they have, more often than not, either lost both of their tubes or have only one fallopian tube remaining. Even if this remaining tube has been treated with methotrexate it is very likely that the ectopic pregnancy will have caused some damage to the fallopian tube so their individual risk of another EP will be heightened plus the likelihood of conceiving naturally greatly reduced. Furthermore, multiple ectopic pregnancies suggest that there was damage, narrowing or distortion in both of the tubes so their individual diagnosis would not have been that of the average statistic. There is also a good chance that there were other intervening factors like endometriosis that could have caused the problems with the fallopian tubes.
If they were advised to go for IVF following one ectopic pregnancy this is most likely because examination of the fallopian tubes takes place when an ectopic pregnancy is treated. Medical professionals look at the fimbriae and whether there is any narrowing or signs of damage to the remaining tube. If they see problems from this examination they would often recommend the IVF route depending upon the severity of what they see and how they consider this would increase the risk of another ectopic pregnancy. They may have considered that a tube was completely blocked on this examination so there was no chance of conceiving through it or have thought that someone was at an increased risk, above average, because of the degree of blockage.
Age could also be a factor in the advice.
I have never seen or heard recommendations to try IVF following an EP without there being intervening gynaecological circumstances to suggest this would create a much lower risk than trying to conceive naturally. It would be very interesting to see the information and the medical argument they are postulating in the sources you have read.
I have read the study again too following your comments and despite the title being “Ectopic Pregnancy After Infertility Treatment” I agree, on reflection, that the author isn’t clear whether they are discussing statistics after infertility treatment or generally. I have looked at several other sources from other researched journal articles to specific IVF clinic advice and exactly the same can be argued for every source; They say the same as the attached journal article and are equally unclear about whether they are talking generally or specifically in relation to IVF.
Sorry to not be able to clearly answer your question but this could therefore mean that the 10% statistic is accurate and we are incorrectly querying the paper or it could mean that the data is limited or hasn’t yet been analysed. I am going to try to contact some key people in the field so I can get more definitive answers and will come back to you as soon as I have the information.
Statistics on ectopic pregnancy are difficult to assess generally even for natural ectopic pregnancies because of how they are recorded. It is often speculated that incidences are higher than records indicate. As you say, the numbers are smaller for IVF and, adding in the recording difficulties, it could be that the figures are an issue.
Any other questions, give me a shout and I will come back to you when I have more information on the statistics in the paper.
Best wishes,
EPT Host 13