I have now been pregnant twice. Both pregnancies were tubal ectopics, both ruptured, and both required emergency surgery and shots of Methotrexate. In both cases, I was lucky to escape with my life. (You can find the gory, bloody details here: 1st Ectopic, 2nd Ectopic.)
I feel like an idiot for letting this happen to me twice. If I had known more and been more alert, I might have caught and resolved these ectopics before emergency intervention was required. Perhaps I would still have my tubes. Hell, perhaps I would have a baby in my arms.
Since a lot of people end up here via Google searches on ectopic pregnancy, I thought I'd do a post on "lessons learned about ectopic pregnancy" based on my own personal experience. Ectopic pregnancies can be very hard to detect and even harder to end.
1) Home pregnancy tests might not detect an ectopic pregnancy. During my first ectopic, I had a negative home pregnancy test on cycle day 3, only to discover a 6.5 week ectopic pregnancy 2 weeks later.
2) A low Beta HCG (>1) might indicate an ectopic pregnancy. During my second ectopic, I had a Beta HCG of 5.9 after an IVF cycle (10 days past day-3 transfer). At the time, the nurses told me 5.9 was a negative pregnancy test, but I now know that anything above 1 is slightly positive. If I had a a follow-up Beta HCG blood test, my ectopic pregnancy would have been detected a full 5 weeks earlier and I would not have required emergency surgery.
3) You can get your period and still have an ectopic pregnancy. During both of my ectopic pregnancies, I received my period right on schedule and had no idea I was pregnant.
4) Getting a shot of Methotrexate does not remove the risk of an ectopic pregnancy rupturing. My second ectopic ruptured 8 days after a Methotrexate shot.
5) Surgery might not resolve the ectopic; you might need a shot of Methotrexate anyway. The opposite of #4 holds as well; you might get surgery but still need Methotrexate. My first ectopic was treated surgically with salpingostomy - they carefully cut open the tube and tried to scoop the ectopic out. It did not work and the ectopic pregnancy persisted; HCG levels continued to rise. I required a shot of Methotrexate 9 days after surgery to finally "resolve" the ectopic.
It is more common for ectopics to persist after a tube-sparing salpingostomy than after a tube-removal operation, such as a salpingectomy.
6) Ruptured ectopics can have very different symptoms. A ruptured ectopic can seem like a heavy period, with a slow bleed over several days and minimal pain (like my first one). Or it may be a massive internal bleed with an acute onset of pain and no vaginal bleeding (like my second). Prior to the rupture, you might have pregnancy symptoms or you might not, and you might feel great or you might feel like crap.
7) Your chances of subsequent ectopic increase the more ectopics you have. About 2% of pregnancies are ectopic, however once you've had one your chances of a second are increased 10-fold, to a 20-30% chance per pregnancy. Once you've had 2 ectopic pregnancies, the chance of a third pregnancy being ectopic is 50%.
8) If you've already had one ectopic, please be extra-extra cautious. Because ectopic pregnancy can go undetected for so long and can kill you within hours of a rupture, please be extra careful if you have already had a prior ectopic.
If you are having unprotected sex, consider taking home pregnancy tests several days into your cycle or after your period stops, to increase the chances of catching an ectopic pregnancy.
If you are completing an IUI or IVF cycle, demand follow-up Beta HCG blood tests until either the results are definitively negative (HCG less than 1) or you have an ultrasound confirming an intrauterine pregnancy.
If you are not planning to conceive, go on birth control, or consider a vasectomy for your partner. Tubal ligation is another possibility, but there is still a small chance you'd get pregnant with a TL and an even higher chance that the pregnancy would be ectopic.
9) If you have a nagging feeling something is really wrong, get it checked out. With my first ectopic, I did not have many physical symptoms. Instead, I had a feeling that something was very wrong and I even had a suspicion it was an ectopic pregnancy. That feeling turned out to be right.
A few weeks earlier I had read a book by Dr. Marie Savard, How to Save Your Own Life, that convinced me to listen to the "something is really wrong" feeling. She said patients very often intuitively know how serious their medical condition is, and that if a little voice is telling you something is really wrong, something probably is. Listen and get checked out.