My brother Mike is a real doctor. I mean it. He is a general surgeon in a small town in North Carolina and has not had a full night’s sleep in about 27 years. He is always being called out to the ER to help save someone’s life (or at least remove their appendix) in the middle of the night. The life of a fertility doctor is very different.
Some weeks are more reproductive psychiatry than reproductive endocrinology and emergencies are rare. We have an occasional patient with OHSS in the hospital and once in a while we have an ectopic pregnancy that requires laparoscopy but most of the time there are not a lot of medical surprises. However, among our surprises are the unexpected multiple pregnancy, ectopic pregnancy or heterotopic pregnancy.
Multiple pregnancies are always tricky to predict. Even if you transfer a single embryo, it can split leading to identical twins! Ectopic pregnancies after IVF are rare but not impossible (see below). Heterotopic pregnancies occur when one embryo ends up in the uterus but another one gets stuck in the tube.
Ultimately if you practice reproductive medicine long enough you will see quite a range of unexpected results. Fortunately, most patients do not get OHSS, most patients do not have ectopic pregnancies and most patients do not have heterotopic pregnancies.
So here is today’s Question of the Day from the book that my surgeon brother fell asleep reading: 100 Questions and Answers about Infertility.
55. How can you have an ectopic pregnancy after IVF?
As described in Part 3, an ectopic pregnancy can occur within the section of the fallopian tube that passes through the muscle of the uterus or within the short segment of fallopian tube that remains after surgical removal of the tube. The incidence of ectopic pregnancy following IVF ranges from 0.5 % to 3%, but this figure may be decreasing. For the past several years, embryo transfer has been routinely performed using ultrasound to properly guide the embryo catheter to the optimal uterine location. The exact mechanism responsible for an ectopic pregnancy following an IVF procedure is unknown. Some believe that embryo migration up into the fallopian tubes occurs because of local cellular activity or fluid mechanics present inside the uterus. Sometimes the opening of the fallopian tube in the uterus is dilated because of disease, making it easier for the embryos to enter the tubes.