Infertility: My third ectopic pregnancy.

Last spring I wrote a bit about my struggle with infertility up to that point. In the most recent entry I shared my feelings about having to go through a bilateral salpingectomy (i.e. removing both of my fallopian tubes), and what it would mean for my future TTC journey. Here’s an excerpt:

Some studies suggest that a salpingectomy can increase the success rate of IVF for patients who have had repeated ectopic pregnancies. Moreover, it would prevent me from having another life-threatening ectopic pregnancy in the future.

This is what my doctors told me in 2015, and I fully believed them. When you’re struggling with infertility, you quickly learn more than just the basics about how babies are made, and you learn to question everything people, including doctors, tell you. However, with my understanding of the female reproductive system, it seemed logical that no tubes would equal no place for a pregnancy to get stuck, and I saw no reason to question what I was told in this instance. A year and a half later, I would learn the hard way how wrong this was.

In early February this year, I was thrilled to get a positive result on a pregnancy test after my second IVF transfer. I also felt slightly nauseous, with aversions to certain foods/smells. It was still very early and based on past experience I knew better than to get too carried away, but I felt hopeful. A couple more days went by, and the positive test results grew stronger.

However, one evening I noticed some spotting, and the nausea disappeared. My mood fell. Everyone is always so quick to remind you that this doesn’t have to mean anything, but after a couple of miscarriages it gets hard to convince yourself that it’s anything other than the beginning of the end.

During the following days the spotting increased and then, inevitably, the bleeding started and my dream of an October baby came to an end. A chemical pregnancy, I concluded, and my mind went straight to the one egg we had waiting for us in the freezer, trying to figure out when we would be able to schedule the next transfer (spoiler alert: we have since transferred that egg and it did not lead to a pregnancy).

My official test day (the day the clinic instructs you to take a pregnancy test) was a few days later, on a Monday. I fully expected to get a negative result at that point. If it were, I considered not even mentioning the chemical pregnancy to my doctor, because I was worried they might postpone the next transfer an extra month if I said that I had been pregnant. It seemed unnecessary to waste another month just because I was “pregnant” for a couple of days.

To my great surprise, the test came out positive. A strong positive, even though I had been bleeding for three days at that point, and more than a usual period. I told my boyfriend that if I didn’t know any better, I would think that it was another ectopic. When I called the clinic to report the result they said it can take a while for the hormones to leave your body, and they told me to take another test the upcoming Friday. Most of my followers on my IVF Instagram account agreed that it was most likely just hormones that hadn't left my body yet. However, one girl suggested the possibility of an ectopic. A cornual/interstitial ectopic. This was new to me.

On Tuesday, I started bleeding a lot, so much that I had to go home and change during the day. I scheduled an appointment with my local doctor (the fertility clinic is located far away) for the next morning and wrote the following on Instagram:

Maybe this is the end of it though. I'm in the most pain I've been since it started today as well, especially on my right side (cue hours of googling cornual pregnancy which I learned is definitely a possibility even without tubes, if not more so).

On Wednesday, I went to see my doctor. He did an ultrasound but couldn't see anything. I felt stupid for taking up his time but I had been in a lot of pain when I made the appointment. By that point I was just a bit sore. My doctor did not check my hCG (i.e. the pregnancy hormone level in my blood). We talked about the possibility of an ectopic but he said that most likely, it was an early miscarriage and that the hormones just hadn't left my body yet.

On Friday, I took another test according to the fertility clinic's instructions. The result was still positive, and it actually looked stronger than on Monday. At that point, the bleeding had stopped entirely. I felt slightly nauseous again, like I had during the days after I took the first pregnancy tests. The fertility clinic told me to visit my local doctor and take a blood test, which I did. Because my doctor's office closes early on Fridays they didn't get the results from the lab in time to contact me before the weekend.

On Saturday, I didn't feel anything special, and there was no more bleeding. However, by mid-day on Sunday, I started feeling a lot of pain in my lower abdomen. I felt nauseous and feverish, but I didn't start bleeding again. Something about all this felt very familiar. I stopped eating, because even though I still wasn't sure what was going on, I wanted to be able to have surgery straight away rather than have to wait because I had eaten too recently, if it came to that. After having spent several hours just lying on the couch, I decided to take another pregnancy test. It was as strong as ever, even though I took it in the evening unlike the previous ones which were taken in the morning. The test result convinced me that it was time to go to the hospital.

At the hospital, everything felt like May 2015 again. We skipped the regular emergency ward and headed straight to the OB/GYN ward. Once there, it took a while before the doctor was able to see me. I just lay down on the sofa in the waiting room, writhing in pain. To my great surprise, a nurse came and admitted me even though the doctor hadn't seen me yet. Later, I realized why. They had looked in my medical records and seen the result of Friday's blood test - which I didn't yet know about. I wrote this on my Instagram:

hCG was 4,000 on Friday. 4,000! Ultrasound shows blood in my abdomen. Suspected ectopic. Cornual then. Can't believe I suspected it almost a week ago. I should be prepped for surgery soon. How can this be happening again? It should be impossible. I was told it wouldn't happen again when they removed my tubes.

I had to wait several hours before I could have surgery because the doctors were busy that night. I just lay in my hospital bed shaking from pain while my boyfriend screamed at the nurses to give me more pain meds once the effects of the previous ones wore off. Lovely. I was lucky when I had emergency surgery to remove my second ectopic because the hospital was less busy then. After midnight I finally had surgery and when I woke up I learned that I had in fact had a cornual ectopic pregnancy on the right side of my uterus. Half a litre of blood had leaked into my abdomen.

I was shocked and all I could think about was that I had suggested to my doctor already on Tuesday that it could be cornual and that he had taken one look at my empty womb on Wednesday and said he couldn't see anything. If he had taken a blood test I would have known how high the hCG was already that day and it would have been investigated further. Surgery would probably still have been necessary, but I wouldn't have had to reach the critical point that I did on Sunday.

In retrospect, I struggle with understanding why this has happened to me not once, not twice, but three times, and with the fact that it could very well happen again. But I also feel grateful that I have always known early on that my pregnancies weren't viable. I have never ended up in the hospital thinking all was well only to learn that the pregnancy was ectopic. That would have been infinitely worse. I also feel grateful that I have access to free, public healthcare, and that I live in a country where laws against "abortion" don't prevent medical intervention to end an ectopic pregnancy, putting womens' lives at risk. Because there are countries like that and my heart breaks for those women. But that's a different story that you can research elsewhere and I won't even provide links because the minutes of googling I did on the subject disgusted me too much.

If you have had your tubes removed, I want you to know that even if doctors tell you it's impossible to have another ectopic, it's just not true. I have been in touch with many girls undergoing IVF who, like me, were unaware of cornual and interstitial ectopics. The fact that something is statistically unlikely doesn't mean that it's impossible. It happened to me, and it can happen to you. Educate yourself, know the signs and teach everyone you know ♥