Pregnancy Planning after Ectopic Pregnancy - Dr. Rashmi Chaudhary

Once a woman starts treatment for planning pregnancy after she has undergone treatment for ectopic pregnancy she is under immense mental pressure and trauma. She has lots of questions in her mind because most of the patients might have lost their one fallopian tube. Some of the patients still will be regaining their one fallopian tube if they have undergone medical management of ectopic pregnancy with injection methotrexate. But we have a common query when they should start planning, whether their fertility potential will be normal, how much time will they take to become pregnant or whether everything will be normal or whether there will be chances of recurrence or not. So they are under too much of emotional stress, so they need more of understanding and more of emotional support. As per data it has been found that there is no time limit to wait for planning pregnancy after you have undergone treatment for ectopic pregnancy. But, on an average we gynaecologist would say that you should wait for two to three menstrual cycles after the treatment of ectopic because the woman is out of the mental trauma from the past experience, as well as the hormonal balance comes back to normal and the ectopic pregnancy site which has been removed and stitched reverts back to normal regain its previous strength as well as comes back to normal. In some cases where the mother has undergone treatment of ectopic with injection methotrexate we tell the couple to wait atleast till the beta HCG comes back to normal and then we advice a folic acid supplement for atleast three months and then they should start planning for pregnancy. Because folic acid levels are lowered in the body by the inj.methotrexate and if there is a deficiency of folic acid it might lead to development of neural tube defect. Another common anxiety in women who have undergone ectopic pregnancy treatment is that how much time will I take to conceive as I have already lost one of my fallopian tube. But they should not be disheartened because one fallopian tube is lost, but another one is there and sometimes both the ovaries will ovulate simultaneously and sometimes only one ovary will ovulate and next time of the cycle the next ovary will ovulate. It has been found that about 65% of the women conceive with first 18 months of try and more than 85% they conceive after 2 years of try. So ideally these couple should adopt a healthy life style, they should have adequate folic acid supplementation, increased intake of green vegetables, fruits. They should try for the pregnancy by using the ovulation tests or they can go for the basal body temperature. They should try for pregnancy around the time of the ovulation. They could also take the help of the vaginal discharge or breast tenderness or the changes that happen in the middle of the month. If they don’t conceive with all these measures then they should seek the gynaecologist’s opinion. If the woman is under the age of 35, they can try for one year, no problem. But if the age is more than 35 and if within 6 months they are not getting pregnant then they should seek the gynaecologist’s advice. Here we advice them to complete thyroid hormonal assay and most important thing is a tubal patency test in which we do the histrosalpingogram and we check the patency of the fallopian tubes, whether it is open or because of previous impact it is blocked. If everything is fine and if a woman is having irregular cycle we help them in conceiving by ovulation induction, sometimes by intra uterine insemination. In persistent cases they can go for the IVF.

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