Hi everyone. I relied on this community a lot while going through my back to back ectopics this year, and I’m now at the point of trying to figure out how to move forward. I’d especially love to hear from people who have had two or more ectopic pregnancies.
I’ve had two ectopics/PULs, both treated with MTX. The first I was two months in before getting diagnosed and the resolution was messy and scary. The second, I quickly knew I was having another so we treated early but it was never actually located. After the second one in May, I decided to see an RE, partly to evaluate my fertility but mostly because I wanted to understand whether there might be an underlying reason this has happened twice.
My fertility workup has been reassuring, especially given I just turned 40. My recent AFC was 26, AMH 4.3, FSH 7.1, estradiol 40.7, and the rest of my hormonal testing and ultrasound were normal. No thyroid issues or anything else discovered. I’ve also previously had an HSG showing both tubes completely open. Interestingly, I conceived my second ectopic just days after that HSG.
My RE has said that unfortunately there often isn’t an identifiable reason for recurrent ectopics, and that things like subtle tubal dysfunction, adhesions or endometriosis can still exist despite a normal HSG.
He estimates my risk of another ectopic if I conceive naturally at around 25% after two prior ectopics, versus roughly 2–3% with IVF and a single blastocyst transfer given my history. Because of that difference, he’s recommending IVF as the safest next step. He isn’t saying I can’t try naturally again, just that IVF would substantially reduce the recurrence risk.
I’m 40, so obviously age and time are also part of the equation. At the same time, I seem able to conceive naturally and my fertility testing is reassuring, which makes it emotionally complicated to choose IVF primarily because of the ectopic risk rather than infertility itself.
I’m also still struggling with not knowing why this happened twice. I don’t have the typical symptoms of endometriosis, but I’ve wondered about silent endometriosis or another issue that wouldn’t necessarily show up on an HSG or routine ultrasound. I was in deep grief due to unexpected loss the year before conceiving, so I wonder if general inflammation from stress was a factor.
So I’d really love to hear from anyone who has been in a similar position:
• After two or more ectopics, how did you decide whether to try naturally again or move to IVF, and what happened?
• Did anyone eventually find an underlying cause despite normal testing/HSG, or did you ultimately have to accept that there wasn’t an explanation?
I’m not looking for anyone to make the decision for me, and I know everyone’s medical situation is different. I’m mostly hoping to hear how others with multiple ectopics navigated this particular crossroads.
Thank you to everyone who shares. This community was incredibly helpful to me when I was going through both pregnancies, and I’m grateful it exists.