Ectopic Pregnancy In PCOS: Why It Happens & What Do We Need To Know?

In a normal pregnancy, the egg implants and develops in the uterus. But in Ectopic pregnancy the egg implants not within the uterus but outside of the uterus. Almost 96% of ectopic pregnancy occurs in the fallopian tube wherein the pregnancy is not supposed to be there. It could also happen in the cervix that’s in the mouth of the uterus, in the ovary; in the abdomen, it could happen in different parts of the woman’s reproductive system. None of these areas actually have the space or the nurturing tissue that a uterus has. As the foetus grows, it will rupture the organ that contains it resulting in the tearing of the organ. This causes severe bleeding and endangers the mother's life. A classical ectopic pregnancy does not develop into a live birth.

But if there has been some reason because of which the egg is obstructed in the fallopian tube, or if the sperm is obstructed in the fallopian tube, when there is no way the two can meet, then it gives rise to infertility.

It is difficult to identify ectopic pregnancy as the symptoms are often similar to normal pregnancy. These include missed periods, nausea, absence of periods, fatigue, vomiting and frequent urination. However, the most common warning sign is vaginal bleeding. There can also be pain in the pelvis and abdomen area that can range from mild to severe to very sharp.

An ectopic pregnancy happens when a fertilised egg is unable to make its way to the uterus because of an infection in the fallopian tube which may be caused by an STD, abortion in an unhygienic situation, genital tuberculosis or a genital tract procedure done The embryo cannot reach the uterus and therefore it gets stuck in the fallopian tube and starts growing there. Since the fallopian tube has a very thin wall the pregnancy cannot really extend much beyond two months.

Women, especially women with PCOS who are on hormones for various reasons like conceiving, irregular periods, or oral contraceptives to manage the pain,  in those women because of the hormones levels being high it could affect the movement of the cilia which are the hair like processes on the cells which are lining the fallopian tube. It affects the movement of those cilia and therefore these high levels of hormones can sometime prevent the embryo from reaching the uterus and it slows down its progress towards the uterus. And hence that embryo implants in the fallopian tube. So, PCOS woman would have a higher chance of an ectopic pregnancy but it does not mean that every pcos woman would have ectopic. It does not mean that the chances are so high that we should not try to conceive.

In the past when ultra sound was not available, when pregnancy tests were not available, nobody knew about ectopic pregnancy. Women would complain about abdominal pain and collapse due to severe bleeding. But today with the advancements in diagnosis and advanced pregnancy test we are able to understand a woman’s pregnancy and if there are any risk of having ectopic pregnancy. Ultra sound helps us to know where that ectopic pregnancy is and we can diagnose it being in the tube.

So, in short, ectopic pregnancy is something which can be easily diagnosed both through blood test and sonography and hence every time you are pregnant, it’s good to see the doctor early and get yourself under medical supervision.

Dr Duru Shah

Guest Author The author is fertility specialist