Español 
Français 
Deutsch 
Italiano 
Nederlands 
International 
Ectopic pregnancy: what it is, symptoms and warning signs you mustn’t ignore
At Vida Fertility, we know that a positive beta test after weeks, months or even years of trying can feel like one of the most eagerly awaited moments: a mixture of excitement, relief and hope. That is why, when symptoms such as abdominal pain, bleeding or a feeling that ‘something isn’t right’ appear, fear can strike suddenly. And that fear is entirely understandable.
This article, written by Dr Katharina Spies, a specialist in assisted reproduction and medical director of Vida Fertility Madrid, aims to provide you with clear, accurate and accessible information: what an ectopic pregnancy is, why it can occur, what symptoms should raise a red flag, how it is diagnosed, and what options are available afterwards, both medically and in terms of fertility.
- 1. What is an ectopic pregnancy?
- 2. Why is an ectopic pregnancy dangerous?
- 3. Why do ectopic pregnancies occur?
- 4. Causes of an ectopic pregnancy
- 5. Symptoms of an ectopic pregnancy
- 6. How is an ectopic pregnancy detected?
- 7. Treatment options for an ectopic pregnancy
- 8. Tests following an ectopic pregnancy
- 9. Which women are most likely to have an ectopic pregnancy?
- 10. Frequently asked questions about ectopic pregnancy
- 10.1. If I’ve had one fallopian tube removed, can I have IVF?
- 10.2. Is it better to try for a natural pregnancy or to opt for assisted reproduction after an ectopic pregnancy?
- 10.3. Does the fallopian tube always have to be removed in the case of an ectopic pregnancy?
- 10.4. Am I at greater risk of another ectopic pregnancy?
- 10.5. When can I try to get pregnant again?
- 11. Fertility consultation at Vida Fertility
- 12. Our fertility treatments
- 13. The best fertility clinics in Spain
What is an ectopic pregnancy?
An ectopic pregnancy is a serious medical condition in which the embryo implants outside the womb, usually in a fallopian tube. Although it may initially appear to be a normal pregnancy, it cannot progress safely and requires early medical assessment.
If you are going through this, there is something important we want you to know: it is not your fault. An ectopic pregnancy does not happen because you have done anything wrong.
Why is an ectopic pregnancy dangerous?
An ectopic pregnancy is a condition that must be assessed and managed quickly, because the embryo has implanted outside the womb, almost always in a fallopian tube. The problem is that the fallopian tube is not designed to support a growing pregnancy. It lacks the space and elasticity of the womb. Therefore, if the pregnancy continues, the tube may rupture and cause internal bleeding, which can indeed be life-threatening for the woman.
“Having said that, I want to emphasise something important: if it is detected early, we can take action before a serious complication arises. That is why we strongly urge women to seek advice promptly if they experience pelvic pain, bleeding, a positive beta-hCG result that is not progressing as expected, or a history of ectopic pregnancy,” says Dr Spies.
Why do ectopic pregnancies occur?
An ectopic pregnancy occurs when the embryo implants outside the uterus, most commonly in a fallopian tube. It cannot develop like a normal pregnancy and requires medical assessment, but what are the causes of an ectopic pregnancy?
Causes of an ectopic pregnancy
Often, there is no single cause; however, the causes and factors that may increase the risk of an ectopic pregnancy are usually related to the health of the fallopian tubes. Among the most common are:
- Pelvic inflammatory disease, often associated with sexually transmitted infections such as chlamydia or gonorrhoea.
- A previous ectopic pregnancy may be a contributing factor
- Surgery on the fallopian tubes or tubal ligation
- Uterine conditions such as: endometriosis, anatomical abnormalities of the fallopian tubes
- Lifestyle factors: smoking or a maternal age over 35.
In assisted reproduction, although embryo transfer takes place within the uterus, an ectopic pregnancy is still possible; that is why we always confirm the location of the pregnancy via ultrasound.
Dr Katharina Spies would like to emphasise that “having a risk factor does not necessarily mean it will happen, and not having any does not rule it out entirely either. Therefore, in the event of a positive beta-hCG result accompanied by pain, bleeding or hormonal changes that do not fit the expected pattern, we prefer to investigate promptly rather than wait”.
Symptoms of an ectopic pregnancy
The symptoms of an ectopic pregnancy can be very confusing at first, because some women experience signs similar to those of an early pregnancy: a missed period, nausea, breast tenderness or a positive pregnancy test.
The most common symptoms are pelvic or abdominal pain, vaginal bleeding, a missed period and a positive pregnancy test. Some women also experience nausea, discomfort on one side of the abdomen or pain that is different from that of a normal period.
How is an ectopic pregnancy detected?
The diagnosis of an ectopic pregnancy is usually made by combining the patient’s medical history, symptoms, a gynaecological examination, a transvaginal ultrasound scan and blood tests to measure beta-hCG, the pregnancy hormone.
The transvaginal ultrasound allows us to visualise the uterus, ovaries and fallopian tubes with greater precision. We are looking to confirm whether the gestational sac is inside the uterus. If the beta-hCG test is positive but we do not see an intrauterine pregnancy, this may be because it is too early, because it is a very early miscarriage, or because there is a pregnancy of unknown location or an ectopic pregnancy. That is why, sometimes, a single appointment does not provide all the answers.
The blood beta-hCG test helps us understand how the pregnancy is progressing. In many cases, it is repeated every few days to see whether the hormone level rises as expected, remains stable or falls. This progression, together with the ultrasound scan and the patient’s symptoms, guides us towards a diagnosis.
At Vida Fertility, each case is approached with an individualised assessment, diagnostic technology and personalised support, because we know that behind every positive beta test there is a story, a hope and, very often, a long journey to get there.
Treatment options for an ectopic pregnancy
The treatment of an ectopic pregnancy depends on several factors: the location of the pregnancy, the gestational age in weeks, the level of beta-hCG, the ultrasound findings, whether there is pain, your future desire to become pregnant, whether there is internal bleeding, and how you are feeling at the time.
The main options are ‘watchful waiting’, medical treatment with methotrexate, or surgery.
- Watchful waiting is only considered in very specific cases: when beta-hCG levels are low and there are no signs of complications. It involves monitoring the situation through blood tests and check-ups to ensure that the body resolves the ectopic pregnancy on its own.
- Medical treatment with methotrexate, a drug that stops the growth of the ectopic pregnancy tissue so that the body can gradually reabsorb it. It is usually prescribed when the fallopian tube has not ruptured, the woman is stable and the case meets safety criteria.
- Surgery is indicated when there is a suspicion of rupture, severe pain, internal bleeding, instability, or when medical treatment is not appropriate. This is often carried out via laparoscopy, a minimally invasive technique. In some cases, the fallopian tube can be preserved, but in others it must be removed if it is severely damaged or ruptured.
Tests following an ectopic pregnancy
Once treatment has been successfully completed and the patient is well and keen to become pregnant, we can assess tests aimed at her future fertility.
Not all of the tests listed below will necessarily be required, as at Vida Fertility we assess each case individually, taking into account: your age and fertility; if you have a male partner, we will assess semen quality; ovarian reserve; medical history; the condition of your fallopian tubes; history of miscarriages; previous treatments; and the length of time you have been trying to conceive.
- Hormone tests
- Endometrial biopsy
- Hysteroscopy
- Karyotype
Which women are most likely to have an ectopic pregnancy?
Women with a history of pelvic inflammatory disease, infections such as chlamydia or gonorrhoea, a previous ectopic pregnancy, fallopian tube surgery, tubal ligation, endometriosis, anatomical abnormalities of the fallopian tubes, smoking, or who are over 35 years of age are at greater risk of an ectopic pregnancy.
It can also occur in women undergoing assisted reproductive treatments. Although in IVF the embryo is transferred into the uterus, it is still necessary to confirm via ultrasound that the pregnancy is correctly located.
As Dr Katharina Spies explains, having a risk factor does not mean it will happen, and not having any does not rule it out either. Therefore, if you have a positive beta result accompanied by pain, bleeding or irregular hormonal changes, it is best to seek advice promptly rather than wait.
Frequently asked questions about ectopic pregnancy
If I’ve had one fallopian tube removed, can I have IVF?
Yes. IVF does not require the fallopian tubes to be patent, as the eggs are fertilised in the laboratory and the embryo is transferred to the uterus. The decision will depend on your age, ovarian reserve, semen analysis, medical history and reproductive prognosis.
Is it better to try for a natural pregnancy or to opt for assisted reproduction after an ectopic pregnancy?
It depends on your age, whether your fallopian tubes are healthy, how long you have been trying, your ovarian reserve and whether there are any other factors contributing to infertility. For women over 35, with low ovarian reserve, damaged fallopian tubes or a history of multiple ectopic pregnancies, it is advisable to consult a specialist at an early stage.
Does the fallopian tube always have to be removed in the case of an ectopic pregnancy?
Not always. In some cases, it can be treated without removing the fallopian tube, but in others it is necessary to remove it if it is severely damaged or ruptured. The priority is to protect the woman’s health.
Am I at greater risk of another ectopic pregnancy?
Yes, having had an ectopic pregnancy increases the risk of it happening again. For this reason, during your next pregnancy, it is recommended that you inform your gynaecologist as soon as possible and have an early ultrasound scan.
When can I try to get pregnant again?
It depends on the treatment you have received and your physical and emotional recovery. If methotrexate was used, the medical team usually advises waiting a while before trying to conceive, as the drug interferes with folate metabolism.
Fertility consultation at Vida Fertility
If you’re going through this, there’s something important we want you to know: it’s not your fault. An ectopic pregnancy doesn’t happen because you’ve done anything wrong. And although you may now feel uncertain, sad or afraid to try again, many women do go on to get pregnant after an ectopic pregnancy, especially when they receive proper follow-up care and a personalised plan.
At Vida Fertility, we’re here to help you understand what has happened, look after your health and work with you to assess the safest way to try for a baby when you’re ready.
Vida Fertility Events
At Vida Fertility, we believe that feeling informed is the first step towards a more confident fertility journey.
Through our events, talks and private consultations, we help patients understand their options, ask questions and receive personalised guidance from our fertility specialists in Spain.
Discover our upcoming events and meet the Vida Fertility team.
Ask for a consultation
You may also like
Last news
Testimonials
The best fertility clinics in Spain
📍 C/ Palermo 15, Hortaleza, 28043 Madrid
📞 Phone number: +34 919 29 83 23
🕒 Opening hours: Monday to Friday from 8am to 7pm
📍 Av. Óscar Esplá 1, Bajo, 03008 Alicante
📞 Phone number: +34 919 29 83 23
🕒 Opening hours: Monday to Friday from 8am to 7pm
ℹ️ The information published on Vida Fertility is reviewed by our fertility specialists and medical team, following up-to-date scientific criteria and evidence-based medicine. Our team is a member at scientific societies such as SEF, ESHRE and SEGO.
