Trying to Conceive Again
Explaining Ectopic Pregnancy: Trying to conceive again (with subtitles)
Answering your questions on conceiving after an ectopic pregnancy
It is likely you have been advised to wait for three months if you have had methotrexate, or for two full menstrual cycles (periods) after surgery or expectant management, before trying to conceive. The bleed that occurs in the first week or so of treatment for an ectopic pregnancy is not your first period. It is the bleed that occurs in response to falling hormones associated with the lost pregnancy.
Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over two years. The time it takes to conceive and chances of conceiving depends on many factors such as the health of your Fallopian tube(s), age, your general and reproductive health and how often you have sex.
Detailed general information can be found here on our website. Please remember that online medical information is no substitute for expert medical care from your own healthcare team.
Below is a list of common questions that we are asked about trying to conceive. This page covers questions on timing, ovulation, lifestyle, testing, assisted conception, and pregnancy tests.
Time related questions
Why must I wait for three months before trying to conceive?
While there is no clear, researched evidence on how long a couple should wait to try to conceive after having treatment for ectopic pregnancy, we and other medical professionals advise that it may be best to wait for at least three months or two full menstrual cycles (periods) before trying to conceive for both physical and emotional reasons. The bleed that occurs in the first week or so of treatment for an ectopic pregnancy is not your first period. It is the bleed that occurs in response to falling hormones associated with the lost pregnancy.
Physically, this timeframe is to allow your cycle to return to normal and for there to be a clear period to date a new pregnancy from. The date of the first day of the period is what is used to decide when to scan a new pregnancy; information that is invaluable in ensuring you are not suffering from another ectopic pregnancy.
The first proper period you have after an ectopic pregnancy may be heavier than usual and the second more like your usual period. A normal period would suggest you are hormonally ready to be able to try to conceive. Having two periods can also give an idea of menstrual cycle length, which may be different for a few months after your ectopic before settling back into its usual rhythm.
This wait allows the internal inflammation and bruising from the ectopic and any associated treatment to heal.
In addition to the physical aspects of ectopic pregnancy, many people also feel an intense emotional impact. Taking time before trying to conceive again enables the necessary process of grief to surface and be worked through. The emotional recovery that is often needed can be significant and many underestimate this aspect.
If you have had either one or two injections of methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood or urinary tests) and then take a folic acid supplement for 12 weeks before you try to conceive.
This is because the drug may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs, and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as cleft lip and palate, or even spina bifida or other neural tube defects.
If you have had medical management followed by surgery, you can start taking a folic acid supplement again once your doctors have confirmed that all of the pregnancy has resolved. This is particularly important if you have been having blood tests to check hCG levels after your surgery. You can start to try to conceive again 12 weeks after the date that the methotrexate was administered.
The NHS website has more information on vitamins, supplements, and nutrition during pregnancy.
Ovaluation related questions
When will I ovulate again?
Before your first period arrives, you will ovulate. The period when it returns will indicate that you are ovulating again. It is possible to ovulate 14 days after surgical treatment and during methotrexate treatment, so it is important to be aware that it is possible to become pregnant without having a period first, if you are not using some form of contraception.
Have I only got half of my fertility?
When a person has only one Fallopian tube, they are still able to get pregnant from an egg released by the opposite ovary as an egg from one ovary can travel down the Fallopian tube on the other side. Approximately one-third of pregnancies are a result of pick-up of the egg from the ovary on the opposite side to the remaining Fallopian tube. It may be reassuring to know that when you ovulate from the ovary by the removed Fallopian tube which is opposite to the remaining Fallopian tube, it is not a ‘wasted’ cycle.
What do ovulation kits predict?
An ovulation predictor kit measures Luteinising Hormone (LH). A surge in LH leads to ovulation within the next 12 hours. The egg does not always get released from the ovary in spite of a surge but it is a very good marker. A positive pregnancy test around 14 days after you think ovulation occurred is the only way of establishing that it actually did.
Urinary ovulation predictor kits are used typically daily around the time ovulation may be expected. A conversion from a negative to a positive reading would suggest that ovulation is about to occur within 24–48 hours, giving two days to engage in sexual intercourse or artificial insemination with the intention of conceiving.
As sperm can stay viable in the female reproductive system for several days, LH tests are not recommended for contraception, as the LH surge typically occurs after the beginning of the fertile window.
Is it true that I ovulate on alternate sides each month?
We naturally assume that we will ovulate from alternative ovaries each month (left ovary, right ovary, left, right etc.) This is not true and varies. Some will ovulate from the same side each month with an occasional ovulation from the other side, while others will ovulate randomly from side to side.
Both ovaries compete each month to produce an egg and usually, the one that is ‘pulling ahead in the race’ continues while the other one gives up (but not always – sometimes ovulation occurs from both ovaries in one cycle or twice from one ovary – this explains how we get non-identical twins naturally). It depends on which ovary contains the egg that is at the right stage of development at the point in time at the time of ovulation and is nothing to do with a set pattern.
The side we ovulate from does not strictly matter as an egg from one ovary can travel down the Fallopian tube on the other side.
How can I tell if I am ovulating?
The menstrual cycle lasts about 28 days for most and ovulation usually happens 10 to 16 days before the start of your next period. When you’re ovulating, you are at your most fertile so it is the best time of the month to have sex. Physical signs of ovulation include an increase in vaginal discharge. This changes from white, creamy or non-existent to clear, stretchy and slippery (like egg-white consistency) when you ovulate.