An ectopic pregnancy happens when a fertilized egg implants outside the uterus. It can’t lead to a viable pregnancy and can pose serious health risks if not detected early. Thankfully, it’s rare, and there are a few ways to reduce the risk before the implantation.
This guide explains:
How an ectopic pregnancy happens with IVF
What might increase the risk
How to avoid ectopic pregnancy in your IVF journey
What is an ectopic pregnancy?
As ectopic pregnancy most often occurs (approximately 90%+ of cases) in the fallopian tube, a part of the reproductive system through which eggs are carried from the ovaries into the uterus, it is sometimes called a tubal pregnancy.
Still, ectopic pregnancies can also happen in other places, including:
Ovaries
Interstitial area (where the fallopian tube meets the uterus)
Cervix
Previous Caesarean scar
Abdominal cavity
In sporadic cases, heterotopic pregnancy can also occur, where one embryo implants in the uterus while another implants outside of it.
No matter where an ectopic pregnancy happens, the outcome is the same. The pregnancy can’t continue, and medical treatment is necessary to protect your health.
Can you have an ectopic pregnancy with IVF?
Yes, it’s possible to have an ectopic pregnancy even during IVF.
It may seem surprising since, in IVF, embryos are placed directly into the uterus, bypassing the fallopian tubes. But sometimes, an embryo can still migrate after transfer, travel back through the fallopian tube, and implant elsewhere.
That is why post-transfer monitoring is crucial. Your care team can catch and treat ectopic pregnancy early, before it becomes dangerous.
Source: RDNE stock project
How common is ectopic pregnancy with IVF?
Although ectopic pregnancy is rare, it’s still one of the most serious complications that can occur during early pregnancy. In the general population, about 1–2% of pregnancies are ectopic. In the United States, ectopic pregnancy rupture accounts for an estimated 2.7% of pregnancy-related deaths.
When it comes to IVF, the risk is slightly higher than in natural conception, partly because many people pursuing IVF have underlying tubal issues, prior surgeries, or other conditions that bump up the risk.
The number varies depending on the fertility clinic, but research shows that the risk of ectopic pregnancy during IVF cycles ranges from 1.4–5.4%. If we include other types of assisted reproduction, such as intrauterine insemination (IUI), the overall ectopic pregnancy rate is 2–5%.
Does IVF increase the risk of ectopic pregnancy?
IVF doesn’t cause ectopic pregnancy, but the medical factors that make IVF necessary in the first place can make it more likely. The leading causes of ectopic pregnancy in IVF include:
Fallopian tube damage: Irregularly-shaped fallopian tube, previous sexually transmitted infections, inflammations, surgeries, or conditions like endometriosis can scar the fallopian tubes or cause blockages.
Hormonal imbalances: Reproductive hormones help guide the movement of eggs and embryos.
Egg and sperm abnormalities: Subtle issues with egg and sperm can interfere with fertilization and development.
Maternal age: People over 40 are nearly three times more likely to experience an ectopic pregnancy than those under 20, and those with diminished ovarian reserve carry more than twice the risk compared to people with normal ovarian function.
High ovarian response: In IVF cycles using a woman’s own eggs, the risk of ectopic pregnancy appears to rise as the number of eggs retrieved increases, potentially because the elevated hormone levels required to stimulate high egg production may interfere with normal uterine contractions.
Embryo transfer technique: Deep placement of the catheter, excessive pressure, or retrograde flow of transfer fluid may lead to embryo migration.
Transferring multiple embryos: When multiple embryos are transferred, the odds increase that at least one might implant outside the uterus.
Embryo quality: Poor-quality embryos may implant unpredictably or fail to implant altogether.
How to prevent ectopic pregnancy in IVF: 7 steps
Ectopic pregnancy can’t always be prevented, but there are steps available to reduce the risk, such as:
Evaluate and manage tubal health before IVF
Treat underlying infections early
Stop smoking
Manage underlying reproductive health conditions
Choose a reputable IVF clinic
Monitor hormone levels throughout the cycle
Choose high-quality embryos and prioritize single embryo transfer
1. Evaluate and manage tubal health before IVF
Damaged or blocked fallopian tubes are among the most significant risk factors for ectopic pregnancy. Have your tubal health assessed before IVF. Your fertility doctor may recommend one or a combination of the following tests:
Test | How it works | What it detects |
|---|---|---|
Ultrasound | Standard or transvaginal ultrasound | May detect abnormally swollen tubes (e.g., hydrosalpinx) |
Hysterosalpingography (HSG) | X-ray with contrast dye injected into the uterus and tubes | Identifies blockages, scarring, and whether tubes are open |
Sonosalpingography | Saline-infused ultrasound | Visualizes tubal flow in real time without radiation |
Selective salpingography | Fluoroscopy-guided catheterization of each tube | Allows diagnosis and potential tubal flushing of blockages |
Laparoscopy | Minimally invasive surgery under general anesthesia | Allows direct view of tubes and other pelvic structures, detecting conditions like endometriosis |
Falloscopy | Tiny camera inserted directly into the fallopian tubes | Visualizes the inner lining of the tube for detailed assessment |
If your evaluation shows hydrosalpinx or severe tubal scarring, your doctor may recommend one of the following treatments:
Salpingectomy: Surgical removal of one or both fallopian tubes
Salpingostomy (neosalpingostomy): Opening or draining a blocked fallopian tube through a small incision
Tubal ligation or clipping: Surgically blocking the tubes to indirectly help avoid embryo migration without removing them entirely
Antibiotic therapy: Antibiotic treatment in case of an infection to prevent further tubal damage
Source: Nataliya Viatkevich
2. Treat underlying infections early
Sexually transmitted infections (STIs), such as chlamydia and gonorrhea, are one of the most common causes of pelvic inflammatory disease (PID). When left untreated, STIs can spread from the cervix to the uterus, fallopian tubes, and ovaries, causing inflammation, scarring, and blockages. Even a single episode of PID can leave lasting damage.
This scarring is a leading contributor to tubal factor infertility and significantly raises the risk of ectopic pregnancy.
Here’s how to stay protected:
Get tested regularly, even if you have no symptoms
Treat infections promptly if the test comes back positive
Inform your partner to prevent possible reinfection
Practice safe sex until you’re ready to conceive
3. Stop smoking
Smoking directly harms the reproductive system, and its impact is particularly pronounced in the fallopian tubes.
Studies show that people who smoke are 1.7 to 3.9 times more likely to experience a tubal ectopic pregnancy compared to non-smokers. Exposure to cigarette smoke, whether active or passive, disrupts the normal function of the fallopian tubes.
Quitting smoking before IVF can:
Restore normal tubal function and blood flow
Improve egg quality and ovarian response
Increase implantation and live birth rate
Reduce risk of miscarriage and pregnancy complications
Lower chance of ectopic pregnancy
Source: Cottonbro studio
4. Manage underlying reproductive health conditions
Conditions like endometriosis and polycystic ovary syndrome (PCOS) are associated with a higher risk of ectopic pregnancy. Endometriosis can cause inflammation, scarring, and adhesions in and around the fallopian tubes, which can interfere with embryo movement or trap the embryo in the wrong location. PCOS is linked to hormonal imbalances and abnormal uterine or tubal function.
Management strategies for these conditions include:
Hormonal regulation to improve cycle predictability and endometrial receptivity
Laparoscopic surgery to remove endometrial lesions and adhesions
Lifestyle changes like weight management, anti-inflammatory diets, or insulin-sensitizing medications
Switching to frozen embryo transfer if hormone levels or endometrial conditions are suboptimal in a fresh cycle
5. Choose a reputable IVF clinic
Clinics with highly trained specialists and advanced protocols tend to have lower rates of complications, including ectopic pregnancy.
Before you choose your fertility clinic, here are some questions to ask:
Do you use ultrasound guidance during embryo transfer?
How do you ensure accurate placement of the embryo?
Do you perform a mock transfer?
What is your clinic’s rate of ectopic pregnancy, and what do you do to minimize that risk?
How do you decide whether to use a fresh or frozen embryo transfer?
What steps do you take if a patient has risk factors for ectopic pregnancy, such as tubal damage, PCOS, or history of infection?
Reputable clinics will be transparent about their protocols and success rates, and happy to explain how they tailor care to reduce risks and optimize outcomes.
6. Monitor hormone levels throughout the cycle
Two key hormones that help create the ideal uterine environment for implantation are:
Estrogen, which helps thicken the uterine lining
Progesterone, which stabilizes it and supports early pregnancy
If these hormones are too low or too high, they can affect how the uterus contracts and how well it supports implantation. Your clinic must monitor your hormone levels closely, especially if you have conditions like PCOS or are on high doses of ovarian stimulation medication.
After embryo transfer, hCG (pregnancy hormone) is monitored to confirm implantation. In a normal pregnancy, hCG levels rise steadily. In ectopic pregnancies, they often rise slowly or plateau.
7. Choose high-quality embryos and prioritize single embryo transfer
Research shows that the lowest ectopic pregnancy rates occur with single, frozen blastocyst-stage transfers. Studies also show that high-quality embryos are more likely to implant properly and less likely to migrate.
After fertilization, embryos are monitored and graded based on morphology to assess quality. Your clinic may recommend preimplantation genetic testing (PGT) to evaluate them further.
Source: Pavel Danilyuk
Below are the typical options:
Type of PGT | What it does |
|---|---|
Checks embryos for missing or extra chromosomes to improve implantation chances and reduce miscarriage risk | |
Identifies embryos that carry specific single-gene inherited conditions, like cystic fibrosis, muscular dystrophy, or hemophilia | |
Screens for structural rearrangements, such as chromosomal translocations and inversions, that can lead to failed implantation or miscarriage | |
Estimates embryos’ polygenic risk for common, adult-onset diseases, such as diabetes and heart disease |
While PGT-A, PGT-M, and PGT-SR assess embryo viability and chromosomal health, polygenic embryo screening offers a deeper look into the long-term health potential, especially important if you have several equally healthy embryos and you need to choose only one.
Because IVF is a long and complex process that involves many such decisions, having expert support and guidance at every stage can alleviate the stress and help you make the best choices for your family.
Nucleus IVF+ is the first IVF option built for genetic optimization and designed to help parents give their child the best possible start on life, starting from a safe pregnancy.
How Nucleus IVF+ helps you prepare for the unexpected
Instead of leaving families to navigate complex medical decisions alone, Nucleus pairs parents with clinical experts who provide guidance at every stage, from selecting the right clinic or donor to understanding diagnostic tests, and ultimately, choosing the healthiest embryo for transfer.
With Nucleus IVF+, you don’t have to become a medical expert or geneticist to have a baby. Our experts and technology simplify the journey, while keeping you in control of the choices that matter most.
Through intuitive software, you can compare embryos side-by-side, sorting by the factors that matter most to you and your family.
With scientific precision and compassionate guidance, Nucleus goes beyond standard recommendations and gives you the confidence that every decision you make is informed, thoughtful, and aligned with your vision for your family's future.
How to start with Nucleus IVF+
Book a call today to start your personalized journey with Nucleus IVF+. From there, we’ll guide you through every step:
Choosing the right clinic
Screening for over 2,000 conditions
Finding the perfect donor, if necessary
Navigating your IVF cycle
Selecting the healthiest embryo for transfer
Nucleus’s comprehensive approach can increase your chances of a successful pregnancy by up to 20%.
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Featured image source: MART Production
