{"version":"1.0.0","segments":[{"startTime":0.64,"endTime":2.886,"body":"Today we talk about ectopic"},{"startTime":2.998,"endTime":5.926,"body":"pregnancies. I'm Doctor"},{"startTime":5.958,"endTime":8.33,"body":"Mark Amos, and this"},{"startTime":8.71,"endTime":11.57,"body":"is taco. About fertility Tuesday."},{"startTime":22.71,"endTime":24.97,"body":"Whether you're trying to get pregnant naturally"},{"startTime":25.68,"endTime":27.86,"body":"or with assistive reproductive technology,"},{"startTime":28.52,"endTime":31.096,"body":"one thing that is true is you always have the"},{"startTime":31.128,"endTime":33.42,"body":"risk of an ectopic pregnancy."},{"startTime":34.72,"endTime":37.568,"body":"People who are undergoing infertility treatment, who have"},{"startTime":37.624,"endTime":40.12,"body":"infertility, have a higher risk of an ectopic"},{"startTime":40.16,"endTime":42.808,"body":"pregnancy. The rate of an"},{"startTime":42.824,"endTime":45.664,"body":"atopic pregnancy is approximately 1% or less"},{"startTime":45.752,"endTime":48.152,"body":"for the general population. But if you have"},{"startTime":48.176,"endTime":50.34,"body":"infertility, your chances are higher."},{"startTime":51.89,"endTime":54.834,"body":"So in this episode, we, talk about fertility Tuesday."},{"startTime":55.134,"endTime":57.654,"body":"We're going to talk about what an ectopic pregnancy"},{"startTime":57.694,"endTime":60.606,"body":"is, how you determine it, and"},{"startTime":60.63,"endTime":63.054,"body":"what the treatment is for it. An"},{"startTime":63.094,"endTime":66.054,"body":"ectopic pregnancy means when the pregnancy is"},{"startTime":66.094,"endTime":68.438,"body":"not inside the uterus, it's ectopic in its"},{"startTime":68.486,"endTime":71.182,"body":"location. That location can be in the"},{"startTime":71.198,"endTime":73.91,"body":"fallopian tube. That location can be in the"},{"startTime":73.942,"endTime":76.39,"body":"cervix. It can be on the ovary, it can be in the"},{"startTime":76.422,"endTime":78.956,"body":"abdomen. It can even be in the"},{"startTime":78.98,"endTime":81.196,"body":"uterus near the tube, which is called"},{"startTime":81.26,"endTime":83.652,"body":"corneal ectopic, which is actually very"},{"startTime":83.708,"endTime":86.23,"body":"dangerous. Ectopics, are always"},{"startTime":86.302,"endTime":89.262,"body":"dangerous because they can grow and they"},{"startTime":89.278,"endTime":92.03,"body":"can eventually burst the structure they're in and"},{"startTime":92.062,"endTime":94.79,"body":"cause bleeding, such as a tubal pregnancy"},{"startTime":94.942,"endTime":97.47,"body":"or a cervical pregnancy, or even the corneal"},{"startTime":97.502,"endTime":100.422,"body":"pregnancy. All of those can enlarge"},{"startTime":100.478,"endTime":103.19,"body":"and eventually rupture the structure they're"},{"startTime":103.222,"endTime":106.122,"body":"in, which can lead to heavy bleeding and even"},{"startTime":106.178,"endTime":109.098,"body":"death. This is one of the reasons it's so"},{"startTime":109.146,"endTime":111.73,"body":"important to follow up with your reproductive doctor, because"},{"startTime":111.842,"endTime":114.724,"body":"being a fertility patient already puts you at, higher risk"},{"startTime":114.788,"endTime":117.732,"body":"for ectopic pregnancies. And this is because people"},{"startTime":117.772,"endTime":120.668,"body":"who are infertile have higher chances of having tubal"},{"startTime":120.7,"endTime":123.284,"body":"disease. The earlier you can find the"},{"startTime":123.308,"endTime":125.884,"body":"ectopic pregnancy, the better the"},{"startTime":125.908,"endTime":128.468,"body":"outcomes. The later you find the ectopic"},{"startTime":128.5,"endTime":131.428,"body":"pregnancy, the worst outcomes. But we'll talk"},{"startTime":131.46,"endTime":133.992,"body":"about that a little bit more when we talk about treatments."},{"startTime":134.812,"endTime":137.62,"body":"Now, one of the most common thoughts when people think of"},{"startTime":137.636,"endTime":140.284,"body":"ectopic is they think the embryo is stuck."},{"startTime":140.468,"endTime":143.188,"body":"And they're true that they are stuck,"},{"startTime":143.3,"endTime":146.26,"body":"but they're not stuck in the way we think of it. When"},{"startTime":146.276,"endTime":149.212,"body":"we think of stuck, we think that the embryo is in a small tube and their"},{"startTime":149.252,"endTime":152.124,"body":"shoulders are stuck between and can't move past it. But that's"},{"startTime":152.148,"endTime":154.428,"body":"actually not what's happening. The"},{"startTime":154.46,"endTime":157.308,"body":"tube is so large, we can see with our"},{"startTime":157.34,"endTime":160.272,"body":"eyes, and we can even sew it together. In surgeries,"},{"startTime":160.692,"endTime":163.172,"body":"an embryo is microscopic."},{"startTime":163.332,"endTime":165.924,"body":"There's no way the embryo is getting stuck between the"},{"startTime":165.948,"endTime":168.564,"body":"tubes. So what that means is that when"},{"startTime":168.588,"endTime":171.268,"body":"your hysterosal pingogram, also known as the"},{"startTime":171.3,"endTime":174.156,"body":"HSG, shows that your tubes are open,"},{"startTime":174.284,"endTime":176.78,"body":"you still have a risk for an ectopic because it's"},{"startTime":176.836,"endTime":179.592,"body":"not a narrow tube that causes the problem,"},{"startTime":180.372,"endTime":183.192,"body":"it's the surface of the tube that causes the problem."},{"startTime":183.732,"endTime":186.036,"body":"So, for example, the little"},{"startTime":186.164,"endTime":188.706,"body":"fimbriae or, the cilia that"},{"startTime":188.81,"endTime":191.082,"body":"move the embryo down the fallopian"},{"startTime":191.138,"endTime":194.002,"body":"tube may not be working well. Or there could be like"},{"startTime":194.018,"endTime":196.866,"body":"a tar tissue that's causing it to stick and it"},{"startTime":196.89,"endTime":199.654,"body":"sticks to the surface, and that's why it doesn't move."},{"startTime":200.074,"endTime":202.954,"body":"Now, when it lands in the ovary or lands"},{"startTime":202.994,"endTime":205.97,"body":"in the cervix, that could be for other reasons, such as"},{"startTime":206.122,"endTime":209.042,"body":"it went too far in the uterus or that it never got picked up by"},{"startTime":209.058,"endTime":211.868,"body":"the tube and landed somewhere. And the"},{"startTime":211.916,"endTime":214.876,"body":"embryo is programmed to invade whatever tissue it lands"},{"startTime":214.9,"endTime":217.196,"body":"on. Eventually, when it starts to make its own"},{"startTime":217.22,"endTime":220.18,"body":"placenta. Nothing you do is"},{"startTime":220.212,"endTime":223.1,"body":"causing an ectopic. Sure, something that may have happened to you in"},{"startTime":223.132,"endTime":225.948,"body":"life may put you at higher risk for ectopic pregnancies,"},{"startTime":225.996,"endTime":228.364,"body":"such as endometriosis, pelvic"},{"startTime":228.404,"endTime":231.068,"body":"inflammatory disease, a, history of a sexually transmitted"},{"startTime":231.092,"endTime":233.884,"body":"disease. But everyone has a risk of an"},{"startTime":233.9,"endTime":236.404,"body":"ectopic. It's just that certain people have a higher"},{"startTime":236.46,"endTime":239.448,"body":"risk. Once youve had an ectopic, your"},{"startTime":239.472,"endTime":241.544,"body":"risk for another ectopic is about"},{"startTime":241.6,"endTime":244.488,"body":"15%. Even if you removed the"},{"startTime":244.512,"endTime":247.24,"body":"tube that was affected. The reason that is"},{"startTime":247.288,"endTime":249.976,"body":"because when you remove that tube, you did get rid of the"},{"startTime":250.016,"endTime":252.8,"body":"tube that caused the problem. But whatever"},{"startTime":252.848,"endTime":255.832,"body":"disease state you had had to come from somewhere"},{"startTime":255.864,"endTime":258.808,"body":"that could be on either tube. Meaning, lets"},{"startTime":258.832,"endTime":261.056,"body":"assume its something in the abdomen, like"},{"startTime":261.096,"endTime":263.802,"body":"endometriosis. Well, its not like"},{"startTime":263.834,"endTime":266.482,"body":"endometriosis is only going to stick to one side of your"},{"startTime":266.514,"endTime":269.49,"body":"pelvis. So its possible that then both tubes can"},{"startTime":269.498,"endTime":272.338,"body":"be affected. So if one is affected, its possible"},{"startTime":272.402,"endTime":275.33,"body":"the other one is too. So removing one tube doesnt really"},{"startTime":275.378,"endTime":278.122,"body":"reduce your risk. In the same token, if the"},{"startTime":278.154,"endTime":281.098,"body":"infection came from, lets say, the vagina, its not"},{"startTime":281.122,"endTime":283.858,"body":"like the bacteria can go into the uterus and say, hey guys,"},{"startTime":284.002,"endTime":286.938,"body":"were not going to the right side today, we are all going to the"},{"startTime":286.962,"endTime":289.684,"body":"left. Dont go over there. No, it's going to"},{"startTime":289.7,"endTime":292.484,"body":"affect both sides. And since it's going to affect both"},{"startTime":292.54,"endTime":295.388,"body":"sides, it means both tubes have risk and probably both"},{"startTime":295.452,"endTime":298.404,"body":"have tubal disease. That's why I'm actually"},{"startTime":298.46,"endTime":301.156,"body":"concerned, even with one ectopic, that that"},{"startTime":301.196,"endTime":304.18,"body":"disease state could be in the other tube. That's one of the"},{"startTime":304.188,"endTime":307.068,"body":"things I talk about with patients that we"},{"startTime":307.092,"endTime":309.892,"body":"can't assume that tube, just because it's open is still working"},{"startTime":309.964,"endTime":311.976,"body":"and that there could still be problems."},{"startTime":312.756,"endTime":315.426,"body":"A really interesting association with ectopic,"},{"startTime":315.772,"endTime":318.738,"body":"pregnancies is smoking. People who smoke"},{"startTime":318.77,"endTime":321.514,"body":"cigarettes have a higher risk of ectopics"},{"startTime":321.578,"endTime":324.57,"body":"compared to the general population. This may have"},{"startTime":324.586,"endTime":327.154,"body":"to have something to do with the cilia or"},{"startTime":327.178,"endTime":329.746,"body":"fimbria function, since we know smoking can also"},{"startTime":329.794,"endTime":332.466,"body":"affect Cilia and the trachea."},{"startTime":332.634,"endTime":335.142,"body":"Just an interesting fact they thought you should know."},{"startTime":335.442,"endTime":338.17,"body":"So then the question is, how do you determine if you have an"},{"startTime":338.186,"endTime":341.186,"body":"ectopic pregnancy? Well, if you're with a fertility doctor,"},{"startTime":341.234,"endTime":343.762,"body":"they always assume everyone has an ectopic until proven"},{"startTime":343.802,"endTime":346.722,"body":"otherwise because we need to watch for a closure because our"},{"startTime":346.762,"endTime":349.682,"body":"infertility patients have a higher risk of having"},{"startTime":349.722,"endTime":352.722,"body":"atopic pregnancy. Usually what you do is you"},{"startTime":352.762,"endTime":355.41,"body":"start by checking hcg levels early on in the"},{"startTime":355.426,"endTime":358.41,"body":"pregnancy, and what you're looking for is"},{"startTime":358.426,"endTime":361.194,"body":"you're looking for kind of a doubling of the rate. Now,"},{"startTime":361.258,"endTime":364.218,"body":"it technically does not have to double as long as it's"},{"startTime":364.25,"endTime":367.098,"body":"going up around 67%. That's perfectly"},{"startTime":367.13,"endTime":369.738,"body":"normal. And some studies have even shown as little as"},{"startTime":369.77,"endTime":372.632,"body":"55% could be normal. But what we look"},{"startTime":372.672,"endTime":375.64,"body":"for is changes in the numbers. Are they going up and down?"},{"startTime":375.696,"endTime":378.672,"body":"Are they plateauing and then going back up? And when we see"},{"startTime":378.712,"endTime":381.52,"body":"that, then we really get concerned about an"},{"startTime":381.536,"endTime":384.432,"body":"ectopic pregnancy. It doesnt matter if youre pregnant"},{"startTime":384.472,"endTime":387.312,"body":"naturally with IUI or IVF. When those"},{"startTime":387.352,"endTime":389.852,"body":"numbers start doing that, we start getting worried."},{"startTime":390.632,"endTime":393.424,"body":"Now, we dont want to treat at that point"},{"startTime":393.568,"endTime":396.456,"body":"because we could be harming a pregnancy. So what we do is we"},{"startTime":396.504,"endTime":398.572,"body":"watched. Now,"},{"startTime":399.152,"endTime":402.064,"body":"eventually the ATG levels will get to a"},{"startTime":402.088,"endTime":405.008,"body":"level called the discriminatory zone. The discriminatory"},{"startTime":405.08,"endTime":407.88,"body":"zone is the point where you would expect to see an"},{"startTime":407.936,"endTime":410.252,"body":"embryo in the uterus"},{"startTime":410.872,"endTime":413.528,"body":"as a gestational sac. And if you"},{"startTime":413.56,"endTime":416.552,"body":"dont, then you would know that there must be something wrong."},{"startTime":416.672,"endTime":419.092,"body":"Now, this can be difficult because"},{"startTime":419.472,"endTime":422.264,"body":"if someone got pregnant naturally and their"},{"startTime":422.288,"endTime":425.288,"body":"cycles are irregular, we may not really know how far along"},{"startTime":425.32,"endTime":428.184,"body":"they are in the pregnancy. So we use those ECG"},{"startTime":428.248,"endTime":431.132,"body":"values to get to that discriminatory zone, which is usually around"},{"startTime":431.172,"endTime":434.028,"body":"about 1000 to 1500. If"},{"startTime":434.06,"endTime":437.004,"body":"your hcg level was around 1000 1500 and there was"},{"startTime":437.028,"endTime":439.9,"body":"still nothing in the uterus at that point, we"},{"startTime":439.916,"endTime":442.884,"body":"would assume it is an ectopic pregnancy or pregnancy"},{"startTime":442.908,"endTime":445.748,"body":"of unknown location. Now, you could think,"},{"startTime":445.78,"endTime":448.748,"body":"well, what if they had twins? Then the ECG levels would be"},{"startTime":448.78,"endTime":451.636,"body":"lower and it still wouldn't show because it would need to be 2000"},{"startTime":451.684,"endTime":454.552,"body":"or 3000 to show that in rib. And that's true."},{"startTime":454.942,"endTime":457.886,"body":"But for most people, natural twinning does not"},{"startTime":457.934,"endTime":460.606,"body":"occur at a high rate, usually about one in"},{"startTime":460.614,"endTime":463.598,"body":"240. Now, if the patient is taking like clomid"},{"startTime":463.63,"endTime":466.318,"body":"or femara, then that's something that should be thought of,"},{"startTime":466.47,"endTime":468.878,"body":"and it's not unreasonable to wait a little bit"},{"startTime":468.91,"endTime":471.678,"body":"longer. Now, when we're talking about artificial"},{"startTime":471.71,"endTime":474.454,"body":"insemination or ivF, we actually know"},{"startTime":474.558,"endTime":477.054,"body":"the date of the pregnancy, and"},{"startTime":477.078,"endTime":480.038,"body":"so the discriminatory zones are not going to be"},{"startTime":480.11,"endTime":482.99,"body":"as important because we know the date of the pregnancy. And"},{"startTime":483.006,"endTime":485.928,"body":"so eventually we know we should see something by"},{"startTime":485.96,"endTime":488.744,"body":"at least five weeks, three days, if not five weeks, five"},{"startTime":488.808,"endTime":491.456,"body":"days. And if we don't see anything at that point in the"},{"startTime":491.464,"endTime":494.256,"body":"uterus, then we know it's an ectopic"},{"startTime":494.304,"endTime":497.304,"body":"pregnancy. So again, couple ways to"},{"startTime":497.328,"endTime":499.852,"body":"determine ectopic. One is"},{"startTime":500.152,"endTime":503.024,"body":"expecting to see a gestational sac in"},{"startTime":503.048,"endTime":505.848,"body":"the uterus at the right time, which is at least by"},{"startTime":505.88,"endTime":508.488,"body":"five weeks, three days to five weeks, five days."},{"startTime":508.64,"endTime":511.4,"body":"Or if we don't know when the implantation"},{"startTime":511.456,"endTime":514.203,"body":"occurred, then using a discriminatory"},{"startTime":514.267,"endTime":517.147,"body":"zone, by checking ECG levels, and when"},{"startTime":517.179,"endTime":519.907,"body":"they get past that discriminatory zone, at that"},{"startTime":519.939,"endTime":522.411,"body":"point, you make the call that is an ectopic"},{"startTime":522.451,"endTime":525.147,"body":"pregnancy. The question is, why is this so"},{"startTime":525.179,"endTime":527.691,"body":"important? Well, because if you"},{"startTime":527.731,"endTime":530.227,"body":"don't treat it early enough, as we mentioned"},{"startTime":530.259,"endTime":532.811,"body":"earlier, it's going to cause more"},{"startTime":532.851,"endTime":535.803,"body":"problems. The earlier you catch it, the"},{"startTime":535.827,"endTime":538.814,"body":"safer it is and the easier the treatments are. So"},{"startTime":538.838,"endTime":541.79,"body":"then what are the treatments? Well, there's a"},{"startTime":541.806,"endTime":544.702,"body":"couple. The first treatment would be called"},{"startTime":544.782,"endTime":547.638,"body":"expected management, and that's something very rare that you would"},{"startTime":547.67,"endTime":550.214,"body":"do. That means just watching and waiting."},{"startTime":550.398,"endTime":553.158,"body":"That's not unreasonable to do. If it's very"},{"startTime":553.23,"endTime":556.062,"body":"early in the pregnancy and the ecg levels are well"},{"startTime":556.102,"endTime":559.086,"body":"below 200, even if the pregnancy is at five"},{"startTime":559.134,"endTime":561.942,"body":"weeks, three days and the ecg levels are very low,"},{"startTime":562.102,"endTime":564.444,"body":"it's not unreasonable to keep watching."},{"startTime":564.638,"endTime":567.376,"body":"However, it's also not unreasonable to still"},{"startTime":567.424,"endTime":570.36,"body":"treat. The second treatment"},{"startTime":570.416,"endTime":573.032,"body":"would then be medical treatment. Medical"},{"startTime":573.112,"endTime":576.048,"body":"treatment is going to be methotrexate. What"},{"startTime":576.08,"endTime":578.968,"body":"methotrexate is, is a chemotherapy agent that"},{"startTime":579.0,"endTime":581.052,"body":"affects folic acid"},{"startTime":581.712,"endTime":584.384,"body":"by inhibiting the metabolism of"},{"startTime":584.408,"endTime":587.104,"body":"folate. It interferes with the synthesis"},{"startTime":587.168,"endTime":589.928,"body":"of DNA and rna, which are the"},{"startTime":589.96,"endTime":592.304,"body":"essential components of growth and"},{"startTime":592.328,"endTime":594.648,"body":"reproduction of the cell. So"},{"startTime":594.68,"endTime":597.344,"body":"methotrexate can potentially stop the"},{"startTime":597.368,"endTime":600.056,"body":"pregnancy from going forward. It's a fairly"},{"startTime":600.104,"endTime":602.616,"body":"safe drug. It's a very low dose chemotherapy"},{"startTime":602.664,"endTime":605.608,"body":"agent. So there are patients that we"},{"startTime":605.64,"endTime":608.584,"body":"don't recommend taking it, which I won't go into depth in"},{"startTime":608.608,"endTime":611.56,"body":"this, but for most patients they can take it. And what"},{"startTime":611.576,"endTime":614.088,"body":"it will do is it will cause the pregnancy then to"},{"startTime":614.12,"endTime":616.776,"body":"stop. The last treatment is surgical"},{"startTime":616.824,"endTime":619.632,"body":"treatment, and that would be a laparoscopic surgery"},{"startTime":619.712,"endTime":621.62,"body":"where you would go in with a"},{"startTime":621.676,"endTime":624.348,"body":"laparoscope, and then you would either"},{"startTime":624.5,"endTime":626.924,"body":"resect the ectopic pregnancy from the"},{"startTime":626.948,"endTime":629.916,"body":"tube, or you would remove the"},{"startTime":629.964,"endTime":632.432,"body":"tube that has the ectopic pregnancy in it."},{"startTime":633.092,"endTime":635.988,"body":"70% to 80% of the time, the ectopic pregnancy"},{"startTime":636.02,"endTime":638.996,"body":"is going to be in the outer portion of the tube, which means"},{"startTime":639.044,"endTime":641.908,"body":"sometimes it can be removed from the tube without removing"},{"startTime":641.94,"endTime":644.732,"body":"the tube. The other 20% to 30%"},{"startTime":644.772,"endTime":647.388,"body":"of time, it's going to be in the"},{"startTime":647.5,"endTime":650.34,"body":"smaller portion of the fallopian tube called the"},{"startTime":650.356,"endTime":653.2,"body":"isthmus, and this can"},{"startTime":653.216,"endTime":656.0,"body":"be sometimes more difficult to remove the pregnancy"},{"startTime":656.136,"endTime":659.088,"body":"from the tube and potentially may have to remove the"},{"startTime":659.12,"endTime":662.056,"body":"tube. Now, there are contraindications"},{"startTime":662.144,"endTime":665.008,"body":"to giving methotrexate. For example, if someone's breastfeeding, you"},{"startTime":665.04,"endTime":667.984,"body":"cannot give it. There are certain disorders that you can't give"},{"startTime":668.008,"endTime":670.816,"body":"it with, but the other thing is that it doesn't"},{"startTime":670.864,"endTime":673.72,"body":"always work. And so when we give it,"},{"startTime":673.856,"endTime":676.84,"body":"what happens is we have to look at the situation. Is this a"},{"startTime":676.856,"endTime":679.784,"body":"pregnancy that's further along? If it is, then you"},{"startTime":679.808,"endTime":682.304,"body":"usually will just go to surgery. But if it's early"},{"startTime":682.368,"endTime":685.202,"body":"enough, especially if there's no heartbeat yet, methotrexate, ah,"},{"startTime":685.944,"endTime":688.792,"body":"has a very good chance of working, and that will prevent"},{"startTime":688.832,"endTime":691.504,"body":"you from needing a surgery, and even more important,"},{"startTime":691.608,"endTime":694.36,"body":"an emergency surgery where you get"},{"startTime":694.416,"endTime":696.848,"body":"thrown into the ER and then have to have your tube"},{"startTime":696.88,"endTime":699.872,"body":"removed under emergent circumstances"},{"startTime":699.992,"endTime":702.132,"body":"where you're bleeding and hemorrhaging inside."},{"startTime":702.592,"endTime":705.552,"body":"Usually when you're given methotrexate, you'll be told to stop folic"},{"startTime":705.592,"endTime":708.496,"body":"acid and stop eating green leafy vegetables because those"},{"startTime":708.544,"endTime":711.106,"body":"have folate in it. and you don't want to be taking something"},{"startTime":711.274,"endTime":714.042,"body":"that the medicine's going against. So you would recommend"},{"startTime":714.082,"endTime":716.778,"body":"stopping those. During the time you're taking the methotrexate,"},{"startTime":716.93,"endTime":719.786,"body":"the chances of success of it stopping the"},{"startTime":719.794,"endTime":722.262,"body":"ectopic is very high, in around 90%."},{"startTime":722.562,"endTime":725.434,"body":"Sometimes some people need to get a second dose of methotrexate,"},{"startTime":725.498,"endTime":728.418,"body":"which is normal, and then what they'll do is watch those"},{"startTime":728.45,"endTime":731.434,"body":"ACG levels go down. Now, what's important is"},{"startTime":731.458,"endTime":734.378,"body":"when they look at the ECG levels, a lot of people"},{"startTime":734.41,"endTime":737.36,"body":"get nervous when they see they're still going up when"},{"startTime":737.376,"endTime":740.136,"body":"they draw the blood. What theyre looking for is between the"},{"startTime":740.184,"endTime":743.104,"body":"fourth day from the methotrexate and the"},{"startTime":743.168,"endTime":745.624,"body":"7th day from the methotrexate is if"},{"startTime":745.648,"endTime":748.152,"body":"the ECG level goes down by"},{"startTime":748.192,"endTime":751.072,"body":"15%, as long as it does that, it means its"},{"startTime":751.112,"endTime":753.92,"body":"working. Now, just because the ACG levels are"},{"startTime":753.936,"endTime":756.52,"body":"going down does not mean youre completely out of the woods."},{"startTime":756.656,"endTime":759.612,"body":"Ive seen people with ACG levels as low as 15"},{"startTime":760.032,"endTime":762.696,"body":"rupture their tube even after getting methotrexate"},{"startTime":762.744,"endTime":765.726,"body":"therapy. So you're never 100% out of"},{"startTime":765.734,"endTime":768.31,"body":"the woods. And for that reason, if there's suspicion of an"},{"startTime":768.326,"endTime":771.166,"body":"ectopic pregnancy, you really don't want to be leaving"},{"startTime":771.214,"endTime":773.822,"body":"town, getting on planes. You kind of want to lay"},{"startTime":773.862,"endTime":776.782,"body":"low and make sure you have someone with you. So if anything"},{"startTime":776.822,"endTime":779.414,"body":"ever happens in emergency, you can get to the ER right"},{"startTime":779.438,"endTime":782.358,"body":"away. But for most people, they don't end up"},{"startTime":782.39,"endTime":785.238,"body":"having an emergent procedure."},{"startTime":785.39,"endTime":788.11,"body":"If the methotrexate is working, the hcg levels are"},{"startTime":788.126,"endTime":791.008,"body":"dropping. Now, an interesting fact is if"},{"startTime":791.04,"endTime":793.73,"body":"you go and save the tube by, using methotrexate,"},{"startTime":793.882,"endTime":796.882,"body":"or remove the ectopic pregnancy without"},{"startTime":796.938,"endTime":799.414,"body":"removing the tube or remove the tube,"},{"startTime":799.794,"endTime":802.762,"body":"does that affect your chances then in the future of having another"},{"startTime":802.818,"endTime":805.784,"body":"ectopic? the answer is that regardless which"},{"startTime":805.824,"endTime":808.792,"body":"treatment you do, you will still have the same 15%"},{"startTime":808.848,"endTime":811.72,"body":"chance of having another ectopic. And that was the point"},{"startTime":811.752,"endTime":814.528,"body":"I was making earlier when I said it's a disease"},{"startTime":814.576,"endTime":817.562,"body":"state. So if it's on one tube, it's probably on"},{"startTime":817.578,"endTime":820.546,"body":"the other tube as well. Now, once you've had an"},{"startTime":820.57,"endTime":823.25,"body":"ectopic pregnancy, it's very important in the"},{"startTime":823.282,"endTime":826.026,"body":"future to always get into your Ob doctor"},{"startTime":826.09,"endTime":829.01,"body":"early in the pregnancy. So that way if you do have an ectopic,"},{"startTime":829.042,"endTime":831.574,"body":"it can be caught early, it can be treated early."},{"startTime":832.194,"endTime":834.986,"body":"No one wants to have surgery if you don't need it. Now, there"},{"startTime":835.01,"endTime":837.89,"body":"are special circumstances where surgery is absolutely"},{"startTime":837.922,"endTime":840.322,"body":"needed, such as if there's a large"},{"startTime":840.378,"endTime":843.352,"body":"pregnancy with a heartbeat that's further along. But"},{"startTime":843.368,"endTime":845.88,"body":"the other situation thats very uncommon, thats happened to me"},{"startTime":845.912,"endTime":848.838,"body":"twice in the history of going through, as"},{"startTime":848.846,"endTime":851.166,"body":"a fertility doctor, is whats called a"},{"startTime":851.19,"endTime":854.174,"body":"heterotopic pregnancy. And thats where you have one"},{"startTime":854.214,"endTime":857.158,"body":"pregnancy in the uterus and one pregnancy in"},{"startTime":857.166,"endTime":860.086,"body":"the tube. In that situation, you cannot give"},{"startTime":860.11,"endTime":862.822,"body":"methotrexate because you would cause the pregnancy in the"},{"startTime":862.838,"endTime":865.534,"body":"uterus to pass away, too, and that would be horrible. So"},{"startTime":865.574,"endTime":868.566,"body":"instead, what you do is you do surgery and just"},{"startTime":868.63,"endTime":870.948,"body":"remove the ectopic, pregnancy from the"},{"startTime":870.98,"endTime":873.98,"body":"tube. And that way you can preserve the pregnancy"},{"startTime":873.996,"endTime":876.812,"body":"in the uterus. And when I've done that every time, it's always"},{"startTime":876.852,"endTime":879.812,"body":"been successful. And so it's a fairly successful"},{"startTime":879.852,"endTime":882.748,"body":"procedure. In the"},{"startTime":882.78,"endTime":885.148,"body":"end, the ectopic pregnancy for going through"},{"startTime":885.18,"endTime":887.512,"body":"IVF is about 1%."},{"startTime":888.052,"endTime":890.708,"body":"For the general population, it's about 1% or"},{"startTime":890.74,"endTime":893.324,"body":"less. And for people who have had an"},{"startTime":893.348,"endTime":896.22,"body":"ectopic pregnancy, at least one, it would be a 15%"},{"startTime":896.276,"endTime":898.742,"body":"chance of another ectopic. With each"},{"startTime":898.782,"endTime":901.71,"body":"ectopic, those chances keep going up by about"},{"startTime":901.766,"endTime":904.638,"body":"15%. My goal is not to scare"},{"startTime":904.67,"endTime":907.342,"body":"you, to make you think youre going to get an ectopic, but just so you"},{"startTime":907.382,"endTime":910.302,"body":"understand this and that if this happens, youll have a little bit of a better"},{"startTime":910.342,"endTime":913.198,"body":"understanding of what may be happening, why your doctors checking"},{"startTime":913.23,"endTime":915.962,"body":"those hormones so often and why theyre"},{"startTime":916.342,"endTime":919.262,"body":"wanting to give you treatment, such as medical treatment or surgical"},{"startTime":919.302,"endTime":922.064,"body":"treatment in all these situations, as I, always"},{"startTime":922.104,"endTime":925.08,"body":"talk about, you talk to your doctor, and this conversation"},{"startTime":925.112,"endTime":927.816,"body":"needs to be with them. Not every situation is the"},{"startTime":927.84,"endTime":930.8,"body":"same. Hopefully this is something that you have been interested"},{"startTime":930.832,"endTime":933.72,"body":"in or something that you learned about today or maybe were worried"},{"startTime":933.752,"endTime":936.728,"body":"about and now are less worried about. As always, I always"},{"startTime":936.776,"endTime":939.736,"body":"appreciate everyone who listens to this podcast, and if you like it, please tell"},{"startTime":939.76,"endTime":942.48,"body":"a friend about it. Give us a five star review on your"},{"startTime":942.512,"endTime":944.904,"body":"favorite podcast medium. As"},{"startTime":944.944,"endTime":947.734,"body":"always, I'll be back next week on,"},{"startTime":947.714,"endTime":949.248,"body":"taco belt fertility."}]}