My experience with an ectopic pregnancy and IUS

Yes, I have an IUS (intrauterine system) and yes, I got pregnant whilst having it, it in the tubes -.-

Here’s the story behind it and all the frustrating consequences that I experienced after finding out about it.

The Pregnancy Test

Monday, the 30th of January 2023, started off as a typical week, going to uni and meeting up with friends for sushi afterward. Everything changed when I got home and took a pregnancy test… just to be sure… and it turned out to be positive! Just like a COVID-Test, it was either one or two lines, and just like the shock of a positive COVID-Test, I was ultimately shocked when I saw two lines on that test.

How was this possible? It’s important to note: I’ve had a hormonal IUS for half a year now — and IUSs have a Pearl Index of 0.2, meaning that theoretically, they should prevent pregnancies more than 99% of the time. Well, I guess I was part of the unlucky 0.2% that did get pregnant. These pregnancies with an IUS mostly occur when there’s a problem with the IUS, e.g. it gets rejected or moves from its designated space.

So what now? Because I took the test in the evening, I had to wait till the next day to go get checked by the doc. As you can imagine, there was not a lot of sleep that evening. But rather deep talks, phone calls, and circling thoughts. Finally, the next day arrived and I called my gynecologist, who turned out to be on holiday -.- Eventually, I got an appointment with another gynecologist — and to confirm, I had to do another pregnancy test, which of course, was also positive. With the help of an ultrasound, she verified that the IUS was sitting perfectly in the place it should be. She took another while to further look at the images and told me then, “there is nothing in your uterus”. She ensured me that there was no need to panic at the moment, it could be too early to see anything, but it could also be an ectopic pregnancy, a pregnancy in an abnormal place, not in the uterus.

Finally, she decided to send me to the ER (emergency room), to which I drove myself, as I did not have any symptoms, with my mother sitting in the passenger seat beside me.

Hospital Visits

After having arrived at the local hospital, I immediately got an intravenous access (which I would come to receive quite a few times in these few days). But because I was not a super-super emergency patient about to die, I did have to wait for quite a while until a doctor came to see me. She then did the same diagnostics as the other doctor had done already, measuring the pregnancy hormone β-HCG, but this time in the blood, which allowed for quantification: it was 479 U/l. As a reference, a non-pregnant woman has a β-HCG level of 0–5 U/l, so I was definitely pregnant. However, calculating from my last period, I would theoretically be pregnant almost in the 7th week, in which β-HCG would be above 1,000 U/l and rather in the 10,000s. So, this was the first indication of an ectopic pregnancy.

And again, in the ultrasound, she was unable to spot an amniotic sac or anything similar to an embryo in the uterus. After calling in another senior physician and exploring neighboring areas in the ultrasound, they found a structure that resembled an ectopic pregnancy in my right fallopian tube. However, they were not 100% sure — they told me that it could also still be a normal pregnancy, just in a very early stage. So, I was sent home and was supposed to come back in two days to see how everything had developed, unless something unexpected happened in between.

The next day, I proceeded to go to my class at university as normal. I felt fine for most of the day, but as I was walking home, my lower belly suddenly started hurting and later I also noticed that I was bleeding. So I decided to go to the hospital again, with my parents’ support. After the same examinations as the day before, the structure in the right fallopian tube was still visible in the ultrasound, but the β-HCG level had sunk to 359 U/l! So that was good news! It meant that my body had realized by itself that the pregnancy was in the wrong place and was degrading the pregnancy tissue. It was such a great relief to me and everyone around me who was tied up in the situation. The doctor told me to come in again for my control appointment tomorrow, on Thursday, and then every two days until the hormone levels were back to normal. And that would be it! Back to life, back to uni, back to living.

— Unfortunately, we all thought wrong.

The next day when I went in, thinking it was just a short follow-up appointment, the doctors told me they had bad news. Firstly, the β-HCG level was at 441 U/l and secondly, they told me that I’d need a laparoscopic operation to remove it from my fallopian tube. Now, it’s important to note that β-HCG levels are very sensitive and because I was at my University’s hospital the day in between, different laboratories have different calibrations and measuring techniques, meaning that I had probably been misdiagnosed yesterday and it was now back to the ectopic pregnancy in my right fallopian tube. It was frustrating news. Especially after receiving the “everything is okay” the day before and thinking that it was all a bad dream.

So, now the only option left was to treat this ectopic pregnancy. Principally, there are two ways to treat it: conservative with the medicine methotrexate or operative with a laparoscopy. In my case, after thinking, reading, and discussing it with experts for a long time, I made my mind up to try methotrexate, thereby avoiding an operation and all the complications and risks of it. Of course, methotrexate also has side effects, as it is for example used in chemotherapy (in higher doses). But for me, as β-HCG was also low and stagnant, I decided on this therapy. The only problem was that the hospital had to order it, which, with the weekend coming up, would only be available on Monday. Therefore, I would have to wait till then in the hospital, with β-HCG control measurements every two days.

There was not much happening in the hospital over the weekend. I stayed in bed most of the time, and took walks with the kindest friends that made the time and effort to visit me.

When Monday finally arrived, I was eager to receive the medication and go back home. But of course, there was another obstacle in the way back to normality: the β-HCG levels had risen — and not even just a little. On Saturday, it was 796 U/l, meaning that it almost doubled in two days. On Monday, it was about 1100 U/l, increasing again, not adequately, but still significantly compared to the previous days. When the doctors that were supposed to give me the methotrexate took a look at the ultrasound, they again saw the structure in the right fallopian tube, but said that they weren’t 100% sure. And therefore, refused to give me the methotrexate, but rather told me that we would test again two days later, on Wednesday.

When would this finally end? I’d been here for much too long already, had postponed my semester abroad, missed all the uni courses of the week and now I still had to wait longer!

I did go home for a day on Tuesday, to my supportive parents and boyfriend, who was finally back in town from his exams (we are a medium-distance couple). He came with me to the appointment on Wednesday, where we were sure something had to be done. There were several doctors, who had discussed my case and recommended the operation, after another examination seeing the structure in the ultrasound and a β-HCG level of 1525 U/l. And despite being someone who has difficulties making decisions, the decision on the day came quickly, accepting the operation and getting it done on the same day in the afternoon.

The Operation

The laparoscopy itself only took about half an hour I was told. When I was finally half-awake, it was already more than two hours later from when I looked at the time last. The last thing I remembered was talking to the anesthesiologist and them giving me an intravenous dose of anesthetics. I must say, as a fourth-year medical student, I felt very strange lying on a hospital bed and lying on an operating table because I was so used to being in the hospital, but being on the other side. As you might imagine, it’s definitely more fun being on the other side.

Of course, I don’t remember the operation, only afterward, the doctors told me that it had all gone as planned. It was indeed an ectopic pregnancy in the right fallopian tube and she had made a small incision in the tube to remove the pregnancy tissue. She also removed a cyst, which she had found on the other, left fallopian tube. In the laparoscopy, they also inflate the belly with CO2, which enables better sight into the abdominal area. However, the remaining gas after the operation can cause pain in the upper abdomen, as well as in the right shoulder, which I did experience in the days after.

In comparison to other operations, a laparoscopy is a minimally invasive operation, meaning that only a few “holes” are needed as access points (in my case four). To be honest, I expected the operation to affect me less than it actually did in the end. On the first day right after the operation, I felt very uncomfortable and weak. I had nausea and even vomiting (only liquids as I hadn’t eaten and barely drank a few sips of water the entire day). I received more i.v. pain medication because I was already lying in a weird posture due to the pain. My throat had been damaged by the intubation, which made it painful every time I swallowed. It was also very unpleasant that I wasn’t able to go to the bathroom either (to urinate). Eventually, I had to get another catheter for the night.

Healing

I stayed in the hospital for another two nights after the operation, slowly being able to get up again and eating food that was easily swallowed. A few hours after the operation, the β-HCG level had already sunk under 1000 U/l and two days later, it was at 264 U/l. Back at home, I was very much not-independent. I was unable (and not allowed) to lift heavy things or do any physical activity. I was still in pain and strangely, my back hurt for quite a while, causing me to walk like a hunched 90-year-old lady (no joke)!

On one of the days I wanted to go for a walk, but at half the way, my belly started hurting and I simply did not have enough energy to continue walking. It felt super weak and old. As of now, I’m still recovering. The mental strain of going through something like this (with a bunch of twists and obstacles!) is also not to be underestimated.

I hope you’re not reading this because you’re going through something similar. Look out for yourself and for others. Retrospectively, I was glad to have gone to the doctor early enough and I really do hope no one has to experience anything like this, ever.

Get notified when I publish more articles: https://medium.com/@yvonnelaframboise/subscribe

If you’re not yet able to read all articles on Medium and would like to have access to all by becoming a member (for $5 a month), you can sign up with this link. It’s a referral link and won’t cost you any more than the $5 a month, plus, you would support me directly and I would be infinitely grateful to you! :)