Risk of Recurrent Ectopic Pregnancy
The risk of recurrent ectopic pregnancy after a previous ectopic pregnancy ranges from approximately 10-20%, with most studies reporting rates between 13-29%. 1, 2
Specific Risk Estimates
The recurrence risk varies based on the study population and methodology:
General recurrence rate: Women with a history of ectopic pregnancy face a significantly elevated risk of recurrence compared to those with no prior ectopic pregnancy 1, 3
Post-expectant management: Among women who had expectant management of placenta accreta spectrum (which included one ectopic pregnancy case), the recurrence rate was documented, though this represents a different clinical context 4
Clinical study data: A case-control study of 306 women with single ectopic pregnancies compared to 61 women with recurrent ectopic pregnancies identified that previous ectopic pregnancy itself creates significant risk increase, either from surgical management effects or persistence of original risk factors 1, 2
Key Risk Factors That Increase Recurrence
Beyond the baseline recurrence risk, certain factors further elevate the probability:
History of infertility: Increases recurrence risk substantially (adjusted OR = 3.84,95% CI 2.16-6.86) 5
Salpingotomy for previous ectopic: Triples the risk of recurrence (adjusted OR = 3.04,95% CI 1.21-36.51) compared to non-pregnant controls 5
Tubal surgery and sterilization: Represents the highest risk category for any ectopic pregnancy, including recurrence 1, 6
Pelvic inflammatory disease: Risk doubles with each recurrent episode due to progressive tubal occlusion 1
Protective Factors
Multiparity: Multiparous women are significantly less likely to suffer recurrent ectopic pregnancy (adjusted OR = 0.35-0.36) 5
Contraception use: Current IUD use (adjusted OR = 0.02) or condom use (adjusted OR = 0.16) significantly reduces recurrence risk compared to no contraception 5
Special Consideration: IVF Treatment
For women with recurrent ectopic pregnancy who undergo IVF:
Lower recurrence with IVF: The incidence of ectopic pregnancy after IVF treatment in women with previous recurrent ectopic pregnancy (2.4%) is significantly lower than in women with single prior ectopic pregnancy (6.8%, P = 0.011) 7
Comparable to normal pregnancy: The recurrence rate after IVF (2.4%) is similar to women with history of intrauterine pregnancy only (2.1%) 7
No impact on live birth rates: Previous recurrent ectopic pregnancy does not adversely affect main IVF outcomes including clinical pregnancy rate, miscarriage rate, or live birth rate 7
Clinical Implications
Women with a history of ectopic pregnancy require heightened surveillance in subsequent pregnancies, as the cumulative risk factors (particularly tubal damage from the initial ectopic or its treatment) persist 1, 2. The risk is not modifiable through most interventions, making secondary prevention problematic 2. However, effective contraception with condoms or IUDs between desired pregnancies can reduce recurrence risk 5.