From the Guidelines
The patient should consult with her OBGYN about removing her Nexplanon implant if she wishes to conceive again, as fertility typically returns quickly after removal. Nexplanon is a long-acting contraceptive that prevents pregnancy by releasing etonogestrel, which inhibits ovulation 1. Given her recent ectopic pregnancy surgery on September 12,2024, she should discuss with her OBGYN the optimal timing for attempting pregnancy again. Generally, doctors recommend waiting at least 3 months after an ectopic pregnancy before trying to conceive to allow for complete healing. The OBGYN will likely want to review her records from Yakima Women's Health to understand the details of her ectopic pregnancy and any risk factors that might affect future pregnancies. Some key points to consider in her next pregnancy include:
- Her history of ectopic pregnancy, which slightly increases her risk for another ectopic pregnancy 1
- The importance of preconception care, including folic acid supplementation (typically 400-800 mcg daily)
- Possible additional monitoring in her next pregnancy due to her history of ectopic pregnancy. It is essential for the patient to follow her OBGYN's guidance to minimize risks and ensure the best possible outcome for her future pregnancy.
From the Research
Ectopic Pregnancy and Contraception
- Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity, with a prevalence of 1% to 2% in the United States 2.
- Risk factors for ectopic pregnancy include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility 2.
- The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa, but most ectopic pregnancies do not reach this stage 2.
Nexplanon and Fertility
- Nexplanon is a contraceptive implant that exerts its effects primarily by suppressing ovulation, and it is the most effective method of long-acting reversible contraception 3.
- Persons will experience a rapid return to fertility once the implant is removed 3.
- However, in rare cases, the Nexplanon implant can migrate to the pulmonary vasculature, requiring surgical removal 4.
Ectopic Pregnancy and Future Fertility
- After an ectopic pregnancy, patients may experience ongoing morbidity, including chronic pain, infertility, and psychological distress 5.
- Future fertility is an important aspect in the management of ectopic pregnancy, and patients should be counseled on their options for future pregnancy 5.
- The use of progestin-only contraceptives, such as Nexplanon, may be associated with a higher risk of ectopic pregnancy in the event of method failure, but the absolute risk is still low 6.
Management and Treatment
- Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management 2.
- Patients with a history of ectopic pregnancy should be referred to an OBGYN to discuss their options for future pregnancy and to receive counseling on the risks and benefits of different contraceptive methods 2, 5.