”If I had one ectopic pregnancy, will I have another one?” This question and fear often haunts women who have experienced ectopic pregnancy. At this point, whether you ask a doctor “secretly” or in person, the answer you get is basically – the chance of another ectopic pregnancy is higher than normal. As to how much higher, some may say 15% to 30%, some even say up to 50%, the data varies. In fact, the difference is not much, because for each individual, it is a zero-sum game: either there is 100% recurrence of ectopic pregnancy, or there is no ectopic pregnancy. So, the big question is: What should I do if I had an ectopic pregnancy and now want to have a baby? Try again or IVF? Some people say you can try to conceive naturally first, and if you are still unlucky (ectopic pregnancy), then you can choose IVF next time; but some people think it is better to do IVF directly rather than risking another ectopic pregnancy. At this point, perhaps you may ask, why is it related to IVF? First of all, you need to be clear that the most common cause of ectopic pregnancy is inflammation of the fallopian tubes. Ectopic pregnancy often requires surgery, which is usually divided into conservative surgery (preserving the affected fallopian tube, cutting it open, removing the embryonic tissue and repairing it) and surgery to remove the fallopian tube. The best method is in vitro fertilization-embryo transfer (commonly known as IVF), which means that after ovulation, the eggs are removed and fertilized in vitro, the embryos are cultured, the better embryos are selected and then transferred into the uterus. This technique is used to overcome tubal infertility. Then, “whether to continue to try to conceive naturally after ectopic pregnancy or to resort to assisted reproductive technologies such as IVF needs to be considered in terms of age, fallopian tubes and other factors,” noted Ou Jianping, director of the Reproductive Center of the Third Hospital of Sun Yat-sen University. For example, for young women, such as those in their twenties or thirties, with no inflammation in the pelvis and relatively good tubal condition (even if there is only one tubal left, but the condition is good), they can also try to conceive naturally. Of course, if there is another ectopic pregnancy on the same side of the fallopian tube, then “basically there is no need to keep it anymore,” according to Ou, who believes that the tube should be ligated at this time to prevent the risk of another ectopic pregnancy. However, for older women, “if they are over 40 years old and the examination shows incomplete blockage of the fallopian tubes or adhesions in the pelvic cavity,” Ou recommends that IVF be considered directly, because the risk of ectopic pregnancy is high if the fallopian tubes are in poor condition, and the success rate of IVF is also lower the older the woman is and the lower the ovarian reserve. The older you are, the lower your ovarian reserve and the lower the success rate of IVF. If you choose to try to conceive naturally, you should be monitored closely. Once an ectopic pregnancy is detected, it can be treated promptly to avoid a potentially life-threatening emergency such as ruptured fallopian tube bleeding. Therefore, once you find out you are pregnant, you should go to the hospital for relevant tests, including blood tests for HCG, progesterone and ultrasound. Usually, “if the progesterone is very low, such as below 20ng/ml, or if the HCG rises very slowly and may be accompanied by a little vaginal bleeding or pain and discomfort on one side of the lower abdomen, the possibility of ectopic pregnancy should be ruled out.” Ou reminds that once the diagnosis is confirmed by ultrasound, the patient should be hospitalized immediately to have a chance to save the fallopian tubes from being cut. If you want to choose IVF, you should prepare the relevant documents and go to the fertility center of a regular hospital. What is the best IVF technique? When it comes to IVF, many people take it for granted that the baby is grown in a test tube. No, it is simply a process of removing multiple eggs from the woman’s ovaries, combining them with the man’s sperm in a laboratory, and then moving them back into the woman’s uterine cavity for implantation and gestation. Nowadays, many people hear about the first generation IVF or second generation IVF, but what is the difference between the two? First of all, Ou Jianping emphasized that “the first, second or third generation of IVF is not better than the second generation, as we imagine that the cell phone or computer is updated; my PhD supervisor, Prof. Guanglun Zhuang, first proposed this statement in order to let his peers understand well the relevance of several generations of technology, and slowly it has been understood and accepted by people “. Different IVF techniques are targeted at different causes of infertility. For example, the so-called first generation of IVF, which is the conventional in vitro fertilization-embryo transfer technique, or IVF-ET for short in English, is mainly targeted at infertility caused by female fallopian tube factors. It is a technique that removes the sperm and eggs of the couple with infertility, fertilizes and develops them into embryos in vitro, and then selects high-quality embryos to be transferred into the uterine cavity of the patient to allow them to bed down and achieve pregnancy,. The second generation IVF technology is the intracytoplasmic sperm injection (ICSI) technique, which is mainly aimed at treating male factors (such as azoospermia, oligospermia, weak sperm, and abnormal sperm) that cause infertility. As for the third generation of IVF, it is called Preimplantation Genetic Diagnosis (PGD). In fact, more precisely, it is a diagnosis rather than a treatment, because it is mainly used for genetic screening before implantation of first- or second-generation IVF, targeting some genetically high-risk groups (e.g., couples who are carriers of the gene for thalassemia and have had children with severe thalassemia, habitual miscarriage due to chromosomal translocations, and single-gene congenital inheritance).