I am 35 and have had two ectopic pregnancies. The first (almost two years ago) resulted in the removal of my left tube. The second occurred in my right tube and I was fortunate to save the tube. I've been told that while ectopic pregnancies tend to recur, there are many women who manage to become pregnant after having them. I've also been told that there is a procedure whereby a tube can be inserted into my tube to allow the fertilized egg to travel to the uterus. Do you have any information on this? Is there a specific treatment that would reduce the risk of another ectopic?

A.T.

After two ectopic pregnancies that have involved both tubes, the risk of another ectopic pregnancy is over 50 percent. If you have other risk factors such as previous tubal surgery, or if the remaining tube is compromised by adhesions, blockage, infection or IUD use, the risk may be even higher. While many women who experience an ectopic pregnancy have no obvious risk factor, when ectopic pregnancies have occurred in both tubes, it is likely that the delicate internal architecture of the tube is irreversibly damaged.

There is no such procedure to fix the damaged inside of the tube to restore fertility or reduce the risk of another ectopic. The fallopian tube is much more than an open conduit between the ovary and uterus. Fertilization takes place inside the fallopian tube, and the embryo spends its first two or three days soaking up the ambience of the internal fallopian tube environment. Hormones, nutritional elements and growth factors secreted by the internal lining of the tube are important factors to support this fertilized egg on its journey toward the uterus. Inserting a new tubal lining would not ensure proper nutrition and timing of the embryo passage toward the uterus.

The only procedure available to lower the risk of future ectopic pregnancies is to consider in vitro fertilization (IVF). Bypassing the fallopian tube by removing the eggs from the ovaries, fertilizing them in the lab and transferring the embryos to the uterus is the best way to avoid future ectopic pregnancy risk.