I'm 32 years old. I had an ectopic pregnancy when I was 29, and the doctors were able to save my left ovary and tube. When I was 31 I had another ectopic. This one erupted, and my left ovary and tube were too damaged and had to be removed. Both ectopics happened on the same side (left). My right tube was checked for blockage and is clear. My fear is that I might have another ectopic and lose my right tube and ovary. Should I rely on IVF?

ù Jocelyn

Statistically your chance of another ectopic is less than 50 percent. I would want to see an HSG and look to see if there is any suggestion of damage to the inside of the right tube. There is also a new procedure called falloposcopy that may allow your physician to look inside the fallopian tube and see whether there is damage that may predispose you to another ectopic.

Your chances of another ectopic also depends on whether you have risk factors. Previous infection or tubal surgery is the most common cause. Smoking is also a risk factor for ectopic pregnancy. But most women who experience an ectopic pregnancy have no known risk factors -- just bad luck.

IVF is certainly an option, but since both prior ectopics occurred in your left tube, which has been removed, and all looks okay with the other one, you should talk to your doctor about your chances of normally carrying the next pregnancy. You should ask what steps you can take to minimize the risk of another ectopic and how to guard against potential complications.

Women who decide to try normal conception after repeated ectopics develop a heightened state of alert. As soon as their period is late, they perform a home pregnancy test. If it's positive, they go to their doctor for a quantitative blood hCG test (the pregnancy test that gives a hormone level, not just a "yes" or "no"). This test is repeated in 48 hours, and in a normal pregnancy the hormone level should rise at least 60 percent in that time. About 10 days after your missed period, you have another hCG test and a transvaginal ultrasound performed by a skilled gynecologic ultrasonographer. If the hCG level is above a certain point, your physician should see a pregnancy sac inside the uterus.

If the pregnancy is not seen, you may be miscarrying, or you may have another ectopic. In that case I would administer the medication methotrexate, which can be used to medically dissolve the ectopic before it ruptures. This approach is successful in about 85 percent of women with ectopics, and it is safe to use if we are sure you do not have a normal pregnancy but can't prove it is ectopic.