There is no guaranteed way to prevent an ectopic pregnancy, but you can take meaningful steps to lower your risk. Ectopic pregnancies occur in roughly 1 to 2 percent of all pregnancies, and about half of women who experience one have no known risk factors at all. That said, several of the major risk factors are within your control, and understanding them gives you the best chance of protecting your fertility and catching problems early.
What Makes an Ectopic Pregnancy More Likely
An ectopic pregnancy happens when a fertilized egg implants outside the uterus, most often in a fallopian tube. Anything that damages, scars, or narrows the fallopian tubes increases the chance that an egg will get stuck on its way to the uterus. The major risk factors identified by the American College of Obstetricians and Gynecologists include a previous ectopic pregnancy, prior fallopian tube surgery, previous pelvic or abdominal surgery, sexually transmitted infections, pelvic inflammatory disease, and endometriosis.
Additional factors that raise risk include cigarette smoking, being older than 35, a history of infertility, and the use of assisted reproductive technology like IVF. Some of these you can’t change. But several of the most significant ones, particularly STIs, smoking, and how you approach fertility treatment, are areas where your choices genuinely matter.
Protect Against STIs and Pelvic Infections
Sexually transmitted infections, especially chlamydia and gonorrhea, are among the most preventable causes of tubal damage. These infections can travel from the cervix into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). Even “silent” infections that produce no noticeable symptoms can cause permanent scarring in the fallopian tubes, uterus, and surrounding tissue. That scarring narrows or blocks the tubes, creating the conditions for an ectopic implantation.
Consistent condom use and regular STI screening are the most effective ways to protect your tubes. Chlamydia in particular is common and frequently asymptomatic, so routine screening matters even if you feel fine. If you do test positive, prompt antibiotic treatment can clear the infection before it has time to ascend into the upper reproductive tract and cause lasting damage. The longer an infection goes untreated, the greater the risk of scarring.
Quit Smoking
Smoking is one of the clearest modifiable risk factors for ectopic pregnancy. Chemicals in cigarette smoke impair the ability of the fallopian tubes to move a fertilized egg toward the uterus. The tiny hair-like structures lining the tubes, which normally create a wave-like motion to transport the egg, are damaged by tobacco exposure. Smoking also alters the hormonal environment in the tubes in ways that can encourage implantation in the wrong location. Quitting before you try to conceive reduces this risk.
Understand IVF-Related Risk
If you’re pursuing IVF, it’s worth knowing that assisted reproduction carries a slightly elevated ectopic risk, particularly if the reason for IVF is tubal disease. A large UK analysis of over 160,000 pregnancies found that tubal infertility more than doubled the odds of ectopic pregnancy during IVF cycles. Transferring multiple embryos also increased risk: two embryos raised the odds by about 29 percent compared to a single embryo, and transferring three or more raised it by 69 percent.
There are practical ways to reduce this risk during treatment. Single embryo transfer lowers ectopic rates in addition to reducing the chance of multiples. Extending embryo culture to day 5 (blastocyst stage) before transfer also helps. That UK study found that transferring blastocysts reduced ectopic risk by roughly 27 percent compared to transferring very early-stage embryos. If you’re discussing your IVF protocol with a fertility specialist, these are worthwhile factors to raise.
Tubal Surgery and Sterilization Reversal
Any surgery on or near the fallopian tubes increases the chance of ectopic pregnancy in future conceptions. This includes surgery to repair blocked tubes, remove tubal adhesions, or reverse a prior sterilization. After sterilization reversal (tubal anastomosis), ectopic pregnancy rates range from 4 to 8 percent, compared to about 1.4 percent with IVF. For women with severe distal tubal disease who undergo surgical repair, ectopic rates can reach as high as 17 percent.
This doesn’t mean you should avoid necessary surgery, but it does mean that if you’ve had tubal surgery and become pregnant, early monitoring is especially important. Knowing your surgical history helps your care team watch for warning signs from the very beginning of a pregnancy.
What to Know After a Previous Ectopic
A prior ectopic pregnancy is one of the strongest risk factors for having another one. The recurrence risk is significant enough that early monitoring in any subsequent pregnancy is standard practice. This typically involves blood tests to track your hCG (pregnancy hormone) levels and an early ultrasound to confirm the pregnancy is in the uterus.
In a normal pregnancy, hCG levels roughly double every 48 hours in the early weeks. When levels rise more slowly than expected or plateau, it can signal that the pregnancy may not be developing in the uterus. Transvaginal ultrasound can often visualize where the pregnancy has implanted, though very early ectopic pregnancies can be difficult to spot. If you’ve had a previous ectopic, letting your provider know as soon as you get a positive pregnancy test allows monitoring to start promptly, giving the best chance of catching an ectopic before it becomes dangerous.
IUDs and Ectopic Risk: Clearing Up Confusion
You may have heard that IUDs increase the risk of ectopic pregnancy. The reality is more nuanced. IUDs are highly effective at preventing pregnancy overall, which means they dramatically reduce your absolute risk of any pregnancy, ectopic included. A large study published in JAMA found that the absolute rate of ectopic pregnancy among hormonal IUD users was only about 7 to 16 per 10,000 person-years, depending on the specific device. That’s very low.
The confusion arises because if an IUD fails and a pregnancy does occur, a higher proportion of those pregnancies tend to be ectopic compared to pregnancies conceived without contraception. But this is a statistical artifact of the IUD being so good at preventing uterine pregnancies. Using an IUD does not damage your tubes or make you more vulnerable to ectopic implantation. It remains one of the most effective contraceptive options available.
Early Warning Signs to Recognize
Because not all ectopic pregnancies are preventable, knowing the early symptoms is a crucial layer of protection. The most common warning signs include sharp or stabbing pain on one side of your lower abdomen, vaginal bleeding that’s different from a normal period, shoulder tip pain (caused by internal bleeding irritating the diaphragm), and pain during bowel movements or urination. These symptoms can develop between weeks 4 and 12 of pregnancy.
An ectopic pregnancy that ruptures is a medical emergency that can cause life-threatening internal bleeding. Recognizing the signs early, before rupture, gives you far more treatment options and better outcomes. If you’re in early pregnancy and experience one-sided pelvic pain with or without bleeding, getting evaluated quickly is the single most important thing you can do.