Fertility after conservative and radical surgery for tubal pregnancy

Abstract

A retrospective cohort study was set up to evaluate the effectiveness of conservative and radical surgery for tubal pregnancy towards subsequent fertility. Consecutive patients undergoing conservative or radical surgery for tubal pregnancy between January 1990 and August 1993 in two university hospitals were included in the study. Outcome measures were spontaneous intrauterine pregnancy (IUP) and repeat ectopic pregnancy (EP). Of the 135 patients analysed, 56 underwent conservative surgery and 79 underwent radical surgery. Patients treated with conservative surgery achieved a higher 3-year cumulative pregnancy rate than those treated radically (P < 0.001, log-rank test). In patients treated conservatively, there was only one spontaneous IUP in the period between 18 months and 3 years after the tubal pregnancy. In contrast, patients treated radically continued to conceive in this period. Multivariate analysis showed a fecundity rate ratio (FRR) of 1.9 [95% confidence interval (CI): 0.91 to 3.8] for IUP after conservative surgery in the first 18 months of follow-up. In patients with a history of bilateral tubal disease the FRR was 3.1 (95% CI: 0.76 to 12), whereas in patients without a history of bilateral tubal disease the FRR was 1.4 (95% CI: 0.13 to 16). The FRR for repeat EP was 2.4 (95% CI: 0.57 to 11). Our data indicate a beneficial effect of conservative surgery towards subsequent fertility that was not, however, statistically significant in the multivariate analysis. In view of these inconclusive data and the importance of this major health problem, randomized studies are required to assess whether conservative surgery really improves the fertility prospects of patients with tubal pregnancy.

Temporal Trend in the Frequency of Ectopic Pregnancies in Lombardy, Italy

“…Factors commonly associated with the risk of EP are ART, smoking, STDs [19], intrauterine device use, maternal age and previous EP treatment [20,21]. …”

Re-evaluation of the indication for and limitation of laparoscopic salpingotomy for tubal pregnancy

“…As a result, ectopic pregnancy can be identified early and medical or surgical therapy can be given promptly. Evidences support a conservative approach to the tubal pregnancy in women wishing to preserve their future fertility [1][2][3][4].…”

Intrauterine Pregnancy After Salpingectomy for Tubal Pregnancy Due to Emergency Contraception: A Case Report

“…Fernandez et al (1998) 11 studied 340 patients who underwent salpingectomy for EP after a mean follow-up period of 73 months; they observed a subsequent intrauterine pregnancy rate of 82.1% in patients younger than 30 years with no history of tubal disease, a rate similar to that obtained for another group managed conservatively. Mol et al (1998) 13 evaluated 135 patients undergoing surgery for EP, 56 receiving conservative treatment and 79 undergoing salpingectomy, and found no significant difference in subsequent intrauterine pregnancy rates between the 2 groups. In this case, the patient was 28 years old, and there was no previous history of infertility.…”