The risk of ectopic pregnancy following tubal reconstructive microsurgery and assisted reproductive technology procedures

Abstract

In the presence of tubal infertility, the incidence of EP following ART and tubal microsurgery are approximately comparable with each other and higher than in women without tubal infertility. The success of infertility surgery depends on a careful selection of appropriate patients.

Should IVF be used as first-line treatment or as a last resort? A debate presented at the 2013 Canadian Fertility and Andrology Society meeting

“…Schippert et al (2012), in a recent randomized control trial evaluating spontaneous pregnancy after conservative microsurgical re-anastomosis for tubal infertility, reported ectopic pregnancy rates of 4.5%, similar to the rates of ectopic pregnancy through IVF in women less than 30 years-old with tubal disease (Schippert et al, 2012). Compared with spontaneous conception, IVF treatment offers no reduction in ectopic pregnancy after surgical correction in these women.…”

“…One obvious example is the use of IVF for unilateral tubal factor infertility with the justification that it bypasses the fallopian tubes, thereby mitigating the increased risk of ectopic pregnancy even after successful tubal microsurgery (Schippert et al, 2012). In women who had a prior ectopic pregnancy, 70% subsequently conceived spontaneously with an intrauterine pregnancy in a prospective study by about 12 months after either salpingostomy or methotrexate treatment (Fernandez et al, 2013).…”

Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ?

“…Dans la plus large sé rie de repermé abilisation tubaire (1118 patientes), le taux de grossesse spontané e a é té de 54 % [57]. De plus, le taux de grossesse extrauté rine aprè s anastomose tubo-tubaire ne semble pas excé der ceux observé s aprè s FIV (4,5 % dans la sé rie de Shippert et al) [58]. Les facteurs pronostiques de grossesse spontané e postrepermé abilisation sont l'âge de la femme lors de la chirurgie de ré paration [59], une grossesse anté rieure, la qualité du sperme [60], et la longueur de la trompe restante [61].…”

Operative Gynecology and High Risk Pregnancy

“…Previous abdominal surgeries, microsurgical procedures, hydro-/sactosalpinges, salpingitis, salpingitis isthmica nodosa, and peri-adnexal adhesions showed a significant positive correlation with EP as outcome. The highest EP rate related to all clinical pregnancies was 4.5% in smoking women of <30 years of age with tubal pathology following 'In vitro Fertilization' (IVF) [6].…”