Fertility after radical surgery for tubal pregnancy

Abstract

Objective: To evaluate fertility after salpingectomy performed for ectopic pregnancies (EPs). Design: Retrospective cohort study. Setting: Tertiary care university hospital. Patient(s): Three hundred forty patients (213 with surgery by laparoscopy and 127 by laparotomy) between January 1985 and July 1994, with a mean follow-up period of 73 months (36–162 months). Intervention(s): Salpingectomy performed either by laparotomy or by laparoscopy as indicated. Main Outcome Measure(s): Rate of intrauterine pregnancy (IUP), live births, and recurrent EP. Result(s): Forty-seven (13.8%) patients were lost to follow-up, and 68 (20%) did not want to become pregnant. The overall rate of spontaneous conception was 70.4% in the laparoscopy group and 53.2% in the laparotomy group. The rate of live births was 50% and 37%, respectively; the mean time until conception was 11 and 17.2 months; and the rate of recurrent EP, 10.6% and 9.6%. The multivariate analysis showed a rate of IUP of 82.1% among women younger than 30 years of age with a normal contralateral tube, laparoscopic surgery, and no history of infertility. Conclusions: In this study of fertility after salpingectomy for EP, laparoscopic treatment was superior to laparotomic treatment. Fertility was equivalent to that after conservative treatment in a subgroup of young patients treated with laparoscopy and with no history of tubal pathology.