Fertility outcome after surgical treatment for ectopic pregnancy

Aims: Ectopic pregnancy (EP) is a major event in a woman’s reproductive life and the leading cause of maternal mortality in the first trimester of pregnancy.

Materials and methods: We analysed 417 cases of EP undergoing surgery in our centre within the period of 1989–1998. Our aim was to evaluate fertility rates after surgical treatment for EP.

Results: 349 of 417 (83.7%) patients were managed laparoscopically. 6 (1.4%) women underwent primary and 62 (14.9%) secondary laparotomy. In 274 cases conservative surgery was performed (salpingotomy or partial tubal resection). Follow-up data could be obtained from 261 patients. 196 had an active desire for a new pregnancy and were included in further analysis. The cumulative rate of intrauterine pregnancy (IUP) was significantly higher for women who underwent conservative approach (84.1%) than after salpingectomy (49.0%) (p<0.05). Fertility reducing factors including: EP in the past, contralateral tubal damage (adhesions), abdominal surgical history, pelvic inflammatory disease, were also considered in the analysis of long-term outcome. IUP rates in patients with at least one fertility reducing factor were significantly lower than in the group without these factors (61.3% vs. 92.9%; p<0.05). Patients with fertility reducing factors benefit from conservative treatment. In this group there was a significant difference in IUP rates observed between salpingotomy and salpingectomy (75.0% vs. 39.5%; p<0.05). In the group without fertility reducing factors this difference was not significant (92.2% after conservative approach vs. 8/8 patients after salpingectomy).

Conclusions: Laparoscopic conservative surgery should be considered the gold standard for management of ectopic pregnancy in women who want to preserve their future fertility. Salpingotomy is associated with a higher subsequent pregnancy outcome compared to radical approach while the recurrence rate is not significantly influenced.