Fertility following radical, conservative-surgical or medical treatment for tubal pregnancy: a population-based study

Abstract

Objective: To investigate the factors influencing the choice of treatment for ectopic pregnancy and to compare the subsequent fertility rates of radical, conservative-surgical or medical treatments.

Design: Population-based study of 835 ectopic pregnancies registered between 1992 and 1996.

Setting: Auvergne Ectopic Pregnancy Register (France).

Sample: Four hundred and seventy-six women with tubal ectopic pregnancy who were not using contraception at the time of conception. Subsequent fertility was studied for the 291 women who attempted to conceive again.

Methods: Comparison of reproductive outcomes according to ectopic pregnancy treatment. Cumulative fertility curves were calculated by the Kaplan-Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into account confounding variables.

Main outcome measure: Recurrence and fertility rates after ectopic pregnancy.

Results: The first treatment given was 'radical' for 178 women (37%), 'conservative-surgical' for 262 (55%), and 'medical' for 35 (8%). The treatment failed in 1% for radical treatment, 5% for conservative-surgical treatment, and 36% for medical treatment. The two-year cumulative rate of recurrence was 27% with no significant difference between treatments. For women with previous infertility factors (in particular diseased contralateral tube), the treatments differed significantly, with the rate of intrauterine pregnancy lower for radical treatment and higher for medical treatment than for conservative-surgical treatment. For women with no infertility factor, there was no significant difference between treatments.

Conclusions: These results should be confirmed in a controlled trial. The results of this study provide the elements necessary to plan such a trial.