Fertility after tubal ectopic pregnancy: results of a population-based study

Abstract

Objective: To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility.

Design: Observational population based-study.

Setting: Regional sistry.

Patient(s): One thousand sixty-four women registered from 1992 to 2008.

Intervention(s): Laparoscopic (radical or conservative), or medical treatment.

Main outcome measure(s): Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence.

Result(s): The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy.

Conclusion(s): Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.