Fertility after ectopic pregnancy

Abstract

Objectives: To compare pregnancy rates (PRs) after radical or conservative surgical treatment for tubal pregnancy over a 12.5-year interval (minimum of 3 years) and to assess the relative contribution of various risk factors to future fertility performance.

Design: A retrospective cohort study examining the influence of various risk factors on PRs with stepwise discriminant analysis using a jackknife-type validation program.

Patients: Eighty-eight Olmsted County, Minnesota, women who presented over a 10-year interval with their first ectopic pregnancy (EP), undergoing either radical or conservative surgery at laparotomy, who actively attempted conception after surgery and who were available for follow-up at Mayo Clinic.

Main outcome measures: The primary end point for analysis was the occurrence of a livebirth or EP at 3 years of follow-up after the index EP.

Results: No difference in PR was identified in patients treated with radical or conservative surgery. Patients who underwent conservative surgery had a higher risk of subsequent EP. Patients with a prior history of infertility had significantly reduced fertility potential.

Conclusions: Prior history of infertility was the most significant determinant for fertility potential after surgical treatment for EP. Patients with prior infertility had markedly impaired fertility after surgical treatment of EP, and outcome was not influenced by choice of surgical procedures. Patients without prior infertility had comparable encouraging fertility potential with both conservative and radical therapy. These findings have relevance for future management of infertility in affected patients.