Reproductive outcome following two ectopic gestations: results after conservative surgery

In an 11-year period, 106 women were treated for two ectopic pregnancies (EP). Thirty-one had been surgically sterilized by the second operation. Of the 75 women with at least one patent tube, 70 (93%) were followed up regarding pregnancy outcome, with a mean follow-up period of 4.5 years. Fifty women had had a desire for pregnancy after treatment for the second EP. Of these, 26 (52%) did not achieve any conception; 16 (32%) experienced at least one more EP, and 13 (26%) had at least one intrauterine pregnancy. There were a total of 46 pregnancies, of which 21 (46%) were ectopic and 16 (35%) were carried on term. When conservative surgical techniques had been performed at the first EP, the number of intrauterine pregnancies achieved after the second EP was doubled, and the risk for a third EP was not raised. There was found no statistical difference in laterality of the second EP when the first operation was conservative. It is concluded that women experiencing repeat EP have severely impaired future fertility, with a high risk of a third EP if they conceive.