Ectopic pregnancies due to contralateral fistulas after sterilization by electrocoagulation; case reports

Area of Science:

• Reproductive Medicine
• Gynecology
• Surgical Pathology

Background:

• Sterilization procedures aim to prevent pregnancy by occluding the fallopian tubes.
• Bipolar electrocoagulation is a common method for female sterilization.
• Ectopic pregnancies, particularly tubal pregnancies, represent a failure of contraception.

Observation:

• Three cases of tubal pregnancy following bipolar electrocoagulation sterilization are presented.
• Pregnancies were located distal to the sterilization site, with no continuity to the uterus.
• Tuboperitoneal fistulas, confirmed by methylene blue testing, were identified as the pathway for sperm migration.

Findings:

• Spermatozoa bypassed the sterilized segments via tuboperitoneal fistulas to reach the ovum.
• In two cases, fistulas were contralateral to the ectopic pregnancy; bilateral fistulas were found in one case.
• The mechanism involves transperitoneal migration of spermatozoa to the site of fertilization.

Implications:

• Salpingectomy for post-sterilization ectopic pregnancy requires awareness of potential contralateral fistulas.
• Understanding sperm migration through fistulas is vital for conservative tubal surgery after sterilization failure.
• This highlights the importance of meticulous surgical technique and patient counseling regarding sterilization efficacy.