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Fertility after organ-preserving surgery of ectopic pregnancy: results of a multicenter study
1Department of Obstetrics and Gynecology, Ludwig Maximilian University, Munich, Germany.
Objective:
To evaluate the postoperative fertility rate after ectopic pregnancy (EP) and to compare the impact of different surgical techniques.
Design:
Prospective, multicenter trial.
Setting:
Twenty-five centers with microsurgical facilities.
Patient(S):
A total of 1,025 patients with EP were enrolled between 1984 and 1990.
Intervention(S):
Organ-preserving operation and at least one patent remaining tube. Evaluation of postoperative outcome by standardized questionnaires.
Main Outcome Measure(S):
Postoperative fertility in terms of pregnancy rate (PR) and recurrent ectopic implantation.
Result(S):
The PR was similar after wedge resection (45.9%) and salpingotomy or milk out (42.0%). The recurrence rates did not differ between both groups (7.5% versus 8.2%). In patients with a blocked or absent contralateral tube, the PR was poor (31.2%), and the recurrence rate of EP was high (16.0%), indicating that most pregnancies are achieved through the contralateral tube.
Conclusion(S):
The postoperative fertility rate after an EP is reduced. The type of surgery usually has no significant impact. In the case of a blocked or absent contralateral tube, the patient must be informed about the significantly reduced fertility rate and the elevated risk for EP recurrence.