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Fertility after radical surgery for tubal pregnancy
H Fernandez1, L Marchal, Y Vincent
1Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France.
Objective:
To evaluate fertility after salpingectomy performed for ectopic pregnancies (EPs).
Design:
Retrospective cohort study.
Setting:
Tertiary care university hospital.
Patient(S):
Three hundred forty patients (213 with surgery by laparoscopy and 127 by laparotomy) between January 1985 and July 1994, with a mean follow-up period of 73 months (36-162 months).
Intervention(S):
Salpingectomy performed either by laparotomy or by laparoscopy as indicated.
Main Outcome Measure(S):
Rate of intrauterine pregnancy (IUP), live births, and recurrent EP.
Result(S):
Forty-seven (13.8%) patients were lost to follow-up, and 68 (20%) did not want to become pregnant. The overall rate of spontaneous conception was 70.4% in the laparoscopy group and 53.2% in the laparotomy group. The rate of live births was 50% and 37%, respectively; the mean time until conception was 11 and 17.2 months; and the rate of recurrent EP, 10.6% and 9.6%. The multivariate analysis showed a rate of IUP of 82.1% among women younger than 30 years of age with a normal contralateral tube, laparoscopic surgery, and no history of infertility.
Conclusions:
In this study of fertility after salpingectomy for EP, laparoscopic treatment was superior to laparotomic treatment. Fertility was equivalent to that after conservative treatment in a subgroup of young patients treated with laparoscopy and with no history of tubal pathology.