Fertility after tubal ectopic pregnancy Results of a population-based study
General population study of spontaneous fertility after ectopic pregnancy, according to the treatment. Conservative strategy should be favored, especially for patients with risk factors of infertility.
Marianne de Bennetot, M.D., Benoît Rabischong, M.D., Ph.D., Bruno Aublet-Cuvelier, M.D., Ph.D., Fabien Belard, Hervé Fernandez, M.D., Jean Bouyer, M.D., Ph.D., Michel Canis, M.D., Ph.D., Jean-Luc Pouly, M.D.
Volume 98, Issue 5, Pages 1271-1276.e3, November 2012
To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and identify predictive factors of spontaneous fertility,
Observational population-based study.
One thousand and sixty-four women registered from 1992 to 2008.
Laparoscopic (radical or conservative), or medical treatment.
Main Outcome Measure(s):
Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence.
The 24-month cumulative rate of intra-uterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy and 76% after medical treatment. IUP rate was lower after radical treatment as compared to conservative treatments in univariable analysis (p = 0.0079). In multivariate analysis, IUP rate was significantly lower for patients over the age of 35 year, or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy (HR 0,67; 95% CI 0,50- 0,91). The two-year cumulative rate of recurrences was 18,5% after salpingostomy or salpingectomy, and 25,5% after medical treatment (p=0,86). History of infertility (HR 0,5; 95% CI 0,3-0,8) or of previous live birth (HR 0,6; 95% CI 0,4-0,9) would be protective, in contrast to history of voluntary termination of pregnancy (HR 1,8; 95% CI 1,1-3,0).
Conservative strategy seems to be preferred, whenever possible, to preserve patients’ fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.