Factors affecting fertility following radical versus conservative surgical treatment for tubal pregnancy

OBJECTIVE: The aim of this study was to analyze the fertility prognosis after conservative or radical surgery for ectopic pregnancy. Also, to identify any biological factors that may influence the fertility outcome after an ectopic pregnancy.

METHODS: A retrospective study which was carried out by collating information from the patient's hospital records was performed on 137 cases of confirmed ectopic pregnancy between January 1990 and December 1995 at the Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. The outcome measure of term pregnancy rate and repeat ectopic pregnancy rate was analyzed up to 3 years after the diagnosis of index ectopic pregnancy.

RESULTS: Our results showed that the term pregnancy rates were not significantly different following radical or conservative surgical treatments for ectopic pregnancy, P >0.05, (50% in the conservative group compared with 56% in the radical group). But equally important, the risk of a further ectopic was not increased in the radical surgery group, P >0.05 (11% in the conservative group as compared to 8% in the radical group). The incidence of intrauterine pregnancy rate (term pregnancy + miscarriage) was also comparable in each group. Multivariate regression analysis showed that the factors associated with higher fertility were age 30 years or less, past history of term pregnancy and a negative history of infertility (P <0.05).

CONCLUSION: No significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found after radical or conservative surgical treatment for tubal pregnancy. The patient's age, previous obstetric performance and a history of infertility significantly influenced fertility following the index ectopic pregnancy.