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Salpingectomy for ectopic pregnancy may decrease fertility in some cases

NEW YORK (Reuters Health) – Radical surgery for ectopic pregnancy may decrease the odds of a future spontaneous pregnancy for some women, a new study suggests.

Those women are ones with a history of infertility, tubal disease or age above 35, the study found.

“There are better fertility rates after conservative strategy, especially for patients with a risk factor of infertility,” said Dr. Benoît Rabischong of the Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France and his colleagues in a report online July 18 in Fertility and Sterility.

Dr. Rabischong and his team studied 1,064 women from a regional ectopic pregnancy registry and compared two conservative treatments – laparoscopic salpingostomy (646 patients, 61%) and methotrexate therapy (119 patients, 11%) – to the more invasive laparoscopic salpingectomy (299 patients, 28%).

The women were treated from 1992 to 2008, and all of them sought to become pregnant afterward; 744 were successful spontaneously.

Overall, the 24-month cumulative rate of spontaneous intrauterine pregnancy was 67% after laparoscopic salpingectomy, 76% after laparoscopic salpingostomy, and 76% after methotrexate therapy.

But, as the authors wrote, “The characteristics of these women seemed to influence reproductive performance significantly.”

Indeed, when they looked only at women who were younger than 35, with no history of infertility or tubal disease, management of ectopic pregnancy had no effect on the likelihood of a subsequent spontaneous pregnancy.

However, hazard ratios for spontaneous pregnancy were 0.5 in women over 35 (compared to women under 25), 0.51 in women with a history of infertility, and 0.62 in women with tubal disease. Even so, for women with these characteristics, hazard ratios were 1.2 if they’d already delivered a live infant and 2.0 when the ectopic pregnancy occurred in the presence of an intrauterine device.

In a subset of 430 women with risk factors for infertility, salpingectomy was associated with lower odds for intrauterine pregnancy (HR 0.67). And here again, spontaneous pregnancy was more likely in women with a history of live birth (HR 1.52) and in those who developed ectopic pregnancy while using an intrauterine device (HR 3.60).

“The results of this study and literature data show that it seems preferable, whenever it is possible, to always opt for a conservative treatment to potentiate subsequent fertility while not increasing the risk of recurrence,” Dr. Rabischong and colleagues advise.

Dr. Rabischong did not respond to requests for comment.

SOURCE: http://bit.ly/Osu7sn

Fertil Steril 2012.