Human Reproduction, Vol 13, 1804-1809, Copyright © 1998 by Oxford University Press
BW Mol, HC Matthijsse, DJ Tinga, T Huynh, PJ Hajenius, WM Ankum, PM Bossuyt and F van der Veen
A retrospective cohort study was set up to evaluate the effectiveness of
conservative and radical surgery for tubal pregnancy towards subsequent
fertility. Consecutive patients undergoing conservative or radical surgery
for tubal pregnancy between January 1990 and August 1993 in two university
hospitals were included in the study. Outcome measures were spontaneous
intrauterine pregnancy (IUP) and repeat ectopic pregnancy (EP). Of the 135
patients analysed, 56 underwent conservative surgery and 79 underwent
radical surgery. Patients treated with conservative surgery achieved a
higher 3-year cumulative pregnancy rate than those treated radically (P
< 0.001, log-rank test). In patients treated conservatively, there was
only one spontaneous IUP in the period between 18 months and 3 years after
the tubal pregnancy. In contrast, patients treated radically continued to
conceive in this period. Multivariate analysis showed a fecundity rate
ratio (FRR) of 1.9 [95% confidence interval (CI): 0.91 to 3.8] for IUP
after conservative surgery in the first 18 months of follow-up. In patients
with a history of bilateral tubal disease the FRR was 3.1 (95% CI: 0.76 to
12), whereas in patients without a history of bilateral tubal disease the
FRR was 1.4 (95% CI: 0.13 to 16). The FRR for repeat EP was 2.4 (95% CI:
0.57 to 11). Our data indicate a beneficial effect of conservative surgery
towards subsequent fertility that was not, however, statistically
significant in the multivariate analysis. In view of these inconclusive
data and the importance of this major health problem, randomized studies
are required to assess whether conservative surgery really improves the
fertility prospects of patients with tubal pregnancy.
ARTICLES
Fertility after conservative and radical surgery for tubal pregnancy
Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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