FERTILITY AFTER CONSERVATIVE AND RADICAL SURGERY FOR TUBAL PREGNANCY

A retrospective cohort study was set up to evaluate the effectiveness of conservative and radical surgery for tubal pregnancy towards subseq uent fertility. Consecutive patients undergoing conservative or radica l 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 pregn ancy (EP), Of the 135 patients analysed, 56 underwent conservative sur gery and 79 underwent radical surgery. Patients treated with conservat ive surgery achieved a higher 3-year cumulative pregnancy rate than th ose treated radically (P < 0.001,log-rank test). In patients treated c onservatively, there was only one spontaneous IUP in the period betwee n 18 months and 3 years after the tubal pregnancy. In contrast, patien ts treated radically continued to conceive in this period. Multivariat e analysis showed a fecundity rate ratio (FRR) of 1.9 [95% confidence interval(CT): 0.91 to 3.8] for TUP after conservative surgery in the f irst 18 months of follow-up. In patients with a history of bilateral t ubal 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 subs equent fertility that was not, however, statistically significant in t he multivariate analysis. In view of these inconclusive data and the i mportance of this major health problem, randomized studies are require d to assess whether conservative surgery really improves the fertility prospects of patients with tubal pregnancy.