FERTILITY AFTER RADICAL SURGERY FOR TUBAL PREGNANCY

Objective: To evaluate fertility after salpingectomy performed for ect opic pregnancies (EPs). Design: Retrospective cohort study. Setting: T ertiary care university hospital. Patient(s): Three hundred forty pati ents (213 with surgery by laparoscopy and 127 by laparotomy) between J anuary 1985 and July 1994, with a mean follow-up period of 73 months ( 36-162 months). Intervention(s): Salpingectomy performed either by lap arotomy or by laparoscopy as indicated. Main Outcome Measure(s): Rate of intrauterine pregnancy (IUP), live births, and recurrent EP. Result (s): Forty-seven (13.8%) patients were lost to follow-up, and 68 (20%) did not want to become pregnant. The overall rate of spontaneous conc eption was 70.4% in the laparoscopy group and 53.2% in the laparotomy group. The rate of live births was 50% and 37%, respectively; the mean time until conception was 11 and 17.2 months; and the rate of recurre nt EP, 10.6% and 9.6%. The multivariate analysis showed a rate of IUP of 82.1% among women younger than 30 years of age with a normal contra lateral tube, laparoscopic surgery, and no history of infertility. Con clusions: In this study of fertility after salpingectomy for EP, lapar oscopic treatment was superior to laparotomic treatment. Fertility was equivalent to that after conservative treatment in a subgroup of youn g patients treated with laparoscopy and with no history of tubal patho logy. (Fertil Steril(R) 1998;70:680-6, (C) 1998 by American Society fo r Reproductive Medicine.).