Fertility after ectopic pregnancy - Effects of surgery and expectant management

OBJECTIVE: To evaluate the effects of different manage ment strategies for ectopic pregnancy on fertility. STUDY DESIGN: Retrospective cohort study of 180 consecutive patients who we re diagnosed with ectopic pregnancy between September 1988 and December 199 5. The fertility rate after ectopic pregnancy treated with surgery was comp ared with that after expectant treatment. Statistical analy sis took into c onsideration the following confounding variables: history of sterility, inf ertility, ectopic pregnancy, use of intrauterine device, endometriosis, pel vic inflammatory disease or pelvic surgery prior to ectopic pregnancy, and type of therapy for ectopic pregnancy. RESULTS: Off he 180 women enrolled in the study, 97 desired conception. The intrauterine conception rate was similar in those initially treated expect antly as in those allocated to primary surgery (63% [31/49] vs. 51% [19/37] , P=.37). Successful completion of expectant management was associated with rates of subsequent intrauterine pregnancy similar to those of surgical tr eatment (including primary surgery and surgery after failure of expectant m anagement) (65% [22/34] vs. 54% [28/52], P=.44). Women undergoing delayed s urgery due to failure of expectant management had rates of subsequent intra uterine conception similar to those who underwent primary surgery (9/15 vs. 19/37, P=.79). Several anamnestic factors had a significant and adverse ef fect on reproductive outcome: history of infertility (P =.01), history of e ctopic pregnancy (P=.02) and previous pelvic surgery (P =.001). CONCLUSION: Expectant and surgical management of ectopic pregnancy had simi lar subsequent intrauterine conception rates, even when failure of expectan t management led to secondary surgery. Gynecologic history can identify the subgroup of patients at higher risk of a poor reproductive outcome.