Optimal treatment for patients with ectopic pregnancies and a history of fertility-reducing factors

Publication

Optimal treatment for patients with ectopic pregnancies and a history of fertility-reducing factors

Journal Paper/Review - Nov 10, 2009

Hornung René, Becker Sven, Solomayer Erich, Kurek Raffael, Banys Malgorzata, Aydeniz Babur, Franz Heiko, Wallwiener Diethelm, Fehm Tanja

Units

Frauenklinik

Keywords

Ectopic pregnancy – Laparoscopy – Reproductive outcome – Salpingectomy – Salpingotomy – Fertility-reducing factors – Tubal preserving surgery

Link

http://link.springer.com/article/10.1007/s00404-009-1270-2

Contact

René Hornung

Citation

Hornung R, Becker S, Solomayer E, Kurek R, Banys M, Aydeniz B, Franz H, Wallwiener D, Fehm T. Optimal treatment for patients with ectopic pregnancies and a history of fertility-reducing factors. Archives of gynecology and obstetrics 2009; 283:41-45.

Type

Journal Paper/Review (English)

Journal

Archives of gynecology and obstetrics 2009; 283

Publication Date

Nov 10, 2009

Pages

41-45

Brief description/objective

With most ectopic pregnancy (EP) cases now diagnosed and treated early, a major concern has become future reproductive outcome. The aim of this study was to evaluate long-term reproductive outcome after salpingotomy versus salpingectomy in patients with and without additional fertility-reducing factors.

Methods

As part of a prospective follow-up study, 261 patients underwent laparoscopic management of EP at our institution. History was taken specifically looking at preexisting risk factors for reduced fertility. Patients were then followed with regard to future reproductive events.

Results

Of 261 patients, 196 (75%) reported a subsequent desire for pregnancy. 145 patients had undergone salpingotomy and 51 salpingectomy. In patients without prior history of fertility-reducing factors, the subsequent intrauterine pregnancy rates were >90% for both salpingotomy and salpingectomy groups irrespective of the surgical approach. In patients with preexisting fertility-reducing factors, postoperative intrauterine pregnancy rates were 75% in the salpingotomy group, but only 40% in the salpingectomy group (p < 0.05), showing maximal effect for conservative surgery.

Conclusion

Laparoscopic salpingotomy is of particular benefit for patients with additional fertility-reducing factors desirous of future pregnancy. Reproductive outcome is excellent in patients without such risk factor, irrespective of the surgical approach.