Fertility prospects following ectopic pregnancy

Preserving a fallopian tube following an ectopic pregnancy seems like it would favor a woman's fertility prospects, right?

A new study from Wake Forest Baptist Medical Center looked at pregnancy outcomes in regards to the two surgical treatments for ectopic pregnancy—salpingectomy, in which the affected fallopian tube is removed, or salpingotomy, in which the tube is preserved.

The aim of the study, said co-author Tamer Yalcinkaya, M.D., a reproductive endocrinologist at Wake Forest Baptist, was to assess whether salpingotomy would improve rates of subsequent pregnancy by natural conception compared with salpingectomy.

"In women with a tubal pregnancy and a healthy opposite tube, salpingotomy does not significantly improve fertility prospects compared with salpingectomy," Yalcinkaya said. "We have pondered what we should do, but it's never been studied. This study provides an answer—saving the fallopian tube does not show any improved benefit."

The research was published last month in The Lancet.

The study found that ongoing pregnancy by natural conception was about 61 percent after salpingotomy and 56 percent after salpingectomy. If the opposite tube is normal, doctors can now just remove the tube out which is a quicker procedure, less complex and invasive and eliminates the persistence of another occurring ectopic pregnancy, Yalcinkaya said. Persistent growth of pregnancy tissue occurred more frequently in the salpingotomy group than in the salpingectomy group, the study reports.

Ectopic pregnancy affects 3 percent of all pregnancies and is one of the leading causes of maternal death, but the surgical treatment choices have never been compared head to head, he said.

Yalcinkaya and colleagues conducted a multicenter, international, randomized controlled trial of women aged 18 years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube. A total of 446 women were randomly assigned to receive salpingotomy (215) or salpingectomy (231) from 2004 to 2011. Forty-three (20 percent) women in the salpingotomy group were converted to salpingectomy during the initial surgery because of persistent tubal bleeding, the study said.

Repeat ectopic pregnancy occurred in 18 women (8 percent) in the salpingotomy group and 12 (5 percent) women in the salpingectomy group, the study reports.The number of ongoing pregnancies after ovulation induction, intrauterine insemination, or IVF did not differ significantly between the groups.

Yalcinkaya said his team's meta-analysis, which included their own results and those of one other study, substantiated the results of the trial.