Pregnancy: Determinants of reproductive prognosis after ectopic pregnancy

Abstract

The reproductive prognosis of 115 women desiring pregnancy who underwent surgery for ectopic pregnancy between 1985 and 1990 at the Clinica Luigi Mangiagalli, was analysed after a median follow-up period of 26 months (range 2-83). Probability of reproductive events was assessed by a product-limit model. Women who underwent surgery for ectopic pregnancy had a 54% probability of becoming pregnant (cumulative pregnancy rate, CPR), and a 36% probability of giving birth to a child (cumulative livebirth rate, CLB) during the 3 years after surgery. These percentages dropped with history of previous ectopic pregnancy (respectively 33%, P = 0.07, and 7%, P < 0.05). Increasing age at surgery and presence of adhesions in the contra-lateral tube seemed to be associated with poor reproductive prognosis (CPR = 40% and CLB = 12% for women aged > or = 35 years and CPR = 37% and CLB = 20% in women with adhesions in the contralateral tube), but these findings were not statistically significant. No association emerged between fertility and parity or type of surgery. The recurrence rate of ectopic pregnancy was 20%. No significant association emerged between recurrence of ectopic pregnancy and age, history of previous pregnancy, history of previous ectopic pregnancy, non-intact contra-lateral tube and salpingotomy.

ORIGINAL ARTICLE: Circulating Antibodies to a Conserved Epitope of the Chlamydia Trachomatis 60‐kDa Heat Shock Protein is Associated with Decreased Spontaneous Fertility Rate in Ectopic Pregnant Women Treated by Salpingectomy

“…Impaired reproductive performance after EP is evident from decreased fertility and high EP recurrence rates 4–6 . Functional status of the remaining Fallopian tube after the first episode of EP is generally accepted as the major determinant of subsequent spontaneous conception 5,7,8,9 .…”

Reproductive outcome after treatment of ectopic pregnancy with local injection of hypertonic glucose

“…Scand 76 (1997) Other investigators have found that fertility after treatment for ectopic pregnancy is unrelated to the characteristics of the ectopic pregnancy (size, rupture, location) (1,6,7) or the procedure performed (7)(8)(9), but related to other factors such as a history of infertility, previous abdominal surgery, and the status of the contralateral tube (8,10,11). In contrast, we found a better fertility outcome in patients with smaller size of the ectopic pregnancy, shorter gestational age, lower hCG level at admission, and with shorter time for elimination of hCG.…”

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“…[15] Therefore, AMH level is accepted as a more reliable and objective indicator of ovarian reserve, compared with traditional measures such as FSH level and antral follicle count (AFC). [16] Some studies have reported decreased fertility outcome following EP treatment (17,18). Job-Job-Spira et al followed up the EP treatment outcomes and reported a post-treatment fertility rate of about 66% among the treated women.…”

“…[17] The main reasons that can explain the decreased fertility rate after treatment of EP include age higher than 35 years, tubal abnormality, low socioeconomic state, adnexal adhesion, history of ruptured EP, and type of treatment(medication v/s surgery). [18,19] In a prospective randomized clinical trial, Fernandez et al compared the efficacy of MTX treatment with salpingectomy on subsequent fertility in the women with EP and concluded that MTX is as efficient as laparoscopic salpingectomy surgery in improving subsequent fertility. [20] However, in other study conducted by Fernandez et al, no significant difference in subsequent fertility was reported between MTX and surgical treatments.…”