Study
Type of study
Medical treatment
Conservative surgery
HR
p
n
Spontaneous IUPa rate (%)
n
Spontaneous IUPa rate (%)
De Bennetot et al. [12]
Prospective observational (registry)
119
76 (0.65–0.85)
646
76 (0.73–0.80)
1.07 (0.84–1.36)
Dias Pereira et al. [16]
Randomized trial
34
36
40
43
0.89 (0.42–1.9)
Zilber et al. [17]
Randomized trial
16
81
18
83.5
0.99
Fernandez et al. [18]
Randomized trial
27
96.3
29
62
< 0.05
Fernandez et al. [19]
Randomized trial
87
71
82
67
0.85 (0.59–1.22)
0.37
In the Demeter trial, the rates of recurrent tubal pregnancy were 12 % after medical management and 9 % after conservative surgery (p: nonsignificant) [19]. Similar findings were found in the Auvergne registry [12]. The study demonstrates that subsequent fertility after medical therapy or conservative surgery in this group of patients is comparable.
Symptomatic Tubal Pregnancy
In this group of patients, a surgical management is required and it could be either conservative (salpingostomy) or radical surgery (salpingectomy). The best data comparing fertility rate after salpingostomy or salpingectomy come from the registry and the two randomized trials computed for fertility analyses.
The Auvergne registry reported a higher crude cumulative intrauterine pregnancy rate after salpingostomy (76 %) than after salpingectomy (67 %; p < 0.05) [12]. However, in a multivariate analysis, no significant difference between the treatments was found. In the subgroups of women with a history of infertility, tubal disease or age > 35 years, radical surgery led to lower intrauterine pregnancy rate than conservative surgery (hazards ratio (HR) = 0.67 (0.50–0.91)). In this study, conservative surgery was performed for patients with both symptomatic and nonsymptomatic ectopic pregnancy.
Two recent randomized trials compared fertility rate after conservative and radical surgery. In the first study, 63 women were in the conservative surgery group and 66 others in the radical surgery group. There was no significant difference between the two groups in the 2-year intrauterine pregnancy rates (70 % versus 64 %, p: nonsignificant) [19].
The second randomized trial included 446 women (215 in the conservative surgery group and 231 in the radical surgery group). The 3-year intrauterine spontaneous pregnancy rate was 60.7 % after conservative surgery and 56.2 % after radical surgery (p: not significant) [20]. Table 21.2 shows pregnancy rates after conservative versus radical surgical treatments .
Table 21.2
Spontaneous intrauterine pregnancy rate after conservative (salpingostomy) or radical surgical management (salpingectomy)
Study | Type of study | Conservative surgery | Radical surgery | HR | p | ||
|---|---|---|---|---|---|---|---|
n | Spontaneous IUPa rate (%) | n | Spontaneous IUPa rate (%) | ||||
De Bennetot et al. [12] | Prospective observational (registry) | 646 | 76 (0.73–0.80) | 299 | 67 (0.61–0.74) | 0.78 (0.66–0.93) | |
Fernandez et al. [19] | Randomized trial | 63 | 70 | 66 | 64 | 1.06 (0.69–1.63) | 0.77 |
Mol et al. [20] | Randomized trial | 215 | 60.7% | 231 | 56.2
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