Fertility Prospects After Tube Removal for Ectopic Pregnancy

In women with ectopic pregnancy and a healthy contralateral tube, saving the affected fallopian tube does not significantly improve fertility prospects, according to recent research published in The Lancet. 

Researchers from Wake Forest Baptist Medical Center studied 446 women who were randomly assigned to salpingotomy (n=215), preserving the tube, or salpingectomy (n=231), removing the tube, between 2004 and 2011. Salpingotomy is often considered the preferred method, because it has been thought that a woman having both fallopian tubes makes her more likely to have favorable fertility prospects. 

Pertinent Points

- In women with a tubal pregnancy and a healthy contralateral tube, salpingotomy does not significantly improve fertility prospects when compared with salpingectomy.

- Physicians should consider the less complicated salpingectomy for ectopic pregnancy.

The cumulative ongoing pregnancy rate was 60.7% after salpingotomy and 56.2% after salpingectomy (fecundity rate ratio, 1.06; 95% CI, 0.81-1.38; log-rank P=0.678).

The finding means that if the opposite tube is normal, physicians can simply remove the tube, which is a quicker and less complex procedure than preserving the tube, and still eliminate the persistence of another occurring ectopic pregnancy, said coauthor Tamer Yalcinkaya, MD, a reproductive endocrinologist at Wake Forest Baptist, in a news release.

The study also found that persistent growth of pregnancy tissue occurred more frequently in the salpingotomy group than in the salpingectomy group (14 [7%] vs 1 [<1%]; RR, 15.0; 95% CI, 2.0-113.4). In addition, 8% of women in the salpingotomy group and 5% of women in the salpingectomy group had repeat ectopic pregnancy (RR, 1.6; 95% CI, 0.8-3.3). Finally, the number of ongoing pregnancies after ovulation induction, intrauterine insemination, or IVF did not differ significantly between the groups.

Yalcinkaya said the study is the first to look at the fertility prospects following the two procedures in a head-to-head comparison.