title: Optimal treatment for patients with ectopic pregnancies and a history of fertility-reducing factors.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Women's University Hospital, Tübingen University, Calwerstrasse 7, Tübingen, Germany. sven.becker@med.uni-tuebingen.de
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
authors.forename: Erich
authors.initials: E
authors.lastname: Solomayer
authors.forename: René
authors.initials: R
authors.lastname: Hornung
authors.forename: Raffael
authors.initials: R
authors.lastname: Kurek
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Banys
authors.forename: Babur
authors.initials: B
authors.lastname: Aydeniz
authors.forename: Heiko
authors.initials: H
authors.lastname: Franz
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012422:Rupture, Spontaneous / Q000601:surgery*; D058994:Salpingectomy; D016896:Treatment Outcome; D055815:Young Adult