title: The risk of ectopic pregnancy following tubal reconstructive microsurgery and assisted reproductive technology procedures.
abstract: OBJECTIVE
  The incidence of ectopic pregnancy (EP) in the general population is 2%, whereas the EP rate following assisted reproductive technologies (ART) is between 2.1 and 11%. EP is also an adverse effect of tubal surgery with incidences up to 40% depending on the type, location, and severity of tubal disease and the surgical procedure.
  
  
  METHODS
  This paper looks at the incidence of EP following tubal reconstructive microsurgery, analyzes risk factors for EP following own 1,295 ART cycles and looks on the incidence of EP in 128,314 pregnancies following ART according to the presence or absence of tubal infertility using data from the German IVF Registry (DIR).
  
  
  RESULTS
  In our clinic, the EP rate following resterilization was 6.7%. In the presence of acquired tubal disease, the EP rate following adhesiolysis, salpingostomy, salpingoneostomy, fimbrioplasty, and anastomosis was 7.9%. The EP rate following ART in our clinic was 5.6%. Previous abdominal surgeries, microsurgical procedures, hydro-/sactosalpinges, salpingitis, salpingitis isthmica nodosa, and periadnexal adhesions showed a significant positive correlation with EP as outcome. Data of DIR demonstrate a significantly increased incidence of EP in the presence of tubal pathology. The highest EP rate related to all clinical pregnancies was 4.5% (95% CI 3.0-6.0) in smoking women <30 years with tubal pathology following IVF.
  
  
  CONCLUSIONS
  In the presence of tubal infertility, the incidence of EP following ART and tubal microsurgery are approximately comparable with each other and higher than in women without tubal infertility. The success of infertility surgery depends on a careful selection of appropriate patients.
authors.affiliation: Division of Reproductive Medicine, Department of Gynecology and Obstetrics, Medical School of Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Schippert.Cordula@mh-hannover.de
authors.forename: Cordula
authors.initials: C
authors.lastname: Schippert
authors.forename: Philipp
authors.initials: P
authors.lastname: Soergel
authors.forename: Ismini
authors.initials: I
authors.lastname: Staboulidou
authors.forename: Christina
authors.initials: C
authors.lastname: Bassler
authors.forename: Susanne
authors.initials: S
authors.lastname: Gagalick
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.forename: Klaus
authors.initials: K
authors.lastname: Buehler
authors.forename: Guillermo-José
authors.initials: GJ
authors.lastname: Garcia-Rocha
mesh_terms: D000328:Adult; D005184:Fallopian Tube Diseases / Q000601:surgery*; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000601:surgery; D008866:Microsurgery; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology / Q000209:etiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D012907:Smoking / Q000009:adverse effects; D013243:Sterilization Reversal / Q000009:adverse effects*; D055815:Young Adult