title: Fertility after tubal ectopic pregnancy: results of a population-based study.
abstract: OBJECTIVE
  To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility.
  
  
  METHODS
  Observational population based-study.
  
  
  METHODS
  Regional sistry.
  
  
  METHODS
  One thousand sixty-four women registered from 1992 to 2008.
  
  
  METHODS
  Laparoscopic (radical or conservative), or medical treatment.
  
  
  METHODS
  Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence.
  
  
  RESULTS
  The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy.
  
  
  CONCLUSIONS
  Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.
authors: Department of Obstetrics and Gynecology, Pôle de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France.
authors: Marianne
authors: M
authors: de Bennetot
authors: Benoît
authors: B
authors: Rabischong
authors: Bruno
authors: B
authors: Aublet-Cuvelier
authors: Fabien
authors: F
authors: Belard
authors: Hervé
authors: H
authors: Fernandez
authors: Jean
authors: J
authors: Bouyer
authors: Michel
authors: M
authors: Canis
authors: Jean-Luc
authors: JL
authors: Pouly
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000022:Abortion, Spontaneous / Q000453:epidemiology; D000032:Abortion, Therapeutic; D005260:Female; D005298:Fertility; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D050498:Live Birth; D008727:Methotrexate / Q000627:therapeutic use; D015999:Multivariate Analysis; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D058994:Salpingectomy; D012489:Salpingostomy; D013997:Time Factors; D061685:Time-to-Pregnancy; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate