Fertility Outcome After Conservative Surgical Treatment of Ectopic Pregnancy Evaluated in a Randomized Trial

Objective: To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy.

Design: A randomized trial versus laparotomy was performed between May 1987 and June 1989.

Setting: The study was conducted in a clinical university center, the Sahlgrens Hospital.

Patients: A group of 105 patients with tubal pregnancy were stratified with regard to risk determinants and age and randomized to laparoscopy or laparotomy. Eighty-seven patients who desired pregnancy were evaluated for subsequent fertility outcome.

Interventions: Linear salpingotomy was performed in both surgical groups.

Main Outcome Measure: We evaluated the fertility outcome after laparoscopic salpingotomy for comparison with the outcome after laparotomy.

Results: There was no difference between the groups in the overall fertility outcome. A substantially higher proportion of patients in the laparotomy group were subjected to adhesiolysis performed at a second-look laparoscopy.

Conclusions: The fertility prospects are not impaired by laparoscopic surgery. Adhesiolysis at a second-look laparoscopy, especially after laparotomy, might be beneficial in selected cases and may serve to improve subsequent fertility.