Only about 3% of all pregnancies are ectopic (or tubal) pregnancies, where the fertilized egg implants and begins to grow in a fallopian tube rather than in the uterus. The numbers may be small but the consequences are not. Ectopic pregnancy is one of the main causes of death during pregnancy and fertility is at stake for survivors. Of the two treatment options for ectopic pregnancy, Dr. Tamer Yalcinkaya says there’s been much conversation about which is preferred, but little (if any) comparative study of outcomes.
Yalcinkaya, a reproductive endocrinologist, sought to change that lack of study. He and his colleagues at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, explored the reproductive outcomes of 446 women for 36 months after getting one of two treatments for ectopic pregnancy:
- Salpingotomy:Removes the implanted tissue but leaves the fallopian tube intact
- Salpingectomy: Removes the tube as well as the implanted tissue
The Yalcinkaya study is described as “open-label, multicentre, international, randomized (and) controlled” in order to get a study group that represents the broadest segment of the global population without including details that might influence the research team. The study group was comprised of 446 women 18 years or older, each of whom had a tubal pregnancy confirmed by laparoscopic examination and a healthy fallopian tube not affected by the tubal pregnancy. The women were randomly assigned surgical treatment as follows:
- Salpingotomy: 215
- Salpingectomy: 231
During initial surgery, 43 study participants scheduled for salpingotomy (tubal preservation) were converted to salpingectomy patients due to persistent bleeding at the surgical site.
Each woman was diagnosed between 2004 and 2011; follow-up study was continued until 2013.
The primary objective of the research team was to identify future pregnancies by natural conception occurring within 36 months of surgery. Additional outcomes tracked by the study team included repeat ectopic pregnancy and outcomes of pregnancy achieved via assisted reproductive technologies (ART). The Yalcinkaya research was combined with the findings of a similar study to strengthen the findings of each.
The Yalcinkaya study revealed there was no substantial difference in the positive outcomes of future ART pregnancies between the two groups. The study also found:
Salpingotomy
- 18 women (8%) of the salpingotomy group experienced repeat ectopic pregnancies
- 61% became pregnant by natural conception
Salpingectomy
- 12 women (5%) of the salpingectomy group experienced repeat ectopic pregnancies
- 56% became pregnant by natural conception
Yalcinkaya concludes sparing the fallopian tube (salpingotomy) does not significantly improve a woman’s chances for future non-ectopic pregnancies. Furthermore, tubal removal is less invasive, less complicated, quicker, and significantly reduces the possibility of future ectopic pregnancies.
Source: Yalcinkaya, Tamer M, MD, et al. “Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial (abstract).” The Lancet. Elsevier Limited. Feb 3, 2014. Web. Mar 13, 2014.