Ectopic Pregnancy and Infertility
An ectopic pregnancy is a medical emergency in which a fertilized egg implants itself outside of the uterus, most often in the fallopian tubes. The embryo in such a pregnancy must be removed to save the mother's life. At any rate, there is no chance that the embryo can live in its chosen environment.
There may be no choice but to sacrifice the entire fallopian tube, but if you have a choice, choose a procedure in which the embryo is removed through an incision in the tube. This provides you with the highest chance of having a viable pregnancy in the future. If this is not possible, you may be able to have only a part of the tube removed with the stump left open rather than sutured closed. This means an egg might still be able to travel down the tube into the uterus.
*If you must have both tubes removed or sutured shut, the only way you will be able to conceive is via IVF.
Some statistics on future fertility after an ectopic pregnancy:
*Careful surgery in the case of small, unruptured ectopic pregnancies can preserve the function of the fallopian tubes more than 80% of the time.
*Normal, intrauterine pregnancies follow ectopic pregnancies at a ratio of 6:1, but if one tube is unaffected the ratio rises to around 10:1.
*The subsequent delivery rate after one ectopic pregnancy and conservative tube-sparing surgery is 55-60%, the recurrence of tubal pregnancies is about 15%, and the rate of infertility is 25-30%.
*If the second tube is nonexistent or blocked, the subsequent rate of delivery is from 45-50%, the recurrence of tubal pregnancies is about 20%, and the infertility rate is from 30-35%.
*After 2 or more tubal pregnancies and conservative surgeries the subsequent delivery rate is around 30%, recurrent ectopic pregnancies at 20-30%, with the infertility rate at 40-50%.
*The greater the number of recurrent ectopic pregnancies, the less likely it is that a woman will deliver a baby without fertility treatment.
*An ectopic pregnancy is as likely to occur in a tube that was saved during surgery as in the unaffected tube.
*Salpingostomy, the saving of a tube, and salpingectomy, the removal of a tube, in cases where there is no history of infertility and the second tube is normal give similar delivery rates.
*In a case where the other tube is diseased and there is a history of female infertility, the salpingostomy gives a higher ratio in favor of delivery: 76% vs. 44% according to one study, but also comes with a higher risk of recurrent ectopic pregnancy.
Make sure that your doctor knows of your wish to become pregnant before he operates, if at all possible.