Repeated Ectopic Pregnancy after Unilateral or Bilateral Salpingectomy in Assisted Reproductive Technology
Abstract
Embryo implantation occurs at the fallopian tubes, namely tubal pregnancy, is the major pattern of ectopic pregnancy. Laparoscopic salpingectomy and salpingotomy are the common ways to treat tubal pregnancies based on the damage degree of the tubes. Repeated ectopic pregnancies after unilateral or bilateral salpingectomy are rare reported but not uncommon in assisted reproductive technology (ART). This case report presents three women have had unilateral/bilateral laparoscopic salpingectomy due to at least two previous tubal pregnancies, but they experience repeated tubal pregnancies during their ART treatment. We suggest that the gynecologists should take carefully consideration on patient’s future fertility when performing the surgical treatment on tubal pregnancies. Salpingectomy without proximal tube ligation potentially increase the risk of residual tubal pregnancy in ART treatment. Frozen blastocyst transfer might be an optimal option for those women with the history of repeated ectopic pregnancy.
Keywords: Repeated ectopic pregnancy; Tubal pregnancy; Assisted reproductive technology
Introduction
The incidence of ectopic pregnancy has increased to a level of 2% in developed countries and may seriously affect women’s health and future fertility [1]. Most of ectopic pregnancies occur in the fallopian tubes, namely tubal pregnancy. Tubal pregnancy may be life-threatening if the patients have fallopian tube rupture, heavy bleeding, or hemorrhagic shock. Tubal pregnancies can be treated by either medication or surgery. Methotrexate injection combines with mifepristone is often used to treat ectopic pregnancies that diagnosed at early stage [2]. Surgery is required when patients have viable fetus located at the fallopian tube, or at risk of tube rupture and heavy bleeding. There are two ways to remove the tubal pregnancy by laparoscopy. Salpingectomy will be performed if the damage or bleeding is severe, the affected tube will be removed with the ectopic gestational sac. However, if the damage is minimal, the ectopic gestational sac can be removed from the tube by salpingotomy and leaving the tubes in situ. However, the surgical damages may potentially cause tubal factor infertility [3].
Assisted reproductive technology (ART) has been widely applied in the treatment of infertility, especially for the women with tubal factor infertility. Patients with tubal factor infertility due to previous tubal pregnancy can be treated by in vitro fertilization and embryo transfer (IVF-ET) [4]. However, on the other hand, ART has been associated with increased ectopic pregnancy rate as high as 8.6% [5]. Repeated tubal pregnancy after unilateral/ bilateral salpingectomy is rarely reported but is not uncommon in ART. The patients suffer more painfulness and cost more expenses if they have repeated tubal pregnancy during their ART treatment. Currently, the pathogenesis of ectopic pregnancy is still unknown, and there is no effective method to prevent ectopic pregnancy.
This study presents three cases of repeated tubal pregnancy during their ART treatment. The three patients all received laparoscopic unilateral/bilateral salpingectomy or medication treatment for previous tubal pregnancies. They were diagnosed as tubal infertility, however, they experienced repeated tubal pregnancy during their IVF-ET treatment. One of the three cases had tubal pregnancy located at the right tube with previous pregnancy treated by methotrexate injection, the other two cases had tubal pregnancy located at the residual part of the tube which was removed by salpingectomy previously.
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