Study question: How does long-term reproductive prognosis among women whose first pregnancy is ectopic differ from prognosis in women with other initial pregnancy outcomes?
Summary answer: Women with a first recorded ectopic pregnancy (EP) have a significantly lower long-term delivery rate and a manifold increased risk of further EPs.
What is known already: Women with a first EP have an increased risk of further EPs. Few studies have assessed long-term reproductive outcomes after an EP, and none was controlled.
Study design: The study was designed as a historical controlled cohort study.
Materials and methods: Data were collected from four Danish registries covering the period 1977-2009. Women with an EP as their first recorded pregnancy during the period 1977-1982 were age matched with women whose first recorded pregnancy was a miscarriage, an induced abortion, a delivery, or women with no recorded pregnancies, respectively. The cohorts were followed until the end of 2009 or on average through 30 years.
Main results: When compared with women with a first miscarriage, women with a first EP had a relative risk of deliveries of 0.55 [95% confidence interval (CI) 0.52-0.58], miscarriages of 0.46 (0.41-0.52) and induced abortions of 0.72 (0.65-0.80) and a 4.7 (3.8-5.8)-fold increased risk of further EPs. The relative delivery rate when compared with women with a first induced abortion was 0.89 (0.84-0.95) and with women with no pregnancy 0.69 (0.65-0.72).
Limitations: We had no information about the attempts to become pregnant in the different cohorts. New fertility techniques may have improved the prognosis among women with a first EP.
Wider implications of the findings: These results indicate that fertility is compromised in women whose first pregnancy is ectopic. It is possible that better assisted reproductive techniques that have been developed in recent years could improve the long-term delivery rates for women with EP.
Study funding: All the expenses were covered by Gynaecological Clinic, Rigshospitalet. Ø.L. has within the last 3 years received honoraria for speeches in pharmacoepidemiological issues. L.L.K., P.E. and C.W.S. had no conflict of interest to declare.