A clinical dilemma for fertility preservation in a woman with unilateral salpingectomy followed by contralateral ruptured ectopic pregnancy. A case report.

INTRODUCTION

An ectopic pregnancy (EP) occurs when the blastocyst implants outside the endometrial lining of the uterine cavity. The loss of fertility poses a dilemma in the radical treatment of ruptured ectopic pregnancy. This case report is presented in line with the SCARE criteria.

CASE PRESENTATION

A 36-year-old woman, G3P1 + 1 L1, at 8 weeks of gestation, presented with lower abdominal pain that was localized in the left iliac region. The pain was not associated with per vaginal spotting or bleeding. Pelvic ultrasonography revealed a significant fluid collection in the pouch of Douglas. A left salpingectomy was performed.

DISCUSSION

A history of one ectopic pregnancy increases the risk of a subsequent EP by approximately 10 %, while having more than one previous ectopic pregnancy raises the risk to around 25 %. In communities where reproduction is believed to be an essence of womanhood, the loss of fertility carries serious socio-cultural consequences. These include not only external stigma but also internalized self-stigma that presents a significant dilemma when considering definitive treatment for a recurrent contralateral ruptured EP in a patient with a prior salpingectomy, particularly in low-resource settings, where IVF-ET and egg/embryo freezing are costly or unavailable. Surgical management of recurrent EP does not significantly impact the outcomes of IVF-ET.

CONCLUSION

A patient who refuses salpingectomy after a recurrent ruptured EP faces a dilemma between preserving autonomy and preventing potentially life-threatening complications. A comprehensive approach should include discussions about alternative fertility options, patient education, psychological support, and ensuring that all decisions are fully informed.