There is an increased chance of tubal pregnancy after tubal repair by tubal reversal, salpingostomy or lysis of adhesions and with salpingitis isthmica nodosa.  This chance is higher if there was a previous tubal pregnancy.  When IVF is reasonable, removing the tubes may be a better answer than saving them when tubal pregnancy occurs..

Close monitoring is needed to diagnosis tubal pregnancy.  This can include two or more blood pregnancy tests at 2 to 3 weeks and one or more sonograms at 3 to 3.5 weeks.

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Case History:

Tubal pregnancy treated with methotrexate 1998

D & C for miscarriage 2000

15 or more months of clomiphene 2001 - 2002

Positive Chlamydia Trachomatis IgG but negative IgM and DFA 2003 compatible with past infection but no recent activity.  The infection probably happened before the tubal pregnancy in 1998.

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Laparoscopy with left salpingostomy and right fimbrioplasty 2003

Both tubes were thickened neat the uterus (cornua) suggestive of salpingitis isthmica nodosa.  Fitz Hugh Curtis adhesions, psammoma bodies and  endosalpingiosis were present.  The ends of the tubes were opened and  the fimbriae (fingers) were blunted.