History of induced abortion and the risk of tubal pathology

Tubal pathology is a common cause of subfertility. Identifying risk factors for tubal pathology in the medical history is important to distinguish between those couples who benefit from early tubal patency tests and those in whom presence of tubal pathology is less likely and delaying tubal tests is justified. This study evaluated whether a medical history of induced abortion is associated with an increased risk of tubal disease among subfertile couples. The reproductive history was determined for each couple. Tubal disease was diagnosed by hysterosalpingography and/or diagnostic laparoscopy. The association between reproductive history and the presence of tubal disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI). Data from 6149 couples were available for analysis. The OR for tubal pathology after a previous induced abortion was 1.6 (95% CI 1.3 to 1.9), after a previous ectopic pregnancy, 8.4 (95% CI 6.3 to 12), after a previous spontaneous miscarriage, 1.1 (95% CI 0.87 to 1.3), and after a previous live birth, 1.0 (95% CI 0.88 to 1.2). A history of induced abortion is associated with an increased risk of tubal pathology in subfertile couples. As a consequence, in subfertile women with a history of induced abortion, tubal patency tests should be considered early in the diagnostic work-up.