Return of reproductive performance after expectant management and local treatment for ectopic pregnancy

Abstract

The purpose of this study was to examine hysterosalpingographic findings and reproductive performance in patients previously managed non-surgically for ectopic pregnancy. Forty-nine patients with unruptured ectopic pregnancies were treated either by expectant management (n = 16) or medically (n = 33), using transvaginal methotrexate or sulprostone injection. The treatment was successful in 35 patients (71.5%), 12 out of 16 and 23 out of 33 in the two groups respectively. For all patients, follow-up currently varies from 3 to 52 months with a median follow-up of 16.6 +/- 11.2 months and 7.3 +/- 4.3 months in the two groups respectively. Hysterosalpingography was performed in 25 out of 26 patients who desired further pregnancy. We found evidence of tubal patency on the ectopic pregnancy treated side in 23 cases (92%). In this group, no recurrent ectopic pregnancy was observed. In the expectant management group, eight out of nine patients became pregnant, and the mean time to achieve pregnancy was 16.6 +/- 11.2 months. In the medical treatment group, eight out of 17 patients became pregnant and the mean time to achieve pregnancy was 8.6 +/- 4.2 months. In this last group, seven out of nine non-pregnant patients have had only a short follow-up, 4.5 +/- 3.2 months since treatment completion. No recurrent ectopic pregnancy was observed in this successfully treated group of patients who desired further pregnancy. We conclude that the medical approach to unruptured ectopic pregnancy is associated with a high rate of tubal patency and a reproductive performance similar to conservative surgical methods.

Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility

“…When appropriate inclusion criteria are used (Fernandez et al, 1991a), methotrexate failure rates have been similar to those reported in previous series of laparoscopic surgery (Pouly et al, 1986;Seifer, 1997). Moreover, follow-up and reproductive outcomes have been similar in both treatments (Pouly et al, 1986;Fernandez et al, 1991bPansky et al, 1993;Stovall and Ling et al, 1993). The simplicity and the results of this non-surgical approach demanded further investigation.…”

“…When an ectopic pregnancy was visualized by transabdominal or transvaginal ultrasound, the patient was evaluated to determine her suitability for medical treatment (Fernandez et al, 1991b). This pretherapeutic score is based on six criteria graded on a scale from 1 to 3: gestational age, HCG and progesterone concentration, abdominal pain, haemoperitoneal volume, and diameter of the haematosalpinx, both the latter assessed by ultrasound.…”

Fertility outcomes following expectant management of tubal ectopic pregnancy

“…The rate of intrauterine pregnancies of 83.7% was similar to the findings of previously published studies, which reported intrauterine pregnancies in 65–89% of women following expectant management of tubal ectopics4–7. The cumulative 3‐year intrauterine pregnancy rate after salpingectomy was 46%, which was comparable to the rate of 38% published by Mol et al in 19982.…”

“…Expectant management is not often used in clinical practice and all studies published so far included a relatively small number of patients4–9 (Table 1). The aim of our study was to assess reproductive outcomes following expectant management of ectopic pregnancy in a large number of patients treated in a single center.…”

Does tubal ectopic pregnancy with hemoperitoneum always require surgery?

“…Without that evidence, practice can only be based on small observational studies. There is observational evidence to suggest that the avoidance of surgery may be associated with a decreased recurrent ectopic pregnancy rate, and slightly improved future intrauterine pregnancy rates31–36. Needless to say, conservative management is free from operative laparoscopy and anesthetic risks.…”