Fertility Outcomes after Medical and Surgical Management of Tubal Ectopic Pregnancy

Abstract

and gynecology, division of reproductive endocrinology and infertility, inonu university Faculty of medicine, malatya, turkey SummAry -The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (eP). information on patients treated in our hospital between 2013 and 2014 for eP was retrieved from the computerized patient records. data on whether these patients achieved pregnancy after eP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. in addition to descriptive analysis, the χ 2 -test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after eP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with eP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.

Ectopic Pregnancy: An Overview

“…Available evidence suggests that medical management does not have a negative impact on fertility or future conception probability, not influencing ovarian reserve [42]. Some authors have even found no difference between surgical or medical approach regarding fertility preservation [43]. MTX administration can be systemic or even local under ultrasound guidance, but in a study by Koch et al [27] has been reported that b-hCG clearance is longer when administered locally.…”

Treatment Management of Tubal Ectopic Pregnancy: A 4-Year Retrospective Single Center Experience

“…The literature suggests that there is no difference between the odds of pregnancy formation after medical and surgical treatment for ectopic pregnancy. 22,23 As a limitation of our study, the probabilities of pregnancy formation after treatment were not assessed.…”

Overview of ectopic pregnancy diagnosis, management, and innovation

“…Evidence in literature suggests initial β-hCG levels greater or less than 1500 mIU/mL may provide a method to inform expectant management versus MTX treatment for specific types of EP. 41 , 42 Research has shown that IM MTX injections for patients with confirmed tubal EPs did not result in significantly different outcomes when compared to placebo, especially for clinically stable women with β-hCG < 1500 mIU/mL. 43 Patients with β-hCG > 1500 mIU/mL, however, did have statistically significant changes and negative pregnancy tests after MTX injection compared to placebo.…”

“…Studies such as the DEMETER trial have shown that fertility rates between medical treatment and conservative surgery are not significantly different. 42 , 44 A recent trial exploring the effectiveness of laparoscopic partial tubal resection with end-to-end anastomosis found significantly higher postoperative fallopian tube patency compared to controls. 45 There was no significant difference between ovarian function, operation time, intra blood β-hCG recovery time, and hospital time compared with the control group.…”