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Subsequent Fertility Rates Similiar, Regardless of Ectopic Pregnancy Treatment
March 13, 2013
A new study published by Dr. Perrine Campas and colleagues in the March 13, 2013 edition of the journal Human Reproduction, compared fertility outcomes after treating ectopic pregnancy with methotrexate injection, salpingostomy which preserves the fallopian tubes, or salpingectomy (Fallopian tube removal). This study is the first randomized trial of its kind, designed to compare treatments for ectopic pregnancy and subsequent fertility. Results indicate that post-treatment fertility rates to be similar whether patients experience low risk ectopic pregnancy or high risk ectopic pregnancy, and regardless of the type of treatment recommended per the severity of the ectopic pregnancy.
Scientists from 17 research centers, which make up the Groupe de Recherche en Gynécologie et Obstétrique, examined data from ectopic pregnancies between 2005 and 2009. Over 400 women were studied in two groups: those with low risk ectopic pregnancy, and those with high risk ectopic pregnancy. Just over 200 women in the first group underwent either methotrexate injection or less invasive surgery, while another 200 women in the second group underwent either less invasive surgery or Fallopian tube removal. The researchers discovered no significant difference in the fertility of women who underwent injection or conservative surgery, or women who underwent conservative surgery or Fallopian tube removal. The two groups were not compared to one another due to the severity of some cases which required aggressive surgery.
Within two years after the initial ectopic treatment, rates of spontaneous, non-ectopic pregnancy were 67% for those who experienced low risk ectopic and received the methotrexate injection, 71% for those who experienced a low risk ectopic and underwent conservative surgery, 70% for those who experienced high risk ectopic and underwent conservative surgery, and 64% for those who experienced high risk ectopic and Fallopian tube removal.
The results suggest that patients presenting with ectopic pregnancy should be treated with the medical or surgical therapy appropriate for the severity of the case. Methotrexate injections should be the preferred therapy for low risk ectopic pregnancies simply to prevent a patient from undergoing surgery unnecessarily. High risk ectopic pregnancies should be evaluated on a case-by-case basis and patients should be informed of the benefits and risks of conservative or aggressive surgical treatment.
This data allows fertility doctors to provide greater information to fertility patients being treated for ectopic pregnancy and provides hope to patients looking to conceive after an ectopic pregnancy.