The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility

BACKGROUND:
Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility.


OBJECTIVES:
Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility.


DESIGN:
Retrospective


SETTING:
Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey


PATIENTS AND METHODS:
Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group.


MAIN OUTCOME MEASURES:
Fertility rates within two years following treatment were evaluated according to treatment options.


SAMPLE SIZE:
202 patients


RESULTS:

Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment (
P
=.006 and
P
=.12, respectively). Moreover, ectopic mass size and serum β-hCG levels were significantly higher in the surgical treatment group (
P
<.001 and
P
<.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months,
P
=.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility (
P
=.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) (
P
=.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%,
P
=.72) and admittance to the IVF program (3.9% vs 6.8%,
P
=.39) following ectopic pregnancy treatment.



CONCLUSIONS:
Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility.


LIMITATIONS:
Retrospective study.