Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant m
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GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE
Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management Silvia Baggio1,2 · Simone Garzon3 · Anna Russo1 · Cesare Quintino Ianniciello1 · Lorenza Santi4 · Antonio Simone Laganà3 · Ricciarda Raffaelli1 · Massimo Franchi1 Received: 4 April 2020 / Accepted: 13 August 2020 © The Author(s) 2020
Abstract Purpose To compare fertility and reproductive outcome after surgical, medical, and expectant management for tubal ectopic pregnancy (EP). Methods 133 of 228 patients, who were managed between January 2012 and December 2017 for a tubal EP, tried to conceive immediately after treatment: 86 out of 173 (49.7%) underwent surgical treatment; 38 (21.9%) were treated with methotrexate (MTX), and 49 (28.3%) had expectant management. Clinical data were retrieved by medical records, fertility outcomes were obtained by phone follow-up. The cumulative incidence (CI) of intrauterine clinical pregnancy (CP), miscarriage, live birth (LB), and recurrent EP, and the time between treatment and first intrauterine CP were compared between women treated with MTX, surgery and expectant management. Results The CI of intrauterine CP starting from 12 months after the EP was 65.3% for the expectant management, 55.3% for the MTX group, and 39.5% for surgery (p = 0.012). Post-hoc analysis showed expectant management having higher intrauterine CP and LB, and shorter time between treatment and first intrauterine CP compared to surgery (p
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