Fertility outcomes subsequent to medical and surgical treatment for ectopic pregnancy: A retrospective cohort study in Iran

Background: Ectopic pregnancy (EP) and its treatment methods may affect subsequent fertility outcomes. Objective: To compare methotrexate (MTX), laparoscopic salpingostomy, and salpingectomy methods of EP treatment and their effects on fertility outcomes. Materials and Methods: This retrospective cohort study was performed on women receiving a definitive diagnosis of tubular EP from ۲۰۱۴ to ۲۰۱۷ at Arash Medical Center, Tehran, Iran. In total, ۱۹۴ women were studied, of which ۶۴ were treated with MTX, ۵۲ underwent salpingostomy, and ۷۸ underwent salpingectomy, depending on their clinical status. Basic information, obstetrics history, and major outcomes of the treatment after an ۱۸-month follow-up, including recurrence of EP, miscarriage, and successful intrauterine pregnancy (IUP), were recorded and variables were compared among the three groups. Results: There was no significant difference in fertility outcomes among the three groups. Among the studied variables, predictors of successful IUP after EP treatment were multiparity (Hazard Ratio (HR): ۱.۳۷; ۹۵%CI: ۱.۰۶-۱.۷۷), no history of miscarriage (HR: ۲.۳۷; ۹۵%CI: ۱.۰۱-۵.۵۶), and a higher number of live births (HR: ۱.۵۴; ۹۵%CI: ۱.۰۱-۲.۳۷). On the other hand, predictors of EP recurrence included nulliparity (HR: ۱.۶۱; ۹۵%CI: ۱.۰۲-۲.۵۳) and a lower number of live births (HR: ۳.۸۴; ۹۵%CI: ۱.۴۳-۱۰.۹۸). The effect of other factors, including the utilized therapeutic modalities, was not statistically significant. Conclusion: The current study results demonstrated that after an ۱۸-month follow-up, fertility outcomes, including recurrence of EP and successful IUP, were not significantly different among the subjects with EP treated with MTX, salpingostomy, or salpingectomy. Further studies with long-term follow-ups are recommended.

Keywords:

Ectopic pregnancy , Fertility , Methotrexate , Salpingostomy , Salpingectomy. , حاملگی خارج از رحم , باروری , متوتروکسات , سالپنگوستومی , سالپنژکتومی.