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Fertility outcomes subsequent to medical and surgical treatment for ectopic pregnancy: A retrospective cohort study in Iran
Asgari, Zahra; Chegini, Venus; Hosseini, Reihaneh; Mohajeri, Mina & Ansari, Iman
Abstract
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 2014 to 2017 at Arash Medical
Center, Tehran, Iran. In total, 194 women were studied, of which 64 were treated with
MTX, 52 underwent salpingostomy, and 78 underwent salpingectomy, depending on
their clinical status. Basic information, obstetrics history, and major outcomes of the
treatment after an 18-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): 1.37; 95%CI: 1.06-1.77), no history of miscarriage
(HR: 2.37; 95%CI: 1.01-5.56), and a higher number of live births (HR: 1.54; 95%CI:
1.01-2.37). On the other hand, predictors of EP recurrence included nulliparity (HR: 1.61;
95%CI: 1.02-2.53) and a lower number of live births (HR: 3.84; 95%CI: 1.43-10.98). The
effect of other factors, including the utilized therapeutic modalities, was not statistically
significant.
Conclusion: The current study results demonstrated that after an 18-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.
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