Fertility and recurrence after treatment for ectopic pregnancy

The two questions asked first by most women who have had an ectopic pregnancy are “how will this impact on my future fertility” and “what are the chances of me having an ectopic pregnancy in a future pregnancy”.

A new study published in the journal Fertility and Sterility from the research group in Clermont Ferrand in France gives good new information on these issues. They studied the outcome for 1064 women with an ectopic pregnancy diagnosed between 1992 and 2008 that had been entered into their registry. They found the cumulative pregnancy rate after 24 months ranged between 67 and 76% – with better outcomes when medical (methotrexate) or expectant management approaches were used. However other factors have an impact with reduced pregnancy rates in women over 35 years of age, with a history of sub fertility or tubal disease. The two year cumulative incidence of ectopic pregnancy recurrence was 19% irrespective of the treatment given for the original ectopic. The recurrence was highest after methotrexate – at 25% – although this was not statistically significantly higher than other treatments. Their data also showed a 6.6% need for further treatment following conservative surgery and a need for further treatment of 24% after a single dose treatment with methotrexate. The most important take home message of the paper is that fertility after an ectopic pregnancy is higher in women managed conservatively – i.e. who has the ectopic removed from the tube with conservation of the tube at surgery or who are treated with methotrexate. This is particularly true in women who have a history of sub fertility. These observations are important – but like all studies must be interpreted with caution. Women who have a tube removed often have a larger ectopic pregnancy or have one with  higher hCG levels or have ruptured the tube. These are some of many factors that may alter the fertility outcome for any individual women. There are ongoing randomised studies looking at these issues. For the moment this large population study gives good information on which to base decisions.