Systemic methotrexate therapy versus laparoscopic salpingostomy in tubal pregnancy. Part II. Patient preferences for systemic methotrexate.
OBJECTIVE
To investigate patient preferences for systemic methotrexate therapy relative to laparoscopic salpingostomy in the treatment of tubal pregnancy.


METHODS
Preference assessment in controlled clinical study.


METHODS
Four hospitals and one infertility clinic.


METHODS
Forty patients who had been treated for tubal pregnancy and 40 nonpregnant controls.


METHODS
Preference for methotrexate therapy relative to salpingostomy was established during an interview. Two scenarios were offered for methotrexate therapy: one with and one without preceding diagnostic laparoscopy. Hypothetical tubal patency rates after methotrexate therapy were varied in both scenarios until patients switched in their initial preference.


METHODS
Preference for systemic methotrexate therapy.


RESULTS
Only a few patients switched in their initial preference when the tubal patency rate after systemic methotrexate therapy was varied. Most preferred methotrexate therapy without an increase in the tubal patency rate in a scenario without preceding diagnostic laparoscopy. A small group never opted for methotrexate therapy even when it would guarantee a 100% tubal patency rate.


CONCLUSIONS
Systemic methotrexate therapy would be preferred by most patients as part of a completely nonsurgical management strategy. Tubal patency was a decisive factor for treatment preference in a minority of patients only.
Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands. P.T.NIEUWKERK@AMC.UVA.NL
P T
PT
Nieuwkerk
P J
PJ
Hajenius
F
F
Van der Veen
W M
WM
Ankum
W
W
Wijker
P M
PM
Bossuyt
D000328:Adult; D005186:Fallopian Tube Patency Tests; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use*; D017060:Patient Satisfaction; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012489:Salpingostomy
D008727:Methotrexate