[Fertility after ectopic pregnancy and indications of ART].
There is no simple answer to the problem of fertility after one ectopic pregnancy. Results reported in the literature have been satisfactory with rate of subsequent pregnancy about 60% and the risk of new ectopic pregnancy (EP) around 28%. We have deliberately excluded studies before 1990 except when the methodology was particularly good or the treatment particularly interesting. Strict and exhaustive criteria were lacking in most of these studies due to widely varying aims, the prospective or retrospective nature of the data, the number of patients included, and varying therapeutic decision-making schemes. Many patients were lost to and no mention is given concerning the proportion of patients who desired a subsequent pregnancy. Infertility factors were not considered in most cases. We were looking for fertility results according to treatment used. Among the 50 studies we retained, pregnancy rates after ectopic pregnancy were satisfactory whatever treatment was used, with laparoscopy being the gold standard. Medical treatment was at least as effective as surgical treatment. Associated infertility factors appeared to be the most important for fertility outcome. It is unfortunate that so few study have analyzed outcome in these patients without considering risks factors of EP, infertility factors and the proportion of women who attempted to conceive again.
Rongières
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CMCO, Centre d'AMP, 19, rue Louis-Pasteur, 67300 Schiltigheim. crongieres@noos.fr
Kattygnarath
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D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D012307:Risk Factors
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate