[Fertility after ectopic pregnancy].
BACKGROUND
The subsequent fertility of women who had experienced ectopic pregnancy (EP) is the best criteria of the effectiveness of the treatment. In the absence of randomised trials comparing laparotomy, laparoscopy, medical treatment by methotrexate (MTX) and expectative, the only way to compare treatments is to make use of data from observational studies.


METHODS
The databases consulted were Medline, Cochrane Library, National Guideline Clearinghouse and Health Technology Assessment Database. Keywords used for research: fertility; ectopic pregnancy; expectative; methotrexate; salpingectomy; salpingotomy.


RESULTS
Twenty-four papers of randomised control trial (RCT) or observational studies were analysed. No difference between laparotomy and laparoscopy for fertility was found. Tubal suture does not modify the subsequent fertility. The risk of normal pregnancy or ectopic recurrence is similar between salpingotomy or salpingectomy when controlateral tube is normal. Conversely, in case of altered tube, the fertility appears higher after conservative treatment. Between conservative treatments, surgical or medical, no difference appears.


CONCLUSIONS
Conservative surgical treatment is the gold standard. However, the fertility seems similar with the other treatments. Three ongoing RCT could answer to the three main questions: Which is the best fertility between medical and conservative surgical treatment? Which is the best fertility between radical and conservative surgical treatment? Which is the best fertility between MTX and expectative?
Desroque
D
D
Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 le Kremlin-Bicêtre, France.
Capmas
P
P
Legendre
G
G
Bouyer
J
J
Fernandez
H
H
D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology*; D010535:Laparoscopy; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery / Q000628:therapy*; D058994:Salpingectomy
D008727:Methotrexate