title: The impact of expectant management, systemic methotrexate and surgery on subsequent pregnancy outcomes in tubal ectopic pregnancy.
abstract: BACKGROUND
  The most common treatment modalities of ectopic pregnancy may influence long-term subsequent fertility outcomes in women who previously treated for ectopic pregnancy.
  
  
  OBJECTIVE
  Our objective was to compare long-term subsequent fertility outcomes after treatment with expectant management, systemic methotrexate (MTX) and surgery in tubal ectopic pregnancy.
  
  
  METHODS
  We searched our database for all women diagnosed with tubal ectopic pregnancy between January 2007 and January 2011 who were managed expectantly, with systemic MTX and with surgery. Treatment success and spontaneous pregnancy rates were compared in patients who desire to conceive following a tubal pregnancy.
  
  
  RESULTS
  One hundred twelve of 151 women desired to conceive following tubal ectopic pregnancy. Twenty-seven of 112 (24.1 %) patients were managed expectantly. Fifty-three (47.3 %) and 32 (28.5 %) patients were managed with systemic MTX or surgery, respectively. All patients in expectant and surgery groups were managed successfully. Two (3.7 %) patients had surgery after failed treatment with systemic MTX. Spontaneous intrauterine pregnancy rates were 62.9 % in expectantly managed women, 58.4 % in women with systemic MTX and 68.7 % in women with surgery (p > 0.05).
  
  
  CONCLUSIONS
  Treatment of ectopic pregnancy with either expectant management or systemic MTX is equally effective as compared to surgery. Spontaneous intrauterine pregnancy rates were comparable in expectant management, systemic methotrexate and surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Demirdag
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey. driguler@yahoo.com.
authors.forename: I
authors.initials: I
authors.lastname: Guler
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Abay
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Oguz
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Erdem
authors.affiliation: Department of Obstetrics and Gynecology, Gazi University School of Medicine, 06500, Besevler-Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Erdem
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011274:Pregnancy, Tubal / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008727:Methotrexate
keywords: Ectopic pregnancy; Expectant management; Fertility rates; Methotrexate; Surgery