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Updated: Jul 17, 2026

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

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Interventions for tubal ectopic pregnancy.

P J Hajenius¹, F Mol, B W J Mol

¹Academic Medical Center, University of Amsterdam, Obstetrics and Gynecology (H4-205), Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ. p.hajenius@amc.nl

The Cochrane Database of Systematic Reviews

|January 27, 2007

Summary

Laparoscopic surgery is a cost-effective treatment for tubal ectopic pregnancy, while systemic methotrexate offers a non-surgical alternative for selected patients. Expectant management requires further evaluation.

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Area of Science:

Reproductive Medicine
Gynecologic Surgery
Pharmacology

Background:

Tubal ectopic pregnancy presents treatment challenges.
Current options include surgery, medical management, and expectant approaches.

Purpose of the Study:

To evaluate the effectiveness and safety of surgical, medical, and expectant management for tubal ectopic pregnancy.
To assess primary treatment success, tubal preservation, and future fertility outcomes.

Main Methods:

Systematic review of randomized controlled trials (RCTs) comparing treatments for tubal ectopic pregnancy.
Data extraction and quality assessment performed independently by two reviewers.

Main Results:

Laparoscopic salpingostomy is less successful than open surgery but more cost-effective, with similar long-term fertility outcomes.
Systemic methotrexate shows variable success rates, with multi-dose regimens appearing more effective than single-dose.
Local methotrexate injections improve intra-uterine pregnancy rates but are less successful in eliminating ectopic pregnancy compared to laparoscopic salpingostomy.

Conclusions:

Laparoscopic surgery is a cost-effective option for tubal ectopic pregnancy.
Systemic methotrexate is a viable non-surgical alternative for selected patients.
Expectant management's efficacy remains inadequately evaluated.