High live birth rate after conservative treatment of ectopic pregnancy with methotrexate

The aim of the study was to assess fertility in patients diagnosed with ectopic pregnancy and treated with methotrexate, as well as safety and efficacy of conservative treatment. Also, risk factors of recurrent ectopic pregnancies were determined.

The study included 86 female patients with ectopic pregnancy hospitalized and treated in the clinic of Gynecological Endocrinology, UJCM, Cracow, between 2007 and 2011. A total of 73 patients received a single dose of MTX in the amount of 50 mg/m2 of body surface area. Serum b-hCG concentration was measured on days 4 and 7. The treatment was considered successful when b-hCG concentrations dropped to less than 0.2 mIU/ml without surgery.

Among 34 patients on follow-up, 8 (23.5%) did not attempt to conceive again, whereas 26 patients declared their wish to conceive again. The attempt proved to be successful in case of 16 women (61.53%), and they gave birth to healthy children. Average time to pregnancy was 14.9 months (SD +/- 10.9). The first pregnancy occurred after 6 months and the last after 35 months. No congenital birth defects were found in the newborns.

Systemic, conservative treatment with methotrexate is an effective and safe way of managing ectopic pregnancy even in cases with higher b-hCG concentrations. Most patients can be successfully treated without surgery thus they may even be treated in outpatient settings. High fertility can be maintained and is independent of the skills of the operators and access to laparoscopic techniques. Conservative treatment does not increase the risk of recurrent ectopic pregnancy but should be offered in wards that provide 24-hour surgical care.