Reproductive performance after methotrexate treatment of ectopic pregnancy

Ectopic pregnancies are pregnancies in which the embryo implants in an area outside the uterus. Most ectopic pregnancies occur in the fallopian tubes, which lead from the ovaries to the uterus. These abnormal pregnancies must be terminated because they pose a serious threat to the mother's health. Microsurgical techniques are now performed in an effort to maintain tubal integrity for future fertility. However, it has been estimated that even with microsurgical techniques, only 68 percent of the patients will become pregnant and only 56 percent will have embryos implant inside of the uterus. A new treatment for ectopic pregnancies involves injecting the embryonic sac with the chemotherapeutic drug, methotrexate. The subsequent reproductive functioning of 57 women with unruptured tubal pregnancies who were treated with methotrexate and citrovorum factor is reported. It took an average of 26 days (0 to 157 days) for the women to begin menstruating again. Follow-up information was available for 44 patients. Of the 23 patients who had a hysterosalpingogram, a method of assessing the patency of the fallopian tubes by injecting a contrast material, 19 women had a functioning tube. During the follow-up period, 11 pregnancies were achieved in the 14 women desiring pregnancy (78.6 percent). The pregnancy implanted inside the uterus in 10 women (90.9 percent) and outside the uterus in one (9.1 percent) woman. It took an average of 2.3 months to achieve pregnancy. It is concluded that methotrexate treatment for ectopic pregnancy did not alter the return of menstruation or the functioning of the fallopian tube. Although pregnancy rates were similar to those following conventional surgical methods of treating ectopic pregnancy, the risks and cost of a surgical operation are eliminated with the methotrexate method. (Consumer Summary produced by Reliance Medical Information, Inc.)