Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility

Methotrexate treatment was compared to laparoscopic salpingotomy forconservative management of ectopic pregnancy in a prospective randomizedstudy. One hundred patients were randomized into two groups using randomnumbers. Inclusion criteria were an ectopic pregnancy visualized byultrasound with a pre-therapeutic score <13 as assessed by the followingsix criteria, graded from 1 to 3: gestational age, human chorionicgonadotrophin (HCG) concentration, progesterone concentration, abdominalpain, haemoperitoneal volume and diameter of the haematosalpinx. Thetreatments were either 1 mg/kg of methotrexate injected transvaginally intothe ectopic pregnancy without anaesthesia or administered i.m. when thepregnancy could not safely or easily be punctured (group 1), orlaparoscopic salpingotomy (group 2). Success was defined as the return tonormal (<10 mIU/ml) of HCG concentrations. Treatment was successful for45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%).Medical treatment was significantly (P < 0.05) associated with shorterpostoperative stay (24 compared with 46 h), but HCG returned to normal morequickly after laparoscopic treatment (13 compared with 29 days).Spontaneous reproductive performance was similar in both groups, butoverall intrauterine pregnancy was higher, and repeat ectopic pregnancylower, after methotrexate treatment. In selected cases of ectopicpregnancy, with a pre-therapeutic score <13, methotrexate treatmentappeared as safe and efficient as conservative treatment by laparoscopy andwas associated with improved subsequent fertility.