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Unilateral Salpingectomy and Methotrexate are Associated with Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing IVF.

Related Articles Unilateral Salpingectomy and Methotrexate are Associated with Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing IVF. J Minim Invasive Gynecol. 2017 Mar 08;: Authors: Irani M, Robles A, Gunnala V, Spandorfer SD Abstract STUDY OBJECTIVE: To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF). DESIGN: Retrospective cohort study. DESIGN: Classification: Canadian Task Force Classification II-2. SETTING: Academic medical center. PATIENTS: Patients with a history of previous EP who achieved pregnancy following IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for previous EP. INTERVENTIONS: IVF. MEASUREMENTS AND MAIN RESULTS: A total of 594 patients were included. Seventeen patients had recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with previous 1 EP (8.5% vs. 1.8%; p=0.01; OR=2.2; 95% CI=1.2-4.4). Patients who underwent unilateral salpingectomy (n=245) had a comparable recurrence rate of EP following IVF with those who received MTX (n=283) (3.6% vs. 2.8%; p=0.5; OR=1.3; 95% CI=0.4-3.4). This odds ratio remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (aOR=1.4; 95% CI=0.5-3.8). None of the patients who underwent bilateral salpingectomy (n=45) or salpingostomy (n=21) had recurrence of EP following IVF. CONCLUSION: The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP following IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population. PMID: 28285056 [PubMed - as supplied by publisher]

STUDY OBJECTIVE:

To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF).

DESIGN:

Retrospective cohort study.

DESIGN:

Classification: Canadian Task Force Classification II-2.

SETTING:

Academic medical center.

PATIENTS:

Patients with a history of previous EP who achieved pregnancy following IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for previous EP.

INTERVENTIONS:

IVF.

MEASUREMENTS AND MAIN RESULTS:

A total of 594 patients were included. Seventeen patients had recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with previous 1 EP (8.5% vs. 1.8%; p=0.01; OR=2.2; 95% CI=1.2-4.4). Patients who underwent unilateral salpingectomy (n=245) had a comparable recurrence rate of EP following IVF with those who received MTX (n=283) (3.6% vs. 2.8%; p=0.5; OR=1.3; 95% CI=0.4-3.4). This odds ratio remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (aOR=1.4; 95% CI=0.5-3.8). None of the patients who underwent bilateral salpingectomy (n=45) or salpingostomy (n=21) had recurrence of EP following IVF.

CONCLUSION:

The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP following IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population.

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