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Human Reproduction Update Advance Access published online on September 23, 2004
Human Reproduction Update, doi:10.1093/humupd/dmh043
Copyright © 2004 by the European Society of Human Reproduction and Embryology.
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Received May 26, 2004
Revised August 13, 2004
Accepted August 19, 2004

Review

Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy

Herve Fernandez 1* and Amelie Gervaise 1

1 Service de Gynécologie Obstetrique du Professeur René Frydman, Hôpital Antoine Béclère

* To whom correspondence should be addressed. E-mail: herve.fernandez{at}abc.ap-hop-paris.fr.


  Abstract

Ectopic pregnancy (EP) is a major event in a woman's reproductive life. It complicates infertility treatment and must be recognized early to simplify the treatment strategy, which must always be directed towards optimizing subsequent fertility. Epidemiological findings indicate that tubal history and smoking are the principal risk factors of those EP that are considered reproductive (rather than contraceptive) failures. Adding together the attributable risks for EP allows the construction of a risk scale to determine its probability for any given patient. This risk calculation makes it easier to establish a diagnostic strategy that uses abdominal and transvaginal ultrasound and hCG assays. Progesterone assays are useful only for determining the activity of the pregnancy but do not help to identify its site. Conservative treatment is to be preferred unless the EP occurs on a known hydrosalpinx. All the treatment trials and the Cochrane database meta-analysis show that medical treatment with methotrexate, preferably multidose, is equivalent in efficacy to conservative treatment with laparoscopy in the populations studied. Heterotopic pregnancies, which occur most often after assisted reproduction technology (1-3%), should preferably be treated by salpingectomy except in interstitial sites. There is no consensus that IVF is indicated after EP. The patient's age is probably the determining factor: fertility treatment should not be delayed to an age where the results would be altered, especially with the risk of a recurrent EP.

Keywords: assisted reproduction technology; ectopic pregnancy; fertility; laparoscopy; medical treatment.
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