Fertility Following Methotrexate-mifepristone Treatment Of Ectopic Pregnancy

Objective To observe fertility after methotrexate-mifepristone treatment of ectopic pregnancy and to find the factors affecting fertility. Methods 245 ectopic pregnancy patients between January 2000 and December 2001 were followed-up.Among them,82 patients accepted the combination treatment of methotrexate and mifepriston,36 women of which lost to follow-up,19 of which contracepted,27 of which didn't contracept (Study group);and 163 cases underwent salpingectomy,73 women of which lost to follow-up,52 of which contracepted ,38 of which didn't contracept(Control group).Two groups were observed the IUP rates in 1 year,2 years and 3 years,the infertility rate and the recurrence rate of EP in 3 years,time to first IUP after these two therapy. And characteristics of patients,such as age,history of infertility and EP ,were analysed. Results The post-treatment IUP rate of study group was 40.7% in 1 year,59.3% in 2 years,77.8% in 3 years, significantly higher than control group's,being 18.4%,34.2%,52.6%(P<0.05).The time to first IUP was 2～33 months (13.48±9.92 months)in study group ,and that in control group was 2～36 months(19.85±11.34 months),little longer than the former. The study group's infertility rate was 18.5%,lower than the control (39.5%). In both groups,the recurrence rate of EP was 14.8% and 10.5% respectively,study group was little higher.But no significant difference was found in time to first IUP,the infertility rate and the recurrence rate of EP between the two groups(P>0.05). The IUP rate in patients <36 years old was 67.8% and significantly higher than that(16.7%) in patients ≥36 years old (P<0.05);and the infertility rate and the recurrence rate of EP in the former were 28.8% and 10.2% respectively,higher than those(50% and 33.3%) in the latter, but without statistical significance between them(P>0.05). The IUP rate in those with history of infertility was 0% and significantly lower than that(68.3%) of those without it(P<0.05);and the infertility rate in the former was 100%, significantly higher than that(25%) in the latter (P<0.005);and the recurrence rate of EP in the former was 0% and lower than that(13.3%) in the latter, but no significant difference was found(P>0.05).The IUP rate in the ones with history of EP was 28.6% and significantly lower than that(67.2%) of those without it(P<0.05); the infertility rate in the former was 71.4% and significantly higher than that(25.9%) in the latter(P<0.05); the recurrence rate of EP in the former was 0%,lower than that(13.8%) without history of EP, no significance existing(P>0.05). Conclusions The fertility following methotrexate-mifepristone treatment was superior to that following salpingectomy. Methotrexate-mifepristone treatment can protect ectopic pregnancy patients'fertility in some ways. Furthermore, the IUP rate of cases ≥36 years old decreased;in those with history of infertility and EP the IUP rate degraded and the recurrence rate of EP enhanced.It was proved that some factors ,such as age≥36 ,history of imfertility and EP ,can decrease reproductive performance.