Reproductive potential after methotrexate treatment of ectopic gestation in a community hospital

OBJECTIVE: To compare the rates of ipsilateral tubal patency after methotrexate treatment versus conservative surgical treatment in a small community hospital lacking personnel dedicated to methotrexate management. STUDY DESIGN: From hospital and clinic records, cases of ectopic gestation within a six-year interval were identified. Method of treatment and location of the ectopic gestation were documented by review of records and confirmed by patient interviews. Women desiring fertility were offered hysterosalpingography (HSG) to evaluate tubal patency. HSG was performed under fluoroscopy with water-soluble contrast medium. RESULTS: HSG was completed in 11 cases of linear salpingostomy and 11 cases of ectopic gestations treated by methotrexate. Ipsilateral patency was documented in 8 of 11 (72%) tubes treated by linear salpingostomy and 9 of 11 (81%) methotrexate-treated tubes. One methotrexate case had a prior ipsilateral ectopic treated by salpingostomy, and two additional cases had a prior contralateral ectopic removed by salpingectomy. Each of these three cases had ipsilateral tubal patency after methotrexate for the most recent ectopic gestation. CONCLUSION: Data from this study suggest comparable tubal patency rates after methotrexate and conservative surgery. Comparable tubal patency outcomes were obtained in our community hospital despite a less-rigorous-than normal follow-up protocol. (J Reprod Med 1999;44:335-338).