Fertility outcome following combined methotrexate treatment of unruptured extrauterine pregnancy

Objective To assess the effectiveness of systemic treatment with methotrexate in combination with local injection for unruptured tubal pregnancy, and to evaluate reproductive function following treatment. Design Prospective, open clinical study. Setting University clinic. Population Sixty-seven women with unruptured tubal pregnancy. Methods Systemic methotrexate (intramuscular methotrexate 0.5 mg/kg for up to five days) in combination with local application of 12.5 mg methotrexate via laparoscopy. Main outcome measures The subsequent surgical intervention required and future fertility. Results In 89.6% of women no further surgical intervention was required and 47 women (81%) experienced subsequently an intrauterine pregnancy. In 39 of 40 women who underwent hysterosalpingography following treatment, patency of the affected tube was observed. Conclusions Combined local and systemic methotrexate treatment for unruptured tubal pregnancy seems to be more effective than each therapeutic modality alone.