The impact of treatment modalities for ectopic pregnancy on future fertility outcomes

Aim: This study aimed to evaluate fertility outcomes in patients managed with medical treatment, surgical treatment, or expectant management for ectopic pregnancy.Methods: Patients aged 18–45 years who were diagnosed with ectopic pregnancy at the Obstetrics and Gynecology outpatient clinics of Ondokuz Mayıs University between January 2015 and December 2020 were retrospectively evaluated. Patients were categorized into three groups based on treatment modality: medical, surgical, or expectant management. Demographic characteristics, risk factors for ectopic pregnancy, baseline β-hCG levels, treatment success, recurrence rates, and subsequent spontaneous intrauterine pregnancy outcomes were collected and statistically analyzed.Results: A total of 314 patients were included in the study. There was no statistically significant difference among treatment groups regarding age, previous pregnancy history, or ectopic pregnancy risk factors (all p > 0.05). Treatment success rates differed significantly among groups, with the highest in the surgical group (98.6%), followed by the expectant management (94.1%) and medical treatment (72.5%) groups (p < 0.001). Recurrent ectopic pregnancy rates were comparable among groups without a statistically significant difference (p=0.28). Spontaneous intrauterine pregnancy rates during follow-up differed significantly among treatment groups (40.0% in the medical group, 27.6% in the surgical group, and 52.9% in the expectant group; p = 0.02). Baseline β-hCG levels were not significantly associated with treatment success in any treatment modality.Conclusion: Spontaneous intrauterine pregnancy outcomes differed among treatment modalities in patients with ectopic pregnancy, with lower rates observed following surgical management. These findings suggest an association between treatment modality and subsequent fertility outcomes; however, prospective controlled studies are required to establish causal relationships.