Fertility after nonsurgical treatment of ectopic pregnancy

There is no question that the treatment of choice for ectopic pregnancy is surgery. However, since some ectopic pregnancies terminate in tubal abortion or complete resorption, it is questionable whether surgery is necessary in every case. Some patients can be managed by monitoring rising or falling levels of β-human chorionic gonadotropin (β-HCG) until tubal abortion or resorption occurs. This approach, which may be the best means of preserving tubal function and fertility, was used in 14 patients who fulfilled extremely selective criteria. In some of the patients, surgery later proved to be necessary, but in 11 nonsurgical management was followed by a fall in β-HCG levels, and there were no further untoward effects. Three of these patients subsequently developed intrauterine pregnancies, and one patient had a repeat ectopic.