**5.1 Hysterosalpingography**

The fertility outcome of patients with unruptured EP treated conservatively with either MTX or expectant management can be evaluated indirectly through the hysterosalpingography (HSG) and directly by means of future pregnancy (Debby et al., 2000; Elito et al., 2006). The HSG represents important diagnosis methods after the treatment of EP, in spite of the inconveniences and doubts about the interpretation of this examination. The tubal patency after MTX is 84% and after expectant management is 78% (Elito et al., 2005a). This high rate of radiologically normal tubes after clinical treatment proves that the spontaneous regression of EP does not result in an increased harm or damage to the tube. However, the radiologically normal findings show nothing about the tubal function, when a disturbance can also be the cause of EP. On the other hand, if the results of HSG demonstrate obstruction of the tubes, the possibility of a spontaneous pregnancy will be reduced and should be treated with *in vitro* fertilization. The tubal obstruction is increased in cases with high beta-hCG levels (Elito et al., 2005b). The explanation for higher incidence of tubal obstruction is that in patients with higher levels of beta-hCG there is more invasion of the trophoblast tissue at the tube's serosa, what increases the damage to the tube.

### **5.2 Future pregnancy**

After medical treatment 65% of patients who attempted subsequent pregnancies succeeded, and the incidence of recurrent ectopic pregnancy was relatively low at 13% (Stovall et al., 1989; Lipscomb et al., 2000). Systemic MTX in a single-dose regimen compared with laparoscopic salpingostomy of four trials (Fernandez et al., 1998; Saraj et al., 1998; Sowter et al., 2001; El-Sherbiny et al., 2003), involving 265 haemodynamically stable women with a small unruptured tubal EP, showed no significant differences in the number of IUPs (RR 1.01, 95% CI 0.66–1.54), whereas there was a non-significant trend towards a lower incidence of repeat EPs (RR 0.63, 95% CI 0.14–2.77) (Mol et al., 2008). Systemic MTX in a fixed multiple dose regimen compared with laparoscopic salpingostomy observed that fertility outcome was no significant different for IUP (RR 0.88, 95% CI 0.49–1.60) as well as for repeat EP (RR 0.88, 95% CI 0.21–3.67) (Dias Pereira et al., 1999).
