Extra-uterine pregnancy following assisted conception treatment

Ectopic pregnancy may be the only life-threatening disease in which prevale nce has increased as mortality has declined. The most prominent theory to e xplain this phenomenon involves increased sensitivity of serum P-human chor ionic gonadotrophin (HCG) immunoassay and improved quality of transvaginal ultrasound, combined with a heightened awareness and increased suspicion of the condition among clinicians which has allowed early detection of ectopi c pregnancy. Laparotomy, once the standard treatment of ectopic pregnancy, has been replaced almost entirely by operative laparoscopy. This is associa ted with a shorter hospital stay, fewer post-operative analgesic requiremen ts, reduced costs and lower risk of adhesion formation. Laparotomy, however , remains necessary in cases with haemodynamic instability and with excepti onal locations, e.g. cervical, abdominal and interstitial implantation, In selected cases, non-surgical management has also obtained high success rate s. Among medical therapies, the most common is systemic or local administra tion of methotrexate. The other option is expectant management involving fo llow-up using serial serum HCG measurements and ultrasound scans. Thus, lif e-threatening ectopic pregnancy is now evolving into a medical disease, wit h the possibility of lower-cost treatment, faster recovery and higher subse quent fertility. In this review we assess the risk of extra-uterine implant ation after assisted conception treatment, the accuracy of various diagnost ic tools and focus on the efficacy, safety and the fertility outcomes of su rgical and nonsurgical management of ectopic pregnancy.