Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location

Abstract

Objective: To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART).

Design: Retrospective cohort study.

Setting: Large ART practice.

Patient(s): Women receiving methotrexate or surgery after ART.

Intervention(s): None.

Main outcome measure(s): Follicle-stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield compared between women treated with methotrexate or surgery, with secondary outcomes of clinical pregnancy and live birth.

Result(s): There were 153 patients in the methotrexate group and 36 patients in the surgery group. Neither group demonstrated differences in ovarian reserve or oocyte yield in a comparison of the before and after treatment values. The change in ovarian reserve and oocyte yield after treatment were similar between the two groups. The number of doses of methotrexate was not correlated with changes in ovarian reserve, indicating no dose-dependent effect. Time between treatment and repeat ART was not correlated with outcomes. Live birth in subsequent cycles was similar in the two groups.

Conclusion(s): Ovarian reserve and subsequent ART cycle outcomes were reassuring after methotrexate or surgical management of ectopic pregnancy. No adverse impact of methotrexate was detected in this large fertility cohort as has been previously described elsewhere.

Keywords: ART; ectopic; methotrexate; ovarian stimulation; pregnancy of unknown location; salpingectomy.

Figure 1

Box and whisker plots of pre- and post-treatment oocyte yield, AFC, and FSH values in the surgical and methotrexate groups. Boxes represent the inter-quartile range and the line within the boxes represent the median. The vertical lines protruding from the box extend to the minimum and the maximum values of the data set, as long as these values do not differ from the median by more than one and half times the inter-quartile range. Outliers from this range are represented by dots. There were no statistically significant differences between pre- and post-treatment values within either group.

Figure 2

Scatter plots of the change in oocyte yield from pre- to post-treatment values plotted against the time between ART cycles in day. A- includes all patients in the methotrexate group out to 1780 days. B- includes only patients in the methotrexate group having a repeat ART cycle with 365 days.