Anatomical changes and ovarian reserve assessment following methotrexate therapy in tubal ectopic pregnancy

Abstract

BackgroundMethotrexate (MTX) therapy for ectopic pregnancy (EP) is widely used as an alternative for surgical treatment. Its effects on ovarian reserve or pelvic anatomy are not well established.AimsThe aim was to evaluate anatomical changes and ovarian reserve in cases of tubal EP treated by MTX therapy.Materials and methodsA prospective cohort study was conducted at Tanta University. All patients with EP were enrolled. Eligible patients were treated by MTX. Ovarian reserve was assessed by anti-Mullerian hormone (AMH) level and antral follicle count (AFC) 3 months after treatment. Anatomical changes were assessed by laparoscopy 6 months after treatment.Statistical analysis usedMean, SD, χ2 test, and Student's t-test were used.ResultsThe mean age was 28.24 ± 5.48 years, and the mean BMI was 21.85 ± 4.58. The basal β-human chorionic gonadotropin was 1788.48 ± 1171.92 mIU/ml. The mean gestational age was 42.6 ± 6.0 days. Serum level of AMH was 3.98 ± 1.11 and 3.54 ± 1.49 before and after MTX therapy, respectively, with no significant difference between AMH levels before and after therapy (P = 0.243). AFC after treatment was within normal range, with no significant difference in AFC before and after treatment, (P = 0.251). Peritubal and periovarian adhesions were the most common anatomical changes noticed during laparoscopy.ConclusionMTX therapy is a safe and effective alternative to surgery for undisturbed tubal EP. Two-dose MTX regimen did not compromise ovarian reserve or affect pelvic anatomy.