Does methotrexate administration for ectopic pregnancy following in-vitro fertilization impact ovarian reserve or ovarian responsiveness?

Abstract

Ectopic pregnancy accounts for 1.5-2% of all pregnancies and causes significant morbidity and mortality. Methotrexate (MTX) has replaced surgical management for asymptomatic ectopic pregnancy. Little is known of the impact of MTX on subsequent fertility and IVF outcomes. This study evaluates the effects of methotrexate by comparing ovarian reserve and ovarian responsiveness before and after an ectopic pregnancy treated with MTX. Retrospective cohort study. Patients who had an ectopic from an IVF cycle who were treated with MTX were identified. Women who did not undergo a subsequent IVF cycle after MTX administration were excluded. Age, day 3 FSH, antral follicle count (AFC), IVF stimulation parameters and time from MTX administration to subsequent IVF cycle were compared between cycles. Paired t-test and ANOVA were used for analysis. 157 ectopic pregnancies were identified. 66 women underwent IVF both before and after MTX and were included. 47/66 (71%) patients received a single dose of MTX and 19 (29%) required a second dose. There were no significant differences with regard to day 3 FSH, AFC, duration of stimulation, or peak estradiol. The post-MTX cycle required higher doses of gonadotropins but resulted in the same number of oocytes retrieved. There was no impact of time from MTX administration with regard to these parameters.Tabled 1Patient CharacteristicsPre- Methotrexate (n=66)Post- Methotrexate (n=66)PAntral follicle count15.3±7.515.2±6.60.89Max FSH (mIU/mL)8.8±3.08.0±3.10.11Duration of stimulation (days)11.0±1.411.0±1.60.80Serum E2 (pg/ml) on day of HCG2,563±9712,471±9870.49Total gonadotropin dose (IU)3,678±1,7014,217±1,861<0.01Number of oocytes retrieved13.0±6.313.7±6.50.35Mean±SD. Open table in a new tab Mean±SD. Methotrexate remains first-line therapy for medical management of ectopic pregnancy. There appears to be no adverse impact on ovarian reserve or ovarian responsiveness in subsequent IVF cycles after administration.