The comparison of the effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of the anti-Mullerian hormone level measurement

Abstract

Ectopic pregnancy constitutes 1-2% of all pregnancies and has 6% maternal mortality rate. Both surgical treatment and methotrexate (MTX) administration for ectopic pregnancy is still controversial in terms of ovarian reserve protection. Anti-mullerian hormone (AMH) is the best current available measure of ovarian reserve for different clinical conditions. (ref). To the best of our knowledge there is not any study dealing with the long term effects of these two treatment methods on AMH levels. Therefore we aimed to compare the effects of single-dose MTX and salpingectomy on ovarian reserve in fertile women with ectopic pregnancy in the long term. Cross-sectional study. A total of 181 patients have been included into the study; 101 of them had received single-dose MTX or salpingectomy treatment for ectopic pregnancy in the last 12 to 18 months. Patients who have underwent salpingostomy, tubal milking, fimbriectomy and other tuba-ovarian surgery were excluded from the study. Patients in the salpingectomy group did not receive MTX. Their AMH, follicle stimulating hormone (FSH), estrogen and antral follicle counts were evaluated. The duration of time passed between application of treatment and the measurement of AMH levels for MTX and salpingectomy groups were 15.43 ± 1.77 and 14.91 ± 1.84, respectively (p=0.144). The average age was similar in both groups (p=0.094). None of the three groups displayed a significant difference in terms of FSH, E2 levels and antral follicle counts (p=0.393, p=0.117, p=0.528, respectively).There were no statistically significant difference in AMH levels in all groups (2.96 ± 0.85, 2.82 ± 0.77 and 2.68 ± 0.59 for control, MTX and salpingectomy groups respectively, P=0.147). (Table reference:aData are expressed as mean ± SD. AMH= Anti-mullerian hormone, FSH= Follicle stimulating hormone, E2= Estrogen, AFC= Antral follicle count. Neither single-dose MTX nor salpingectomy does have any detrimental effects on ovarian reserve for the treatment of ectopic pregnancy in terms of serum AMH levels and does alter antral follicle counts in the long term.Tabled 1Comparison of age, measures of ovarian reserve and smoking status.Control(n=80)Methotrexate(n=56)Salpingectomy(n=45)pAge (years)a27.15 ± 3.4927.18 ± 2.9728.33 ± 3.010.094AMH(ng/mL)a2.96 ± 0.852.82 ± 0.772.68 ± 0.590.147FSH(mIU/mL)a6.87 ± 1.797.23 ± 1.417.10 ± 1.330.393E2(pg/mL)a44.61 ± 13.9445.41 ± 13.9540.11 ± 7.630.117AFCa10.25 ± 1.8710.10 ± 1.929.84 ± 2.010.528Smoking (user/total)17/8011/5610/450.949 Open table in a new tab