Methotrexate does not affect ovarian reserve or subsequent assisted reproductive technology outcomes

Abstract

Purpose The purpose of this research was to study whether methotrexate (MTX) as treatment for ectopic pregnancy (EP) impacts the future fertility of women undergoing assisted reproductive technology (ART) Methods In a systematic review and multi-center retrospective cohort from four academic and private fertility centers, 214 women underwent an ART cycle before and after receiving MTX as treatment for an EP. Measures of ovarian reserve and responsiveness and rates of clinical pregnancy (CP) and live birth (LB) were compared in the ART cycles prior and subsequent to MTX. Results Seven studies were identified in the systematic review, and primary data from four institutions was included in the final analysis. Women were significantly older in post-MTX cycles (35.3 vs 34.7 years). There were no differences in follicle stimulating hormone, antral follicle count, duration of stimulation, oocytes retrieved, or fertilization rate between pre-and post-MTX cycles. However, post-MTX cycles received a significantly higher total dose of gonadotropins (4206 vs 3961 IU). Overall, 42 % of women achieved a CP and 35 % achieved a LB in the post-MTX ART cycle, which is similar to national statistics. Although no factors were identified that were predictive of LB in young women, the number of oocytes retrieved in the previous ART cycle and current AFC were predictive of LB (AUC 0.76, 0.75) for the older women. Conclusions MTX does not influence ovarian reserve, response to gonadotropin stimulation, and CP or LB rate after ART. MTX remains a safe and effective treatment option for women with asymptomatic EPs.Capsule As treatment for an ectopic pregnancy, methotrexate does not affect ovarian reserve, response to gonadotropin stimulation, clinical pregnancy, or live birth rates in subsequent assisted reproductive tenchology cycles.

Effects of Methotrexate Therapy on the Levels of Gonadotropic Hormones in Rheumatoid Arthritis Patients of Reproductive Age

“…In women who were treated with MTX for ectopic pregnancy, there were no differences in the FSH levels, antral follicle count, oocytes retrieved, or fertilization rate between pre-and post-MTX therapy. The cumulative dose of MTX in ectopic pregnancies was much lower than in this study [12][13]. Banas et al [14] reported that RA patients underwent menopause at a significantly younger age than healthy women but found no association with MTX treatment [14].…”

Persistent follicular granulosa cell senescence and apoptosis induced by methotrexate leading to oocyte dysfunction and aberrant embryo development

“… 9 Hence, it is recommended that there should be a treatment‐free interval of 3 or more months between discontinuation of MTX regimen and conception. 9 , 10 On the other hand, some researchers suggested that MTX exerted no adverse effects on ovarian reserve and outcomes in assisted reproductive technology cycles in a large fertility cohort, 11 , 12 and female fertility was not negatively affected by MTX treatment based on the results of an anti‐Müllerian hormone (AMH) test. Nevertheless, although these statistical data suggest a low possibility of occurrence of detrimental effects on female reproductive mechanisms due to previous MTX medication, the conclusion based on these may not be applicable to every patient as prescription of medication in the clinical settings varies because of individual differences.…”

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

“…Additionally, MTX systemically administered, intramuscular injected or in situ injected, used alone or in combination with laparoscopy, has long been advocated as an alternative method resolving ectopic pregnancy [40][41][42][43]. Some research suggested MTX didn't exert significant adverse effect on fertility in both spontaneous fertile and infertile population [44,45]. In the case presented, we didn't choose MTX-based treatment to reduce trophoblast activity at the first place.…”