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

Abstract

Objective It is unclear whether the stimulated state of the ovaries as part of ART results in an increased vulnerability to the effects of methotrexate. The objective of this study was to assess ovarian reserve following methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after ART. Design Retrospective cohort study. Setting Large ART practice. Patients Methotrexate or surgery following ART. Interventions None. Main Outcome Measures Follicle stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield were compared between subjects treated with methotrexate and surgery. Secondary outcomes were clinical pregnancy and live birth. Results 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 comparing 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. Conclusions Ovarian reserve and subsequent ART cycle outcomes were reassuring following methotrexate and surgical management of ectopic pregnancy. An adverse impact of methotrexate was not detected in this large fertility cohort as has been previously described.

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

“…One additional study was excluded because none of the patients were undergoing ART [15]. Seven studies met all the inclusion criteria [16][17][18][19][20][21][22]. As shown in Table 1, five of the studies were retrospective cohort analyses and two were prospective observational studies [19,20].…”

“…As shown in Table 1, five of the studies were retrospective cohort analyses and two were prospective observational studies [19,20]. All of the studies used a paired analysis of IVF cycles before and after MTX, but two studies also compared to a control group of patients who underwent salpingectomy [17,22]. The majority of these studies are limited by their retrospective nature and sample size.…”

“…The majority of these studies are limited by their retrospective nature and sample size. Only two studies included more than 50 subjects [16,17].…”

“…Three corresponding authors responded, and their patient-level data was utilized [16][17][18]. Complete data was available for 214 subjects (Hill, n = 117; McLaren, n = 23; Boots, n = 66, Washington University, n = 8).…”

Ovarian reserve after preventive salpingectomy

“…В литературе представлены исследования, опи-сывающие отрицательное воздействие СЭ на овари-альный резерв [9][10][11][12][13][14][15][16], косвенные доказательства снижения функции яичников [17] и данные об от-сутствии влияния операции на женские гонады [8,[18][19][20][21][22].…”