Does methotrexate administration for ectopic pregnancy after in vitro fertilization impact ovarian reserve or ovarian responsiveness

Capsule:
The IVF cycles before and after methotrexate administration to 66 women were compared. Methotrexate does not compromise ovarian reserve, ovarian responsiveness, or IVF success in subsequent cycles.

Authors:
Christina E. Boots, M.D., Robert L. Gustofson, M.D., Eve C. Feinberg, M.D.

Volume 100, Issue 6, Pages 1590-1593, December 2013

Abstract:

Objective:
To evaluate the effects of methotrexate (MTX) on the future fertility of women undergoing IVF by comparing ovarian reserve and ovarian responsiveness in the IVF cycle before and after an ectopic pregnancy (EP) treated with MTX.

Design:
Retrospective cohort study.

Setting:
Private reproductive endocrinology and infertility practice.

Patient(s):
Sixty-six women undergoing IVF before and after receiving MTX for an EP.

Intervention(s):
Methotrexate administration and ovarian stimulation.

Main Outcome Measure(s):
Markers of ovarian reserve (day 3 FSH, antral follicle count), measures of ovarian responsiveness (duration of stimulation, peak E2 level, total dose of gonadotropins, number of oocytes retrieved, fertilization rate), and time from MTX administration to subsequent IVF cycle.

Result(s):
There were no differences after MTX administration in body mass index (BMI), FSH, or antral follicle count. A greater dose of gonadotropins was used in the cycle after MTX, but there were no differences in numbers of oocytes retrieved or high quality embryos transferred. As expected, there was a slight increase in age in the subsequent IVF cycle. The pregnancy rates (PR) were comparable to the average PRs within the practice when combining all age groups.

Conclusion(s):
Methotrexate remains the first line of therapy for medical management of asymptomatic EP and does not compromise ovarian reserve, ovarian responsiveness, or IVF success in subsequent cycles.

  • Amanda N. Kallen

    Very interesting paper! Did the authors consider also a “control” matched group of women who had never received MTX? I do think that since the data was reviewed out to 180 days, MTX would be expected to be cleared by this time (as the authors themselves point out) but it might have also been interesting to see a “nonexposed” group for comparison. Thanks again for a great study and a great topic.

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