Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve

Objective: To evaluate whether methotrexate (MTX) compromises ovarian reserve and future reproductive outcome in women undergoing assisted reproductive technology (ART), when it is used as first-line treatment for ectopic pregnancy (EP). Design: Prospective, observational study. Setting: University-affiliated private IVF unit. Patient(s): Twenty-five women undergoing IVF-ICSI who were treated with MTX (1 mg/kg IM) for an EP after ART. Intervention(S): Evaluation of reproductive outcome and serum anti-Mullerian hormone (AMH) levels. Serum AMH was evaluated before administering MTX and 1 week after the resolution of the EP. Reproductive outcome was evaluated by comparing subsequent IVF-ICSI cycles after EP resolution. Main Outcome Measure(s): Serum AMH levels, cycle length, gonadotropin dose required, peak serum E-2 level, oocytes collected, and embryos obtained. Result(s): Serum AMH levels before MTX were not statistically significantly different from those after treatment (3.7 +/- 0.3 ng/mL vs. 3.9 +/- 0.3 ng/mL). Patients undergoing a subsequent cycle after systemic treatment for EP had similar cycle durations (10.3 vs. 10.8 d), gonadotropin requirements (2,775 vs. 2,630.3 IU), peak E-2 levels (1,884.3 vs. 1,523.6 pg/mL), number of oocytes retrieved (12.1 vs. 10.5), and total number of embryos obtained (7.1 vs. 6.5). Conclusion(s): Single-dose MTX is a safe first-treatment choice that does not compromise future reproductive outcomes in women who are diagnosed with EP after ART. (Fertil Steril(R) 2008;90:1579-82. (C)2008 by American Society for Reproductive Medicine.)