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

Administration of methotrexate for confirmed or suspected ectopic gestation after assisted reproduction and ovarian stimulation does not result in decreased markers of ovarian reserve or altered assisted reproduction outcomes.


Micah J. Hill, D.O., Janelle C. Cooper, M.D., Gary Levy, M.D., Connie Alford, M.D., Kevin S. Richter, Ph.D., Alan H. DeCherney, M.D., Charles Katz, M.D., Eric D. Levens, M.D., Erin F. Wolff, M.D.

Volume 101, Issue 2, Pages 413-419.e4, February 2014



To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART).


Retrospective cohort study.


Large ART practice.


Women receiving methotrexate or surgery after ART.



Main Outcome Measure(s):

Follicle-stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield compared between women treated with methotrexate or surgery, with secondary outcomes of clinical pregnancy and live birth.


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 in a comparison of the 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.


Ovarian reserve and subsequent ART cycle outcomes were reassuring after methotrexate or surgical management of ectopic pregnancy. No adverse impact of methotrexate was detected in this large fertility cohort as has been previously described elsewhere.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)03173-7/fulltext