The effect of administration of methotrexate for ectopic pregnancy on ovarian reserve

INTRODUCTION: Methotrexate(MTX) has an essential role in the treatment of ectopic pregnanct, and high success rates have been achieved. MTX acts on rapidly proliferating cells like ovarian germinal cells. The aim was to elucidate whether administration of MTX has a significantly adverse effect on ovarian reserve.
METHODS: 165 patients were included and divided into 3 groups. 38 patients having MTX treatment(50mg/m2) were group1, 45 patients having surgical treatment (laparoscopy or salpingostomy/salpingectomy by laparotomy) were group2, and 82 patients who admitted to gynecology outpatient clinic were group3, the control group of the study. The patients who had surgery because of rupture following MTX treatment were not included. The patients were investigated for ovarian reserve test 3 months after having negative b-hcg test. Basal levels of hormones FSH, E2 measured, and by transvaginal USG, we counted the number of antral follicles and measured ovarian volume.
RESULTS: The average age of all patients was 29.6±3.8; in group1 30.1±3.9, in group2 30±3.6, in group3 29.2±3.9. There is no statistical difference between groups(p: 0.31). FSH level was 7±1.7IU/L in group1, 7.4±1.6IU/L in group2, and 7±1.4IU/L in group3. There is no difference between groups(p: 0,77). Estradiol level was 44.5±24.2 pg/mL, 45.8±17.6 pg/mL, 48.5±16.4 pg/mL in groups respectively. There is no statistical difference between groups(p: 0.09). There is also no statistically significant difference between groups for basal antral follicle numbers and ovarian volumes(p: 0.11,p: 0.16, respectively).
DISCUSSION AND CONCLUSION: In unruptured ectopic pregnancies MTX treatment has advantages for cost effectivity and morbidity. There is no effect of MTX treatment on ovarian reserve.