Effect of Single and Multiple Methotrexate Doses Treatment on Ovarian Reserve in Ectopic Pregnancy Women: A Prospective Cohort Study

One of the main concerns for women diagnosed with ectopic pregnancy (EP). This study has been designed to evaluate the potential effects of methotrexate (MTX) single and multi-dose exposures on the ovarian reserve.

This was a prospective observational cohort study that was held in the Imam Khomeini Hospital, Ahvaz, Iran, from June 2021 to October 2022. Demographic information such as (age, body mass index (BMI), gravid, and parity) were recorded. Follicle stimulation hormone (FSH), estradiol plasma levels (on day 3 of the cycle), and Anti-Mullerian Hormone (AMH) were measured two times before MTX administration (pre-treatment) and then eight weeks after treatment (post-treatment). Also, antral follicle count (AFC) was evaluated by trans-vaginal ultrasound pre- and post-treatment.

One hundred and seventy-two patients were recruited into the study. There was no difference in levels of FSH, AMH and AFC between single-dose and multiple-dose groups. There was only a statistically significant difference in estradiol levels between the two groups (P: 0.02), and estradiol concentrations were higher in the multiple-dose MTX group.

Administration of MTX (regardless of number of doses) has no negative effect on ovarian reserve and is safe to be used as a treatment for EP.