Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation.
OBJECTIVE
To evaluate the pregnancy rate, ovarian responsiveness, and endometrial thickness in infertility patients with a history of methotrexate exposure who subsequently underwent controlled ovarian stimulation.


METHODS
Retrospective cohort study.


METHODS
University reproductive endocrinology and infertility program.


METHODS
Forty-eight women with infertility undergoing ovarian stimulation after receiving methotrexate treatment for ectopic gestation.


METHODS
Methotrexate administration and controlled ovarian stimulation.


METHODS
Pregnancy rate, cycle day 3 FSH levels, number of oocytes retrieved, and endometrial thickness.


RESULTS
The cumulative intrauterine pregnancy rate achieved with controlled ovarian stimulation at 2 years after methotrexate exposure was 43%, with a mean time to conceive of 181 days. Thirty-five patients with similar fertility treatments pre- and post-methotrexate were identified. Within this group, when an IVF cycle occurred within 180 days of methotrexate exposure, a significant decline in oocytes retrieved was observed. Cycles performed later than 180 days after methotrexate exposure did not exhibit a decrease in oocyte production. Endometrial development was similar at all time points examined.


CONCLUSIONS
These findings suggest a time-limited and reversible impact of methotrexate on oocyte yield. If confirmed by larger clinical series and/or animal data, these results may impact the management of ectopic gestation in the patient with a history of infertility or the timing of subsequent treatments.
McLaren
Janet F
JF
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA.
Burney
Richard O
RO
Milki
Amin A
AA
Westphal
Lynn M
LM
Dahan
Michael H
MH
Lathi
Ruth B
RB
D000328:Adult; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005493:Folic Acid Antagonists / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000453:epidemiology* / Q000628:therapy*; D008727:Methotrexate / Q000008:administration & dosage*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D005493:Folic Acid Antagonists; D008727:Methotrexate