title: Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation.
abstract: 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.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Janet F
authors.initials: JF
authors.lastname: McLaren
authors.forename: Richard O
authors.initials: RO
authors.lastname: Burney
authors.forename: Amin A
authors.initials: AA
authors.lastname: Milki
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Westphal
authors.forename: Michael H
authors.initials: MH
authors.lastname: Dahan
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Lathi
mesh_terms: 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
chemical_list: D005493:Folic Acid Antagonists; D008727:Methotrexate