title: Methotrexate does not affect ovarian reserve or subsequent assisted reproductive technology outcomes.
abstract: OBJECTIVE
  The purpose of this research was to study whether methotrexate (MTX) as treatment for ectopic pregnancy (EP) impacts the future fertility of women undergoing assisted reproductive technology (ART) METHODS: In a systematic review and multi-center retrospective cohort from four academic and private fertility centers, 214 women underwent an ART cycle before and after receiving MTX as treatment for an EP. Measures of ovarian reserve and responsiveness and rates of clinical pregnancy (CP) and live birth (LB) were compared in the ART cycles prior and subsequent to MTX.
  
  
  RESULTS
  Seven studies were identified in the systematic review, and primary data from four institutions was included in the final analysis. Women were significantly older in post-MTX cycles (35.3 vs 34.7 years). There were no differences in follicle stimulating hormone, antral follicle count, duration of stimulation, oocytes retrieved, or fertilization rate between pre- and post-MTX cycles. However, post-MTX cycles received a significantly higher total dose of gonadotropins (4206 vs 3961 IU). Overall, 42 % of women achieved a CP and 35 % achieved a LB in the post-MTX ART cycle, which is similar to national statistics. Although no factors were identified that were predictive of LB in young women, the number of oocytes retrieved in the previous ART cycle and current AFC were predictive of LB (AUC 0.76, 0.75) for the older women.
  
  
  CONCLUSIONS
  MTX does not influence ovarian reserve, response to gonadotropin stimulation, and CP or LB rate after ART. MTX remains a safe and effective treatment option for women with asymptomatic EPs.
authors.affiliation: Obstetrics and Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA. bootsc@wudosis.wustl.edu.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Boots
authors.affiliation: Program in Reproductive and Adult Endocrinology, National Institute of Health, 10 Center Dr Room 1-3140, MSC 1109, Bethesda, MD, 20892, USA.
authors.forename: Micah J
authors.initials: MJ
authors.lastname: Hill
authors.affiliation: Reproductive Endocrinology and Infertility, Fertility Centers of Illinois, 767 Park Ave, Suite 190, Highland Park, IL, 60035, USA.
authors.forename: Eve C
authors.initials: EC
authors.lastname: Feinberg
authors.affiliation: Obstetrics and Gynecology, Stanford University, 900 Welch Rd #350, Palo Alto, CA, 94304, USA.
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Lathi
authors.affiliation: Bernard Becker Medical Library, Washington University, 660 Euclid Avenue, St. Louis, MO, 63110, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Fowler
authors.affiliation: Obstetrics and Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jungheim
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005298:Fertility / Q000187:drug effects*; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D065851:Ovarian Reserve / Q000187:drug effects*; D010062:Ovulation Induction; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Ectopic pregnancy; In vitro fertilization; Methotrexate; Ovarian reserve; Pregnancy rate