Safe Methotrexate Doses for Ectopic Pregnancy

Women diagnosed with ectopic pregnancy (EP) have to take methotrexate and are often concerned with its side effects. The present study evaluated the potential effects of methotrexate (MTX) single and multi-dose exposures on the ovarian reserve. It measured Follicle stimulation hormone (FSH), estradiol plasma levels (on day 3 of the cycle), and Anti-Mullerian Hormone (AMH) two times before MTX administration (pre-treatment) and eight weeks after treatment (post-treatment). It also evaluated antral follicle count (AFC) by trans-vaginal ultrasound pre- and post-treatment and found-

• No difference in levels of FSH, AMH, and AFC between single-dose and multiple-dose groups. 
• Significant difference in estradiol levels between the two groups, with higher estradiol concentrations in the multiple-dose MTX group.

This study shows that MTX administration, irrespective of the number of doses, has no negative effect on ovarian reserve and can safely treat EP.

Zargar M, ShahAli S, Moramezi F. et al. Effect of Single and Multiple Methotrexate Doses Treatment on Ovarian Reserve in Ectopic Pregnancy Women: A Prospective Cohort Study. J Obstet Gynecol India. 2024. https://doi.org/10.1007/s13224-023-01939-5