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. DESIGN: Retrospective cohort study. SETTING: University reproductive endocrinology and infertility program. SUBJECT(S): Forty-eight women with infertility undergoing ovarian stimulation after receiving methotrexate treatment for ectopic gestation. INTERVENTION(S): Methotrexate administration and controlled ovarian stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rate, cycle day 3 FSH levels, number of oocytes retrieved, and endometrial thickness. RESULT(S): 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. CONCLUSION(S): 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.
OBJECTIVE: To evaluate the pregnancy rate, ovarian responsiveness, and endometrial thickness in infertilitypatients with a history of methotrexate exposure who subsequently underwent controlled ovarian stimulation. DESIGN: Retrospective cohort study. SETTING: University reproductive endocrinology and infertility program. SUBJECT(S): Forty-eight women with infertility undergoing ovarian stimulation after receiving methotrexate treatment for ectopic gestation. INTERVENTION(S): Methotrexate administration and controlled ovarian stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rate, cycle day 3 FSH levels, number of oocytes retrieved, and endometrial thickness. RESULT(S): 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. CONCLUSION(S): 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: Christina E Boots; Micah J Hill; Eve C Feinberg; Ruth B Lathi; Susan A Fowler; Emily S Jungheim Journal: J Assist Reprod Genet Date: 2016-03-04 Impact factor: 3.412
Authors: Micah J Hill; Janelle C Cooper; Gary Levy; Connie Alford; Kevin S Richter; Alan H DeCherney; Charles L Katz; Eric D Levens; Erin F Wolff Journal: Fertil Steril Date: 2013-11-20 Impact factor: 7.329