Fertility and sterility · 2008
Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation.
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McLaren Janet F, Burney Richard O, Milki Amin A, Westphal Lynn M, Dahan Michael H, Lathi Ruth B
Аннотация
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.
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.