1
|
Hu Z, Li D, Chen Q, Chai W, Lyu Q, Cai R, Kuang Y, Lu X. Differences in Ectopic Pregnancy Rates between Fresh and Frozen Embryo Transfer after In Vitro Fertilization: A Large Retrospective Study. J Clin Med 2022; 11:jcm11123386. [PMID: 35743455 PMCID: PMC9225258 DOI: 10.3390/jcm11123386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Ectopic pregnancy (EP) is increasingly found in women treated with in vitro fertilization and embryo transfer (IVF−ET). With the development of the freeze-all policy in reproductive medicine, it is controversial whether frozen embryo transfer (FET) could reduce the rate of EP. In this single-center, large-sample retrospective study, we analyzed 16,048 human chorionic gonadotrophin (hCG)-positive patients who underwent fresh embryo transfer (ET) or FET cycles between January 2013 and March 2022. Throughout the study, the total EP rate was 2.09% (336/16,048), 2.16% (82/3803) in the ET group, and 2.07% (254/12,245) in the FET group. After adjustment for age, infertility causes, and other confounding factors, logistic regression results showed no statistical difference in EP rates between FET and ET groups (odds ratio (OR) 0.93 (0.71−1.22), p > 0.05). However, among the 3808 patients who underwent fresh ET cycles, the OR for EP was significantly lower in the long agonist protocol group than in the gonadotropin-releasing hormone antagonist (GnRH-ant) protocol group (OR 0.45 (0.22−0.93), p < 0.05). Through a large retrospective study, we demonstrated a slightly lower EP rate in FET cycles than in fresh ET cycles, but there was no significant difference. The long agonist protocol in ET cycles had a significantly lower risk of EP than the GnRH-ant protocol.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yanping Kuang
- Correspondence: (Y.K.); (X.L.); Tel.: +86-21-23271699 (ext. 5539) (Y.K.); Fax: +86-21-53078108 (Y.K.)
| | - Xuefeng Lu
- Correspondence: (Y.K.); (X.L.); Tel.: +86-21-23271699 (ext. 5539) (Y.K.); Fax: +86-21-53078108 (Y.K.)
| |
Collapse
|
2
|
Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:418-441. [PMID: 32853797 DOI: 10.1016/j.jmig.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve. DATA SOURCES Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve." METHODS OF STUDY SELECTION All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English. TABULATION, INTEGRATION, AND RESULTS Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery. CONCLUSIONS The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy.
Collapse
Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors); Inserm, Centre of Research in Epidemiology and Population Health, U1018, and Faculty of Medicine, University Paris Sud, Le Kremlin Bicêtre, France (Dr. Capmas)
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors).
| |
Collapse
|
3
|
Luo J, Shi Y, Liu D, Yang D, Wu J, Cao L, Geng L, Hou Z, Lin H, Zhang Q, Jiang X, Qian W, Yu Z, Xia X. The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17901. [PMID: 31764787 PMCID: PMC6882622 DOI: 10.1097/md.0000000000017901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/28/2019] [Accepted: 10/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Salpingectomy is routinely performed in ectopic pregnancy (EP). However, the effect of the surgery on the ovarian reserve and ovarian response in EP patients is still uncertain and has not been systematically evaluated. Therefore, we conducted this meta-analysis to provide a comparison of the ovarian reserve and ovarian response between the pre-salpingectomy and post-salpingectomy in EP patients. METHODS Pubmed, Embase, and Cochrane Library were searched for all relevant articles published up to December 2018. We retrieved the basic information and data of the included studies. The data was analyzed by Review Manager 5.3 software (Cochrane Collaboration, Oxford, UK). RESULTS A total of 243 articles were extracted from the databases, and 7 studies were included in the meta-analysis. The ovarian reserve including anti-Mullerian hormone (inverse variance [IV] -0.7 [95% confidence interval [CI] -0.63, 0.49]), antral follicle count (IV 1.7 [95% CI -2.02, 5.42]) and basal follicle stimulating hormone (IV 0.02 [95% CI -0.63, 0.68]) was comparable between the pre-salpingectomy group and the post-salpingectomy group. The amount of gonadotropin was significantly higher in the post-salpingectomy group when compared with that in the pre-salpingectomy group (IV -212.65 [95% CI -383.59, -41.71]). There was no significant difference in the left parameters of the ovarian response including the duration of gonadotropin stimulation (IV -0.32 [95% CI -0.76, 0.12]), the estrogen level on the human chorionic gonadotropin triggering day (IV -4.12 [95% CI -236.27, -228.04]) and the number of retrieved oocytes (IV 0.35 [95% CI -0.76, 1.46]) between 2 groups. CONCLUSIONS The current results suggest that salpingectomy has no negative effect on the ovarian reserve and ovarian response.
Collapse
Affiliation(s)
- Jiaqi Luo
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Yu Shi
- Department of Ultrasound, Peking University Shenzhen Hospital
| | - Dan Liu
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Danni Yang
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Jiahui Wu
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Lijuan Cao
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
- Department of Gynecology & Obstetrics, Nanshan People's Hospital
| | - Lan Geng
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Zhenhui Hou
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Hongbo Lin
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Qiuju Zhang
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Xuefeng Jiang
- Department of Gynecology & Obstetrics, Nanshan People's Hospital
| | - Weiping Qian
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Zhiying Yu
- Department of Gynecology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Xi Xia
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| |
Collapse
|
4
|
Grynnerup AGA, Lindhard A, Sørensen S, Ørskov M, Petersen KR, Madsen LB, Pilsgaard F, Løssl K, Pinborg A. Serum anti-Müllerian hormone concentration before and after salpingectomy for ectopic pregnancy. Reprod Biomed Online 2018; 37:624-630. [PMID: 30287173 DOI: 10.1016/j.rbmo.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022]
Abstract
RESEARCH QUESTION Does salpingectomy for ectopic pregnancy affect the ovarian reserve measured by changes in pre- and post-operative levels of anti-Müllerian hormone (AMH)? DESIGN This is a prospective observational multicentre study of 64 women treated with salpingectomy for an ectopic pregnancy. AMH was measured in serum samples collected at admission before salpingectomy and at follow-up (median time to follow-up [interquartile range] was 3 [3-4] months). Changes in serum AMH levels were investigated using Wilcoxon signed-rank test and the relationship between changes in AMH and age, time to follow-up, and pre-operative serum AMH level was investigated using linear regression analysis. The biological variation of AMH was also calculated. RESULTS Serum AMH levels did not differ significantly before and after salpingectomy (median ∆AMH [follow-up value minus admission value] 0.40 pmol/l, interquartile range -2.0 to 4.0 pmol/l). ΔAMH was independent of age, time to follow-up and pre-operative serum AMH level. The intra-individual biological variation for AMH ranged from 12.1% to 26.3%, depending on time between the two samples. CONCLUSIONS This is the first paired study to investigate serum AMH values before and after salpingectomy in an unselected population of women presenting with an ectopic pregnancy, including both patients who conceived naturally and following fertility treatment. It was found that salpingectomy for ectopic pregnancy had no short-term effect on serum AMH levels, and changes in AMH levels were independent of age, time to follow-up, and pre-operative serum AMH level. Furthermore, the study demonstrated a 6-month biological variation of AMH of less than 30%.
Collapse
Affiliation(s)
- Anna Garcia-Alix Grynnerup
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark.
| | - Anette Lindhard
- Department of Obstetrics and Gynaecology, Zealand University Hospital Roskilde, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Steen Sørensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Hvidovre DK-2650, Denmark
| | - Mette Ørskov
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Kresten Rubeck Petersen
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Lisbeth Buss Madsen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Fie Pilsgaard
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Kristine Løssl
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Anja Pinborg
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| |
Collapse
|
5
|
Yoon SH, Lee JY, Kim SN, Chung HW, Park SY, Lee C. Does salpingectomy have a deleterious impact on ovarian response in in vitro fertilization cycles? Fertil Steril 2016; 106:1083-1092.e5. [DOI: 10.1016/j.fertnstert.2016.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022]
|
6
|
Sahin Ersoy G, Turhan OT, Sakin O, Bulut S. Comparison of the long-term effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of anti-müllerian hormone levels. HUM FERTIL 2016; 19:262-267. [DOI: 10.1080/14647273.2016.1214755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Ohannessian A, Crochet P, Courbiere B, Gnisci A, Agostini A. Methotrexate treatment for ectopic pregnancy after assisted reproductive technology: A case-control study. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:341-344. [PMID: 27216957 DOI: 10.1016/j.gyobfe.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Ectopic pregnancy (EP) occurs in 2% to 5.6% of pregnancies achieved by assisted reproductive technology (ART). EP treatment options include medical treatment by uses of methotrexate (MTX) systemic injection. The objective of this study was to compare MTX treatment effectiveness for EP occurring spontaneously or following ART. METHODS A case-control study performed in the department of obstetrics and gynecology at a tertiary health care center in France. Twenty EP achieved by ART (ART group) and 60 spontaneous EP (SEP group) received MTX treatment between January 2002 and May 2012. The main outcome measures were MTX treatment failure rates, number of MTX injections administered and recovery time. RESULTS MTX treatment failure rates observed in ART and SEP groups were similar (3/20 [15%] versus 10/60 [17%]: OR=0.88 [0.22-3.58]). Mean duration of recovery time in patients with successful MTX treatment did not differ between ART and SEP groups (33±14 days versus 28±13 days, P=0.39). A second MTX injection was required more frequently in ART group than in SEP group (10/20 [50%] versus 10/60 [17%]: OR=5 [1.65-15.15]). CONCLUSIONS It is concluded that MTX treatment is equally effective for spontaneous EP and EP achieved by ART, two injections of MTX being more frequently required in case of ART.
Collapse
Affiliation(s)
- A Ohannessian
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - B Courbiere
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Gnisci
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| |
Collapse
|
8
|
Boots CE, Hill MJ, Feinberg EC, Lathi RB, Fowler SA, Jungheim ES. Methotrexate does not affect ovarian reserve or subsequent assisted reproductive technology outcomes. J Assist Reprod Genet 2016; 33:647-656. [PMID: 26943917 DOI: 10.1007/s10815-016-0683-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE 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.
Collapse
Affiliation(s)
- Christina E Boots
- Obstetrics and Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA.
| | - Micah J Hill
- Program in Reproductive and Adult Endocrinology, National Institute of Health, 10 Center Dr Room 1-3140, MSC 1109, Bethesda, MD, 20892, USA
| | - Eve C Feinberg
- Reproductive Endocrinology and Infertility, Fertility Centers of Illinois, 767 Park Ave, Suite 190, Highland Park, IL, 60035, USA
| | - Ruth B Lathi
- Obstetrics and Gynecology, Stanford University, 900 Welch Rd #350, Palo Alto, CA, 94304, USA
| | - Susan A Fowler
- Bernard Becker Medical Library, Washington University, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - Emily S Jungheim
- Obstetrics and Gynecology, Washington University, 4444 Forest Park, Suite 3100, St. Louis, MO, 63108, USA
| |
Collapse
|
9
|
Pereira N, Gerber D, Gerber RS, Lekovich JP, Elias RT, Spandorfer SD, Rosenwaks Z. Effect of Methotrexate or Salpingectomy for Ectopic Pregnancy on Subsequent In Vitro Fertilization–Embryo Transfer Outcomes. J Minim Invasive Gynecol 2015; 22:870-6. [DOI: 10.1016/j.jmig.2015.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 12/11/2022]
|
10
|
Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015; 13:30. [PMID: 25884617 PMCID: PMC4403912 DOI: 10.1186/s12958-015-0025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. METHODS The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected. RESULTS A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence. CONCLUSIONS EP/HP are tragic events in a couple's reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.
Collapse
Affiliation(s)
- Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdiyah Campus, PO Box 7607, Makkah, KSA.
| | - Elizabeth Dalton
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - William L Ledger
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
| |
Collapse
|
11
|
Ohannessian A, Loundou A, Courbiere B, Cravello L, Agostini A. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod 2014; 29:1949-56. [DOI: 10.1093/humrep/deu174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
12
|
Hill MJ, Cooper JC, Levy G, Alford C, Richter KS, DeCherney AH, Katz CL, Levens ED, Wolff EF. Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location. Fertil Steril 2013; 101:413-9. [PMID: 24269042 DOI: 10.1016/j.fertnstert.2013.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/08/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART). DESIGN Retrospective cohort study. SETTING Large ART practice. PATIENT(S) Women receiving methotrexate or surgery after ART. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle-stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield compared between women treated with methotrexate or surgery, with secondary outcomes of clinical pregnancy and live birth. RESULT(S) There were 153 patients in the methotrexate group and 36 patients in the surgery group. Neither group demonstrated differences in ovarian reserve or oocyte yield in a comparison of the before and after treatment values. The change in ovarian reserve and oocyte yield after treatment were similar between the two groups. The number of doses of methotrexate was not correlated with changes in ovarian reserve, indicating no dose-dependent effect. Time between treatment and repeat ART was not correlated with outcomes. Live birth in subsequent cycles was similar in the two groups. CONCLUSION(S) Ovarian reserve and subsequent ART cycle outcomes were reassuring after methotrexate or surgical management of ectopic pregnancy. No adverse impact of methotrexate was detected in this large fertility cohort as has been previously described elsewhere.
Collapse
Affiliation(s)
- Micah J Hill
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | | | - Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Connie Alford
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Kevin S Richter
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Charles L Katz
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Eric D Levens
- Shady Grove Fertility Reproductive Science Center, Rockville, Maryland
| | - Erin F Wolff
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|