Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis.

STUDY QUESTION Does previous methotrexate (MTX) treatment for ectopic pregnancy (EP) have an effect on ovarian response in women receiving fertility treatment? SUMMARY ANSWER MTX treatment for EP does not seem to affect subsequent fertility treatment. WHAT IS KNOWN ALREADY MTX is commonly used to treat EPs that are diagnosed early. Previous studies have reported conflicting results about its effect on subsequent fertility treatments. STUDY DESIGN, SIZE, DURATION This systematic review and meta-analysis included a total of 329 patients who had participated in 7 observational studies. PARTICIPANTS/MATERIALS, SETTING, METHODS A search of the MEDLINE, EMBASE and PUBMED databases was conducted to identify studies about fertility treatments after MTX treatment for EP, published in English or French up to December 2013. Studies were eligible for inclusion only if they compared indicators of ovarian responsiveness during ART in the cycles before and after an injection of MTX for EP. The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the basal serum FSH level, duration of stimulation, total gonadotrophin dose and serum E2 level on the day of hCG triggering. MAIN RESULTS AND THE ROLE OF CHANCE The mean number of oocytes retrieved during the cycles before and after the MTX treatment did not differ significantly (P = 0.4). The comparisons before and after MTX treatment of the basal plasma FSH level, the duration of stimulation, the total gonadotrophin dose used for stimulation and the estradiol level on the day ovulation was triggered did not find any significant differences. LIMITATIONS, REASONS FOR CAUTION The literature on this topic is sparse, with few studies and even fewer of high methodological quality. WIDER IMPLICATIONS OF THE FINDINGS These results indicate that MTX to treat EP in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive. STUDY FUNDING/COMPETING INTERESTS This work received support from the Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.