Reproductive Outcomes After Methotrexate Therapy for Ectopic Pregnancy

Background & Objective: Ectopic Pregnancies (EP) account for about 2% of pregnancies. If diagnosis and treatment are not rapidly performed, it may result in an acute emergency status that can account for about 6% of pregnancy-related deaths. The present study was conducted with aim to evaluate reproductive outcomes following methotrexate therapy for ectopic pregnancy, including probabilities of spontaneous pregnancy, use of Assisted Reproductive Technology (ART), live birth, abortion, and recurrent Ectopic Pregnancy (EP). Materials & Methods: This retrospective-prospective cohort study was conducted at Shariati Hospital in Tehran, Iran. The outcomes of pregnancy were analyzed in 123 women treated with methotrexate for EP. Data collected from hospital records included maternal age, gestational age, parity, smoking status, and medical history. Patients were followed up to assess future pregnancy outcomes, including spontaneous pregnancy, live birth, abortion, recurrent EP, and need for ART. Results: The mean age of women was 31.3±6.0 years and the mean gestational age was 6.6±2.1 weeks. The average number of prior pregnancies was 1.2±1.2. Among the participants, 21% had a history of infertility, 33% had prior miscarriages, and 13% had a history of ectopic pregnancies. Over a two-year follow-up, 44% pursued additional pregnancies, 38% conceived naturally, and 18% used Assisted Reproductive Technology (ART). More than half of the pregnancies occurred within 7 to 48 months after methotrexate treatment, and there were no recurrences of ectopic pregnancy or abortions reported. Conclusion: The findings of this study suggest that experiencing an ectopic pregnancy should not be a cause for concern regarding adverse outcomes in future pregnancies. Women can be reassured that the likelihood of achieving a subsequent pregnancy is favorable within two years after methotrexate treatment for EP.