Evaluation of the effect of multi-dose methotrexate therapy on ovarian reserve in ectopic pregnancies: is polycystic ovarian morphology a protective condition for ovarian reserve?

Abstract

Objectives: The study aims to evaluate the effects of multi-dose methotrexate (MTX) or subsequent salpingectomy on ovarian reserve and explain the conditions that cause the change in serum anti-müllerian hormone (AMH) levels. Material and methods: Our department had 58 tubal ectopic pregnancy (EP) patients treated with a multiple-dose MTX protocol or subsequent salpingectomy between 2017–2020. Serum AMH level was measured in each patient before the medication and 3–6 months after therapy. Patients’ details were recorded and analyzed later. Results: The mean AMH value decreased in 32 patients (−17.8%), increased in 26 patients (+31.5%) (p < 0.0001). In the group with an increase, there was a significantly high number of patients with a polycystic ovary (PCO) condition compared to the other group (p = 0.0001). The post-treatment serum AMH levels increased in patients with PCO, whereas those decreased in patients without PCO (p < 0.001). Conclusions: Multiple-dose MTX or subsequent salpingectomy treatment in tubal ectopic pregnancy (EP) patients might not refer to significant differences in patients’ AMH levels. Remarkably, post-treatment AMH levels were significantly increased in EP patients with PCO and decreased in those without this condition. PCO may be a protective condition for ovarian reserve.