REVIEW PAPER
Fertility after methotrexate treatment for ectopic pregnancy: a narrative review.
1
Malopolski Institute of Fertility Diagnostics and Treatment – KrakOvi, Krakow, Poland
2
Independent Researcher
3
Department of Genetics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
Submission date: 2025-05-19
Final revision date: 2025-06-05
Acceptance date: 2025-06-16
Publication date: 2025-07-28
Corresponding author
Alicja Lachowska
Malopolski Institute of Fertility Diagnostics and Treatment – KrakOvi, Krakow, Poland
Malopolski Institute of Fertility Diagnostics and Treatment – KrakOvi, Krakow, Poland
Medicine and Public Health 2024;2(2):1-11
KEYWORDS
TOPICS
ABSTRACT
Background:
Ectopic pregnancy (EP) occurs in up to 2% of all pregnancies, and its most common location is the fallopian tube. Treatment options include methotrexate (MTX), surgery and expectant management.
Material and methods:
This review synthesizes the most important studies investigating the effect of MTX therapy for EP on subsequent female fertility.
Results:
MTX treatment for EP does not seem to influence ovarian reserve. There are few studies and multiple discrepancies regarding tubal patency after MTX treatment. The pooled long-term rate of intrauterine pregnancies after MTX treatment was 69.6%, and of recurrent EP, 10.1%. MTX administered for EP treatment has a similar or better effect on subsequent fertility compared to surgery or expectant management.
Conclusions:
MTX administration for EP gives equal or better outcomes in terms of subsequent fertility compared to other treatment methods. However, the chances of pregnancy are lower than in the general population. Due to the small number of RCTs and studies with long-term follow-up, future research is needed to provide definitive conclusions.
Ectopic pregnancy (EP) occurs in up to 2% of all pregnancies, and its most common location is the fallopian tube. Treatment options include methotrexate (MTX), surgery and expectant management.
Material and methods:
This review synthesizes the most important studies investigating the effect of MTX therapy for EP on subsequent female fertility.
Results:
MTX treatment for EP does not seem to influence ovarian reserve. There are few studies and multiple discrepancies regarding tubal patency after MTX treatment. The pooled long-term rate of intrauterine pregnancies after MTX treatment was 69.6%, and of recurrent EP, 10.1%. MTX administered for EP treatment has a similar or better effect on subsequent fertility compared to surgery or expectant management.
Conclusions:
MTX administration for EP gives equal or better outcomes in terms of subsequent fertility compared to other treatment methods. However, the chances of pregnancy are lower than in the general population. Due to the small number of RCTs and studies with long-term follow-up, future research is needed to provide definitive conclusions.
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