REPRODUCTIVE OUTCOME AFTER METHOTREXATE TREATMENT OF TUBAL PREGNANCIES

OBJECTIVE: To evaluate subsequent pregnancy outcomes in women who have been treated with methotrexate for tubal pregnancies. METHODS: Descri ptive study of subsequent pregnancy outcomes in 170 women who were tre ated with methotrexate for tubal pregnancy at Brigham and Women's Hosp ital during 1989-1994. Patients who agreed to participate were adminis tered a telephone interview. Fertility rates and outcomes were calcula ted for patients who tried to conceive after receiving methotrexate. R ESULTS: One hundred four of the 170 women with tubal pregnancies ident ified during the study period returned their consent forms. The other 66 patients were either unable to be reached by phone, and/or their co nsent form was returned without a forwarding address. Ninety-four pati ents (90%) agreed to participate in the study. Eighty-two (87%) women tried to conceive after receiving methotrexate for their tubal pregnan cies, and 57 (70%) were successful. Forty-six (81%) of the 57 women ex perienced intrauterine pregnancies, and 11 (19%) had recurrent tubal p regnancies. When the first subsequent postmethotrexate outcome was exa mined, there were 26 (46%) term births, 5 (9%) preterm births, 11 (19% ) recurrent ectopics and 15 (26%) spontaneous abortions. Over the six- year study period, 42 (74%) women had at least one live birth. There w ere no congenital anomalies Or stillbirths in the subsequent pregnanci es. CONCLUSION: Pregnancy outcomes after methotrexate treatment for tu bal pregnancy are comparable to reported experience with surgical ther apy. Patients who are treated with methotrexate for tubal pregnancies can be assured that their methotrexate exposure should have no untowar d effects on subsequent pregnancies.