Determining the success rate of sequential methotrexate therapy in ectopic pregnancy and evaluating the effects of the treatment on ovarian reserve with anti mullerian hormone levels

In this study, it was aimed to evaluate the success rate, the parameters affecting the success or failure of the sequential multi-dose MTX protocol and the effects of the treatment on ovarian reserve in the treatment of ectopic pregnancy. Between 1.1.2017 and 30.12.2019, sequential multiple dose methotrexate protocol was applied due to ectopic pregnancy in Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, and a total of 63 patients who met the inclusion criteria regarding the study were included in the study. The demographic data, clinical parameters and laboratory values of the patients were extracted from the hospital data bank system, analyzed and the results were statistically compared with each other. The effects of treatment on ovarian reserve were evaluated by comparing AMH levels before and 3-6 months after treatment. In the study, P value less than 0.05 was considered as statistically significant. The success rate of the treatment was found to be 71.4% in 63 patients exposed to sequential multi-dose MTX protocol in this study. In this respect, our study results suggested that MTX treatment is an important alternative to surgical treatment in treating the patients with tubal ectopic pregnancy selected in accordance with the literature. Furthermore, contrary to many studies given in the literature, it was found that the amount of free fluid in douglas showed a statistically significant difference between the groups with and without successful medical treatment, and the success of the treatment was low in the group with high fluid volume (Padj = 0.009). According to the median value, AMH showed a decrease of 12.6% in patients with whom medical treatment were successful, and a 6.7% decrease in patients with whom medical treatment failed and underwent surgery. There was no statistically significant difference between AMH changes before and after treatment in groups with successful or unsuccessful medical treatment (Padj> 0.05). Although the main goal in patients with ectopic pregnancy is to prevent maternal mortality, it should be kept in mind that if the clinical conditions of the patients are appropriate, the treatment methods to be applied may cause infertility later. KEYWORDS: Ectopic Pregnancy, Methotrexate, Anti Müllerian Hormon, Ovarian Reserve, Multi-Dose