Fertility Outcome after Treatment of Unruptured Ectopic Pregnancy with Two Different Methotrexate Protocols

Background: The purpose of this study was to compare the success rates of 70 patients from thesame database, each with an ectopic pregnancy (EP) that was treated with either the single- ormulti-dose methotrexate (MTX) protocols for unruptured EPs.Materials and Methods: This study was a blinded, randomized clinical trial. Treatment protocolswere either single- (50 mg/m2) dose MTX or multi-dose (1 mg/kg MTX + 0.1 mg/kg folinic acid).There were 35 cases in each group. The outcome was measured by adverse events, resolution ofpregnancy without surgical treatment, success rate of MTX treatment, and fertility outcome in eachgroup.Results: With the single-dose protocol, response to treatment was considered successful in 29(82.9%) patients; in the multi-dose protocol 31 (88.6%) responded to treatment. The differencebetween success rates in the groups was not statistically significant (p=0.587). In the singledosegroup, 2 (5.7%) patients and in the multi-dose group, 6 (17.2%) patients had complications(p=0.28). Of the 14 patients in the single-dose group. Clinical pregnancy occurred in 9 (75%)whereas clinical pregnancy occurred in 3 (25%) patients from the multi-dose group. Infertilitywas seen in 4 (33.3%) patients in the single-dose group and in 8 (66.7%) in the multi-dosegroup.Conclusion: We believe that the single-dose MTX protocol could be as successful as multi-doseMTX for the treatment of EP. It is effective, cost-effective, and associated with better fertilityoutcomes than the multi-dose MTX protocol (Registration Number: IRCT201112178435N1).