Methotrexate for assisted reproductive technology (ART) ectopic pregnancy.
Methotrexate for assisted reproductive technology (ART) ectopic pregnancy.
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甲氨蝶呤用于辅助生殖技术（ART）异位妊娠。
DOI：
10.1016/j.fertnstert.2013.11.124
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发表时间：
2014
影响因子：
6.7
通讯作者：
Wolff,ErinF
中科院分区：
文献类型：
--
作者：
Hill,MicahJ;Levens,EricD;Wolff,ErinF
Moragianni博士（1）在我们最近的出版物上发表的社论评论，评估甲氨蝶呤对卵巢储备和随后的辅助生殖技术（ART）治疗结果的影响（2）。甲氨蝶呤的潜在不良反应，特别是在不孕患者接受卵巢过度刺激进行ART后使用时，仍然是一个重要问题。正如Moragianni博士所总结的，大多数文献并未证明甲氨蝶呤的不良反应。然而，由于目前所有研究都是回顾性的，因此数据有限。一项具有充分把握度的随机对照试验将是明确回答这一问题的最合适方法。然而，ART后异位妊娠发生率较低，这使得以前瞻性方式解决这一问题成为一项挑战。我们的研究需要在一个繁忙的忙碌生殖技术项目中进行7年的时间跨度，以收集189名患者。今年早些时候发表的DEMETER（异位妊娠治疗策略的评价和随后生育能力的评价）试验是解决这个问题的一个很好的研究模型（3）。DEMETER试验在法国的17个中心进行，为期5年，随机选择有生育能力的妇女自发发生异位妊娠，接受甲氨蝶呤或保守手术。需要200名受试者才能有80%的把握度来检测随后累积生育率的20%差异。治疗2年后，甲氨蝶呤组的累积妊娠率为67%，手术组为71%，表明甲氨蝶呤对自发生育人群的生育力无显著不良影响。
We read with interest the editorial commentary by Dr. Moragianni (1) on our recent publication, evaluating the effect of methotrexate on ovarian reserve and subsequent assisted reproductive technology (ART) treatment outcomes (2). The potential adverse effects of methotrexate, specifically when used in infertile patients after ovarian hyperstimulation for ART, remain an important issue. As Dr. Moragianni summarizes, the majority of the literature does not demonstrate an adverse effect of methotrexate. However, the data are limited by the fact that all of the current studies are retrospective. An adequately powered randomized controlled trial would be the most appropriate way to answer this question definitively. However, the low rate of ectopic pregnancy occurring after ART has made addressing this issue in a prospective manner a challenge. Our study required a 7-year time span at a busy ART program to accrue 189 patients.The DEMETER (Evaluation of Therapeutic Strategies for Treatment of Ectopic Pregnancies and Evaluation of Subsequent Fertility) trial published earlier this year serves as a good study model to address this question (3). The DEMETER trial took place in 17 centers in France over a 5-year time frame, randomizing spontaneously occurring ectopic pregnancies in fertile women to methotrexate or conservative surgery. Two hundred subjects were necessary to have a power of 80% to detect a 20% difference in subsequent cumulative fertility rates. Two years after treatment, the cumulative pregnancy rates were 67% in the methotrexate arm and 71% in the surgical arm, demonstrating no significant adverse effect of methotrexate on fertility in a spontaneously fertile population.