The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Investigation and Comparison of Anti-Mullerian Hormone in Patients with Tubular Ectopic Pregnancy Treated with Methotrexate and Laparoscopy: A Randomized Clinical Trials Study

Document Type : Original Article

Authors
Marzieh Aghahosseini 1
Samaneh Ebrahiminezhad 2
Ashraf Aleyassin 1
Atoosa Etezadi 3
Sahar Bagheri 2
Marziyeh Asadpour 2
Ayda Najafian 4
1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2 Resident, Department of Gynecology and Obstetrics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department of Obstetrics and Gynecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
4 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
10.22038/ijogi.2026.83733.6248
Abstract
Introduction: Ectopic pregnancy (EP) is one of the main causes of maternal mortality and morbidity in early pregnancy and affects 1-2% of all pregnant women. Common treatments include pharmacological treatment with methotrexate and surgery. Anti-Mullerian Hormone (AMH) is considered as one of the reliable predictor of ovarian reserve. The present study was conducted with aim to compare the effects of laparoscopic salpingectomy and methotrexate treatment on AMH levels in patients with tubular ectopic pregnancy.
Methods: This randomized clinical trial study was conducted in 2024 on 50 patients with tubular ectopic pregnancy who met the inclusion criteria at Shariati Hospital, Tehran. Patients were assigned to two groups of 25, including the laparoscopic salpingectomy group and the single-dose methotrexate treatment group (1 mg/kg). AMH levels were measured before the intervention and 3 to 6 months after the treatment, and the initial and secondary values and the rate of its changes between the two groups were compared. Data analysis was performed using SPSS statistical software (version 22) and independent t-test. P<0.05 was considered significant.
Results: The two groups did not differ significantly in terms of changes in AMH levels (p=0.94), although the decrease was slightly greater in the methotrexate group. Also, there was a significant inverse correlation between age and primary and secondary AMH levels in the two groups, and this correlation was stronger in the methotrexate group (p=0.0001). However, no significant relationship was found between ang and changes in AMH levels (p≥0.05).
Conclusion: As the result of the present study showed, treatment with single-dose methotrexate and laparoscopic unilateral salpingectomy as two common and safe treatment options for EP have no significant difference in terms of effect on ovarian reserve.
Keywords
Ectopic Pregnancy
Methotrexate
Ovarian Reserve
Salpingectomy
Subjects
1.        Hendriks E, Rosenberg R, Prine L. Ectopic pregnancy: diagnosis and management. American family physician 2020; 101(10):599-606.
2.        Obeagu EI, Faduma MH, Uzoma G. Ectopic Pregnancy: A Review. Int J Curr Res Chem Pharm Sci 2023; 10(4):40–4.
3.        Al Naimi A, Moore P, Brüggmann D, Krysa L, Louwen F, Bahlmann F. Ectopic pregnancy: a single-center experience over ten years. Reproductive biology and endocrinology 2021; 19(1):79.
4.        Miraj S, Forood AM, Azimi S, Panahinia P, Ebadi E, Moradpanah S, et al. The cardiovascular burden of gonadotropin-releasing hormone (GnRH) therapy: mechanisms, risks, and interventions. Cardiovascular Toxicology 2025; 25(9):1411-28.
5.        Di Gennaro D, Damiani GR, Muzzupapa G, Stomati M, Cicinelli R, Gaetani M, et al. Ectopic pregnancy: an overview. Clinical and Experimental Obstetrics & Gynecology 2022; 49(12).
6.        Rajaei E, Shahbazian N, Rezaeeyan H, Mohammadi AK, Hesam S, Zayeri ZD. The effect of lupus disease on the pregnant women and embryos: a retrospective study from 2010 to 2014. Clinical rheumatology 2019; 38(11):3211-5.
7.        Hafizi L, Parsai N, Abolhasani Y, Zeinadini S, Shahryarpanah Z, Sameipoor F, et al. Laparoscopic management of endometriosis; new techniques and clinical outcomes. Immunopathologia Persa 2026; 12(2):e44037-.
8.        Boza B, Akşar M, Tolunay HE, Api M. The effect of administration of methotrexate for ectopic pregnancy on ovarian reserve. Eastern Journal of Medicine 2023; 28(2):296-300.
9.        Salem Ahim S, Kazemi M, Boroomand-Saboor M, Zamanpour Z, Rahbarinezhad H, Mahmoodvand T, et al. Role of uterine artery Doppler sonography in prediction and management of preeclampsia: a systematic review analysis of the recent 10-year evidence. J Prev Epidemiol 2026; 11(2):e39328.
10.     Zargar M, ShahAli S, Moramezi F, Shahbazian N. Effect of Single and Multiple Methotrexate Doses Treatment on Ovarian Reserve in Ectopic Pregnancy Women: A Prospective Cohort Study. The Journal of Obstetrics and Gynecology of India 2025; 75(1):22-7.
11.     Sakcak B, Tekyol KK, Adıgüzel C, Yücel O. Evaluation of Ovarian Reserves of Patients who Have Received Methotrexate Treatment Due to Ectopic Pregnancy. Haydarpaşa Numune Medical Journal 2023; 63(2):198.
12.     Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical methods in medical research 2016; 25(3):1057-73.
13.     Centers for Disease Control and Prevention (CDC. Ectopic pregnancy--United States, 1990-1992. MMWR. Morbidity and mortality weekly report 1995; 44(3):46-8.
14.     Roudebush WE, Kivens WJ, Mattke JM. Biomarkers of ovarian reserve. Biomarker insights 2008; 3:BMI-S537.
15.     Svirsky R, Rozovski U, Vaknin Z, Pansky M, Schneider D, Halperin R. The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Reproductive Toxicology 2009; 27(1):85-7.
16.     Azimi SA, Siyasari A, Nasrabad SA, Saboori A, Biglarifar R, Shamsghahfarokhi S, et al. Socioeconomic disparities in uterine cervical cancer burden; an ecological assessment of global incidence and mortality patterns by human development index in 2022. Immunopathologia Persa 2025; 12(1):e43960-.
17.     Gracia CR, Sammel MD, Freeman E, Prewitt M, Carlson C, Ray A, et al. Impact of cancer therapies on ovarian reserve. Fertility and sterility 2012; 97(1):134-40.
18.     Lantinga GM, Simons AH, Kamps WA, Postma A. Imminent ovarian failure in childhood cancer survivors. European Journal of Cancer 2006; 42(10):1415-20.
19.     Uyar I, Yucel OU, Gezer C, Gulhan I, Karis B, Hanhan HM, et al. Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy. Fertility and sterility 2013; 100(5):1310-3.
20.     Boots CE, Gustofson RL, Feinberg EC. Does methotrexate administration for ectopic pregnancy after in vitro fertilization impact ovarian reserve or ovarian responsiveness?. Fertility and sterility 2013; 100(6):1590-3.
21.     Hill MJ, Cooper JC, Levy G, Alford C, Richter KS, DeCherney AH, et al. Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location. Fertility and sterility 2014; 101(2):413-9.
22.     Orvieto R, Kruchkovich J, Zohav E, Rabinson J, Anteby EY, Meltcer S. Does methotrexate treatment for ectopic pregnancy influence the patient's performance during a subsequent in vitro fertilization/embryo transfer cycle?. Fertility and sterility 2007; 88(6):1685-6.
23.     Oriol B, Barrio A, Pacheco A, Serna J, Zuzuarregui JL, Garcia-Velasco JA. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve. Fertility and sterility 2008; 90(5):1579-82.
24.     Provansal M, Agostini A, Lacroix O, Gerbeau S, Grillo JM, Gamerre M. Ultrasound monitoring in patients undergoing in‐vitro fertilization after methotrexate treatment for ectopic pregnancy. Ultrasound in Obstetrics and Gynecology 2009; 34(6):715-9.
25.     Ulug P, Oner G. Evaluation of the effects of single or multiple dose methotrexate administration, salpingectomy on ovarian reserve of rat with the measurement of anti-Müllerian hormone (AMH) levels and histological analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2014; 181:205-9.
26.     Ye XP, Yang YZ, Sun XX. A retrospective analysis of the effect of salpingectomy on serum antiMüllerian hormone level and ovarian reserve. American journal of obstetrics and gynecology 2015; 212(1):53-e1.
27.     Sahin C, Taylan E, Akdemir A, Ozgurel B, Taskıran D, Ergenoglu AM. The impact of salpingectomy and single-dose systemic methotrexate treatments on ovarian reserve in ectopic pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016; 205:150-2.
28.     Sezik M, Ozkaya O, Demir F, Sezik HT, Kaya H. Total salpingectomy during abdominal hysterectomy: effects on ovarian reserve and ovarian stromal blood flow. Journal of Obstetrics and Gynaecology Research 2007; 33(6):863-9.
29.     Lin YJ, Ou YC, Huang FJ, Lin PY, Kung FT, Lan KC. Ovarian response to gonadotropins in patients with tubal factor infertility: salpingectomy versus nonsalpingectomy. Journal of minimally invasive gynecology 2013; 20(5):637-41.
30.     Almog B, Wagman I, Bibi G, Raz Y, Azem F, Groutz A, et al. Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal. Fertility and sterility 2011; 95(8):2474-6.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 2
April 2026
Pages 1-11