PURPOSE:The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF).
METHODS:A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50 mg/m2). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX.
RESULTS:Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499 IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342 IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery.
CONCLUSION:This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.
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【Clinical predictors of failing one dose of methotrexate for ectopic pregnancy after in vitro fertilization.].
【体外受精后甲氨蝶呤因异位妊娠失败的临床预测。】
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DOI：10.1007/s10815-016-0861-7文章类型：杂志文章
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目的：本研究的目的是研究单剂量甲氨蝶呤（MTX）在体外受精（IVF）后处理异位妊娠失败的临床预测指标。
方法：一项回顾性队列研究是对2007年至2014年间在学术不育诊所接受新鲜或冷冻IVF周期后异位妊娠并接受肌内MTX（50 mg / m2）的女性进行的。成功的单剂量MTX治疗定义为治疗后第4天至第7天血清β-人绒毛膜促性腺激素（hCG）下降≥15％。使用针对卵母细胞年龄，转移的胚胎数和先前的异位妊娠进行调整的逻辑回归模型，以评估一剂MTX失败的调整后的优势比（OR）（95％置信区间[CI]）。
结果：纳入IVF后异位妊娠的64例患者。四十只只需要一剂MTX（62.5％），而十五只需要单独的MTX（最多四剂，占总剂量的23.4％），九只需要手术（占14.1％）。通过多变量logistic回归分析，血清hCG的最高三分位数在峰值（≥499IU / L，OR = 9.73，CI 1.88-50.25）和首次MTX给药时（≥342IU / L，OR = 4.74，CI 1.11-20.26） ，更少的胚胎被移植（每增加一个胚胎，OR = 0.37，CI 0.19-0.74）和超声附件质量（OR = 3.65，CI 1.10-12.11）都与需要额外MTX和/或手术的几率相关。
结论：这是第一项报道IVF后异位妊娠妇女的hCG较高，尽管其远低于自发妊娠所描述的治疗失败阈值，但胚胎移植却少了，而附件包块与一次剂量的失败失败的可能性更大。 MTX。这些发现可用于就单剂量MTX成功的可能性向IVF患者提供咨询。
方法：一项回顾性队列研究是对2007年至2014年间在学术不育诊所接受新鲜或冷冻IVF周期后异位妊娠并接受肌内MTX（50 mg / m2）的女性进行的。成功的单剂量MTX治疗定义为治疗后第4天至第7天血清β-人绒毛膜促性腺激素（hCG）下降≥15％。使用针对卵母细胞年龄，转移的胚胎数和先前的异位妊娠进行调整的逻辑回归模型，以评估一剂MTX失败的调整后的优势比（OR）（95％置信区间[CI]）。
结果：纳入IVF后异位妊娠的64例患者。四十只只需要一剂MTX（62.5％），而十五只需要单独的MTX（最多四剂，占总剂量的23.4％），九只需要手术（占14.1％）。通过多变量logistic回归分析，血清hCG的最高三分位数在峰值（≥499IU / L，OR = 9.73，CI 1.88-50.25）和首次MTX给药时（≥342IU / L，OR = 4.74，CI 1.11-20.26） ，更少的胚胎被移植（每增加一个胚胎，OR = 0.37，CI 0.19-0.74）和超声附件质量（OR = 3.65，CI 1.10-12.11）都与需要额外MTX和/或手术的几率相关。
结论：这是第一项报道IVF后异位妊娠妇女的hCG较高，尽管其远低于自发妊娠所描述的治疗失败阈值，但胚胎移植却少了，而附件包块与一次剂量的失败失败的可能性更大。 MTX。这些发现可用于就单剂量MTX成功的可能性向IVF患者提供咨询。
