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Human Reproduction, Vol. 10, No. 10, pp. 2719-2722, 1995
© 1995 European Society of Human Reproduction and Embryology

research-article

Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy

Gregory H. Corsan, Meric Karacan, Suna Qasim, Michael K. Bohrer, Mark X. Ransom and Ekkehard Kemmann

UMDNJ—New Jersey's University of the Health Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility New Brunswick, NJ, USA

Single-dose methotrexate is an alternative to surgery in treating ectopic pregnancy. Because success rates vary, we sought to identify factors which predict treatment outcome. A total of 44 women with ectopic gestation were treated. The non-laparoscopic diagnosis of ectopic pregnancy was made following history, physical examination, ultrasound, endometrial biopsy and the measurement of serial ({beta}-human chorionic gonadotrophin (HCG) and progesterone concentrations. Methotrexate (50 mg/m2 i.m.) was administered, with a second dose given 1 week later in patients with plateauing or rising {beta}-HCG concentrations. Of 44 patients, 23 (52.3%) were successfully treated with one dose. An additional 10 women (22.7%) were also successfully managed but required a second dose, giving an overall success rate of 75.0%. In all, 11 women (25.0%) required surgery, four of whom experienced tubal rupture. Receiver operator curves were constructed to optimally select pretreatment {beta}-HCG and progesterone cut-off concentrations for successful treatment. Using {beta}-HCG <1500 IU/1 or progesterone <7.0 ng/ml (22.3 nmol/1) as acut-off concentration produced a diagnostic test with a sensitivity of 87.5%, a specificity of 90.0%, a positive predictive value of 96.6% and a negative predictive value of 69.2%. Conversely, this model predicts that patients with serum {beta}-HCG concentrations >1500 IU/1 and progesterone concentrations >7.0 ng/ml are at far greater risk of failing single-dose methotrexate therapy.

Key words: ectopic pregnancy/HCG/methotrexate/progesterone


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