Methotrexate as a possible cause of ovarian cysts formation: Experience with women treated for ectopic pregnancies

Objective: To evaluate ovarian morphology after either salpingostomy or local injection of methotrexate (MTX) to cause regression of tubal pregnancies and to define potential correlation to other clinical parameters. Design: Prospective longitudinal follow-up. Setting: Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel. Patient(s): One hundred one women who were treated for tubal pregnancy: 58 by salpingostomy and 43 by local MTX injection. Intervention(s): Serial blood sampling for β-hCG and serial transvaginal sonographic evaluation. Main Outcome Measure(s): Appearance of cysts in the ovaries and their location with regard to the side in which the tubal pregnancy occurred. Result(s): In 6 of 42 (14.3%) patients who were treated with MTX, multiple (range, three to six) ovarian cysts occurred, as compared with 1 of 55 (1.8%) in those who underwent salpingostomy. The largest cyst was 9.4 cm in diameter. No relation of cyst occurrence to the side of the ectopic pregnancy was recorded. The women who developed cysts did not differ in either initial serum β-hCG levels or in the rate of its subsequent regression. Conclusion(s): Multiple ovarian cysts may occur in 15% of patients who are treated with intra-amniotic MTX to cause regression of tubal ectopic pregnancy.