Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy.

Purpose: The purpose of this study was to evaluate the initial and day 4 beta-human chorionic gonadotropin (β-hCG) levels as a predictor of methotrexate (MTX) therapy success for ectopic pregnancy.

Methods: Retrospective study of 87 patients with tubal ectopic pregnancy treated with a single dose of 50 mg/m(2) MTX at Bursa Şevket Yılmaz Research and Education Hospital between January 2011 and July 2012 was performed.

Results: The overall success rate is measured as 72.4 %. The two groups of patients, successfully treated patients (n = 63) and unsuccessfully treated patients (n = 24), were compared. The mean initial β-hCG level was significantly lower in the treatment success group than in the treatment failure group (1,417 mIU/mL versus 5,995 mIU/mL, p < 0.001). The number of cases with decreasing β-hCG level on day 4 was significantly more in the success group compared to the failure group (61.9 and 37.5 %, respectively, p = 0.04). The success rate was 90 % when β-hCG levels were <1,000 mIU/mL, 85.7 % when the levels were between 1,000 and 1,999 mIU/mL, and 76.5 % when the levels were between 2,000 and 2,999 mIU/mL, 54.5 % when the levels were between 3,000 and 3,999 mIU/mL.

Conclusion: Single-dose MTX therapy is a safe and effective treatment modality for tubal ectopic pregnancies with the β-hCG serum concentration below 3,000 mIU/mL, and β-hCG level changes between days 0 and 4 after MTX therapy are important in predicting the outcome of treatment.