TABLE 2

Multiple-dose MTX treatment protocol (28, 29).

Treatment day Laboratory evaluation

Pretreatment hCG, CBC with differential, livertests, creatinine, blood type aantibody screen

1 hCG23 hCG

In both single- and multiple-dose MTX treatment proto-cols, once hCG levels have met the criteria for initial decline,hCG levels are followed serially at weekly intervals to ensurethat concentrations decline steadily and become undetect-able. Complete resolution of an ectopic pregnancy usuallytakes between 2 and 3 weeks but can take as long as 6 to 8weeks when pretreatment hCG levels are in higher ranges(29, 30, 35). When declining hCG levels again rise, the diag-nosis of a persistent ectopic pregnancy is made.

TABLE 3Single-dose MTX treatment protocol (33).

Treatment day Laboratory eval

Pretreatment hCG, CBC with diffliver function tescreatinine, bloodand antibody scr

1 hCG4 hCG7 hCG

Note: Surveillance every 7 days (until hCG <5 mIU/mL).

ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008.

S208 ASRM Practice Commitee Treatment of ectopic pre

Intervention

functionnd

Rule out spontaneous AbRhogam if Rh negative

MTX 1.0 mg/kg IMLEU 0.1 mg/kg IMMTX 1.0 mg/kg IM if <15% decline day

1–day 3

If >15%, stop treatment and start

surveillance4 LEU 0.1 mg/kg IM5 hCG MTX 1.0 mg/kg IM if <15% decline day

3–day 5If >15%, stop treatment and start

surveillance6 LEU 0.1 mg/kg IM7 hCG MTX 1.0 mg/kg IM if <15% decline day

5–day 7If >15%, stop treatment and start

surveillance8 LEU 0.1 mg/kg IM

Note: Surveillance every 7 days (until hCG <5 mIU/mL).Screening laboratory studies should be repeated 1 week after the last dose of MTX. LEU ¼ leucovorin; IM ¼ intramuscu-

larly.

ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008.

When the criteria described earlier are fulfilled, treatmentwith MTX yields treatment success rates comparable to thoseachieved with conservative surgery (2, 30, 31). Numerousopen-label studies have been published demonstrating the ef-ficacy of both MTX treatment regimens. One review con-cluded that MTX treatment was successful in 78%–96% ofselected patients. Post-treatment hysterosalpingographydocumented tubal patency in 78% of cases; 65% of patientswho attempted subsequent pregnancies succeeded, and the

uation Intervention

erential,ts,typeeen

Rule out spontaneous AbRhogam if Rh negative

MTX 50 mg/m2 IM

MTX 50 mg/m2 IM if b-hCGdecreased <15%between day 4 and day 7

gnancy Vol. 90, Suppl 3, November 2008