Conservative treatment of ectopic pregnancy and its effect on corpus luteum activity

Corpus luteum activity was monitored in 15 women undergoing nonsurgical management of ectopic pregnancy with local methotrexate injection followed by alternating oral methotrexate and citrovorum factor (group A, n = 8) or local methotrexate injection alone (group B, n = 7). All patients initially demonstrated a viable corpus luteum (plasma progersterone ranged from 1.4 to 19 ng/ml). The treatment was successful in 14, with the exception of one whose tube ruptured 11 days after local administration of methotrexate, despite a continuous decrease in β human chorionic gonadotropin, 17β-estradiol and plasma progesterone levels. There seems to be no correlation between the success of the treatment and the behavior of β human chorionic gonadotropin, 17β-estradiol and plasma progesterone. Three patients from group A and two from group B displayed an initial rise in β human chorionic gonadotropin following the initiation of the therapy, but the corpus luteum response differed. In group B patients, 17β-estradiol and plasma progesterone levels increased in parallel with β human chorionic gonadotropin. Group A patients displayed a continuous decrease in 17β-estradiol and plasma progesterone levels despite the elevation of β human chorionic gonadotropin, suggesting a possible effect of the systemic methotrexate on corpus luteum activity.