Cansu ÖNAL KANBAŞ, Esra KELEŞ, Evrim BOSTANCI ERGEN, Mustafa EROĞLU
Zeynep Kamil Medical Journal - 2026;57(2):69-73
Objective: This study aimed to validate various beta-hCG decline thresholds for predicting the success of single-dose methotrexate (MTX) treatment, compare fertility outcomes across different treatment modalities, and identify predictors of treatment success in women with tubal ectopic pregnancy (EP). Material and Methods: This retrospective study included 687 women diagnosed with tubal EP and treated with a single-dose MTX protocol between January 2013 and May 2018. Data collected included patient demographics, clinical presentation, serial beta-hCG levels, ultrasound findings, treatment modalities, and subsequent fertility outcomes. The predictive value of different percentage declines in beta-hCG levels between Days 0-4 and Days 4-7 was analyzed. Results: The study included women with a mean age of 30.65+/-5.64 years (range: 16-53). A decline of >=40% in beta-hCG levels between Day 4 and Day 7 following MTX treatment ruled out the need for second-line intervention with 57% sensitivity and 96% specificity (AUC=0.87, 95% CI: 0.81-0.93, p<0.0001). Patients successfully treated with MTX exhibited a significantly greater mean beta-hCG decline (0.39+/-0.24) compared with those requiring second-line intervention (0.08+/-0.22; p<0.0001). Conclusion: Higher beta-hCG decline thresholds between Day 4 and Day 7 demonstrate high specificity for predicting successful MTX treatment in tubal EP. Tubal-preserving strategies, such as salpingostomy and MTX, appear to be associated with improved subsequent pregnancy rates compared with salpingectomy.
