Medical treatment of ectopic pregnancy with methotrexate: outcomes across the 5000 IU/L β-hCG threshold

Abstract

Abstract Purpose To evaluate the clinical significance of establishing a 5000 IU/L β-hCG threshold in the selection of patients for medical treatment of ectopic pregnancy. Materials and methods Between January 2019 and August 2025, a total of 182 patients diagnosed with ectopic pregnancy were treated at Mersin University Faculty of Medicine. Of these, 50% ( n = 91) underwent medical management with single-dose methotrexate, 42.9% ( n = 78) received surgical intervention, and 7.1% ( n = 13) were managed through clinical follow-up alone. Demographic, clinical, and procedural data pertaining to these patients were retrospectively collected from the institutional hospital registry. Comparisons between categorical variables (treatment success vs. β-hCG groups) were performed using the Chi-square test. Continuous variables were analyzed with independent samples t-test or Mann–Whitney U test depending on distribution. Logistic regression was applied to evaluate the effect of β-hCG > 5000 IU/L on treatment success, with odds ratios (OR) and 95% confidence intervals (CI) reported. Statistical significance was defined as p < 0.05. Results Among the 91 patients who received methotrexate treatment, an overall success rate of 92.3% was observed. Complete response was achieved in 95.8% of patients with serum β-hCG levels ≤ 5000 IU/L, while 80% of patients with levels > 5000 IU/L responded successfully. Surgical intervention was required in four patients from the high β-hCG group. The need for a second dose of methotrexate was identified with higher rates in the > 5000 IU/L (40.0%) compared to the ≤ 5000 IU/L group (14.1%). Mean β-hCG levels were 2429 ± 1543 IU/L and 8953 ± 2611 IU/L, respectively. Statistical analysis confirmed that serum β-hCG levels significantly influenced treatment success ( p = 0.039). Patients with serum β-hCG > 5000 IU/L had significantly reduced odds of treatment success, with a 5.7-fold higher odds of failure (OR = 0.18, 95% CI:0.04–0.87, p = 0.033). Conclusion Methotrexate treatment can be used in ectopic pregnancies with serum β-hCG levels above 5000 IU/L in carefully selected, clinically stable patients under close observation and follow-up. This approach may reduce the need for invasive surgical procedures and lower complication risks in carefully selected patients. Our findings highlight the feasibility of medical therapy beyond conventional thresholds, though validation in larger patient series and multicenter studies is warranted.