How Long After Methotrexate Before Trying to Conceive?

What does the evidence say about how long after stopping methotrexate before trying to conceive while trying to conceive?

1. MotherToBaby estimates that most methotrexate is gone within about 1 week in healthy nonpregnant adults, but notes that kidney impairment, interacting medicines, and conditions with excess body fluid can slow clearance. 1
2. A current U.S. methotrexate tablet label directs females of reproductive potential to use effective contraception during use and for 6 months after the final dose, and males with female partners to continue for 3 months. 2
3. MotherToBaby notes that some clinicians suggest waiting 1 to 3 months, while the drug label advises a longer interval, and reports no methotrexate-related birth defects among babies whose mothers stopped before conception in the reviewed reports. 1
4. A 2026 retrospective cohort of 711 pregnancies after methotrexate for ectopic pregnancy found no statistically significant rise in major malformations for conception at 1 to 3 or 3 to 6 months versus more than 6 months. Only 38 pregnancies were in the earliest group, leaving wide confidence intervals and preliminary findings. 3
5. In a separate prospective study, 136 pregnancies followed methotrexate use of up to 30 mg weekly for rheumatic disease within the 12 weeks before conception. Miscarriage and major birth-difference rates were not increased in this preconception group; the observational findings do not replace the prescriber's waiting interval. 4

What to know about how long after stopping methotrexate before trying to conceive while trying to conceive

• Before the final methotrexate dose, ask which interval applies to your indication, dose, kidney function, and product label. Arrange an alternative plan for the condition if methotrexate is being used long term.
• During the waiting interval, use the contraception plan from the prescriber and ask about folic acid. MotherToBaby says reduced kidney function, interacting medicines, or excess body fluid can slow methotrexate clearance.
• Before trying to conceive, confirm the last-dose date, the completed waiting interval, folic acid plan, and stability of the underlying condition. A short-interval cohort after ectopic-pregnancy doses is reassuring but does not replace individual clearance advice.