A Complication of Methotrexate Use for Ectopic Pregnancy

140 Comments:

• At Wed Sep 12, 11:55:00 AM 2007,  A friend in need of advice! said…

  Hello, I have a question. One of my best friend recently had a misscarriage. This is her second miscarriage this year, will she be able to have children? How long does she have to wait in order for her to get pregnant again? Do you know what cause them? She had both misscarriages when she was 5 months pregnant.

   

• At Thu Sep 13, 04:40:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Sept 12: In her case, I do not think she should get pregnant again until she has seen a specialist who can evaluate the inside of the uterus properly by a sonohysterogram and/or hysteroscopy. The most common causes of recurrent pregnancy loss at 5 months are cervical incompetence and congenital abnormalities of the uterus (Mullerian defects) such as a bicornuate or septate uterus. I have written an entire series in this blog earlier this year on recurrent early pregnancy loss that you might want to check out. Thank you for reading! Dr T

   

• At Mon Sep 24, 08:52:00 AM 2007,  Jennifer said…

  hello i have had an ectopic preg ane i have had 2 doses and it has been a month since i have got the shots. my question was when am i going to start my period? and i also know it is wrong to have sex so soon, but is it possible to get pregnant after i have had my shots so soon?

   

• At Thu Sep 27, 06:49:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Jennifer Sept 24: I would recommend waiting at least 3-6 months after an ectopic pregnancy treated with methotrexate. Having had one ectopic pregnancy, you are at much increased risk for having another. It is also VERY unpredictable when you will ovulate again. It is unusual to get pregnant within a month of treatment, but it COULD happen. Remember, you can get pregnant again as soon as you start ovulating, even if you have not had a period. I strongly recommend some form of reliable contraception for awhile before you tro to conceive and I would NOT recommend leaving things up to chance! Thanks for reading. Dr T

   

• At Tue Oct 09, 07:58:00 AM 2007,  Anonymous said…

  Hi Dr. T. I've been given conflicting answers by different gynecologists and rheumatologists in regards to methotrexate "wash out period" and pregnancy and frankly, I'm worried. Some say it's safe to get pregnant 3 months post methotrexate others say 4-6 months. Here's my scenario: I've been on methotrexate 25mg sc weekly dose, last dose being June 28, 07. LMP: sept 8, 07 and I just found out I was pregnant yesterday. Althought it's been almost 4 months since my last dose of methotrexate, I'm very concerned about my childs risk of teratogenicity. What are the chances of this happenning? What would the best course of action be? Also, would folinic acid help, in my case, to decrease the chances of birth defects? Thanks

   

• At Wed Oct 10, 02:14:00 PM 2007,  Anonymous said…

  Hello Dr. My question is regarding what is considered normal for betaHCG levels following MTX treatment for my ectopic pregnancy. On 02/10 I was admitted to the hospital with abdominal pain and slight bleeding for the two weeks prior (last period was Aug 24). Tested positive for pregnancy with betaHCG level at 960. Ultrasound + endovaginal showed nothing in the uterus. BetaHCG tested again on 5/10 was 1544 with u/s and endovaginal showing a small (1.1cm mass)in the right cornua (still nothing in the uterus). BetaHCG tested on 6/10 was 1797. Referred to OBGYN at ER for MTX treatment for ectopic, for which an injection of 50mg was given same day (my weight 49.8kg). BetaHCG tested on 10/10 was 2040 and I have not had the pain and abdominal cramping my Dr had prepared me for. My question is whether it is normal for the betaHCG level to continue rising 4 days after MTX injection? Shouldn't it be falling? Scheduled for another blood test on 13/10 but I was wondering when I should be worried that the MTX treatment is not working? I am 25 years old and would like to conceive in the next few years; thus, I would like to preserve both my tubes if possible and avoid surgery. Thank you kindly for your time and consideration.

   

• At Sat Oct 13, 02:26:00 PM 2007,  Anonymous said…

  Just an update to my October 10th question...betaHCG is now at 2061. The OBGYN at the ER said that it should have fallen to 1600 by now and gave me the option of another MTX injection or surgery (which would likely result in the loss of the right tube and part of the uterus as the pregnancy is in the cornua). I choose another injection. My new question: What are the chances that this second injection will work? Are the chances of MTX treatment being successful the second time around greater, less than or the same as before? Are the risks that it will rupture greater the longer I put off surgery? I'm sorry, I know I should have asked these questions to the Dr at the ER who gave me the results but I was a bit stunned and upset at the time. Thanks again for any answers/advice you can provide.

   

• At Mon Oct 15, 05:37:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous queries Oct 9 and Oct 10: I responded to your questions in my blog posted on October 15, 2007. I hope this helps. Best wishes to both of you and thanks for reading.
  Dr T

   

• At Mon Oct 15, 05:41:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous October 13: As noted in the blog I posted today in response to your initial query, you are probably just one of the 50% who have an increase in their hCG titers during the first 4 days. Presuming this really is an ectopic pregnancy, at your low titer, and with your lack of symptoms, I would be in NO rush to go to the operating room, especially for a cornual ectopic. Your greatest risk would have been not finding out early that you had the ectopic pregnancy in the first place. Again, good luck! Dr T

   

• At Mon Oct 15, 07:17:00 PM 2007,  Anonymous said…

  Thanks for your time and advice Dr T. I came across your site when googling for some answers and am really glad I did. I hope to have some good news by Thursday when I have another u/s and blood test scheduled. Many thanks, TC

   

• At Wed Oct 17, 08:08:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To TC Oct 15: Thanks TC and hope things turn out well for you. Check back in under 'happier' circumstances, okay!?! Dr T

   

• At Thu Oct 25, 06:02:00 PM 2007,  Anonymous said…

  Hello,
  I carry recipocal translocations invovling chromosomes 1 and 5 .
  This doesnt mean that i wont be able to have kids does it? Also, would my baby have to carry the same tranlocation in order for me to have a successful pregenacy? Is it possible that i wouldn't experince any miscarriages?

   

• At Fri Oct 26, 05:10:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Oct 25: With a balanced translocation you can have perfectly normal children, children who carry the same translocation (also 'normal'), and babies that end up with unbalanced chromosome complements that have a high likelihood of miscarriage. Very few of the aneuploid conceptuses resulting from that reciprocal translocation are likely to survive a pregnancy, but I strongly suggest that you sit down with a genetic conselor BEFORE you decide to get pregnant to discuss all of these issues and the evaluation that can be done during a pregnancy. Thanks for the questions and best of luck to you! Dr T

   

• At Sun Nov 04, 11:03:00 PM 2007,  fryerfairy said…

  I have endometriosis and had a cervical pregnancy I was in hospitalfor 3 weeks and I was treated with Methotrexate I think it was 3 shotsI had This was 6 months ago I was told that I might not be able to carry a baby full term, since having this 6 months on I am still in alot of pain and am losing big clots at each period I can no longer cope with the pain and the worry that I may never be a Mum I am only 23. Do you think I will go on to have a baby.

   

• At Tue Nov 06, 12:18:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To fryerfairy: I wish I had my crystal ball for you. Let me ask a few questions: Did you have pain prior to the cervical pregnancy? Is this pain all the time or just at certain times of your menstrual cycle? Did they have to do any surgery in addition to the methotrexate? How do your doctors know that you have endometriosis? Have you had any treatment for your endometriosis to date? Are you having regular periods every month? Did you have any trouble conceiving the pregnancy that you lost? Do you have any other medical problems? Let me know and I will do the best to give you my thoughts. Dr T

   

• At Tue Nov 06, 01:13:00 PM 2007,  fryerfairy said…

  Hi,
  I have had 2 laparoscopies in which the endometriosis was first diagnosed and burnt away the second one I had they checked my tubes and ovaries and removed a lot of endometriosis from my pelvis.
  I had a miscarraige 6 months befor falling pregnant again which resulted in the cervical pregnancy.
  I do suffer with a lot of pain and I can not remember the last time i was pain free, my doctor said that there is a lot of scarring and a lot of growths could this be the reason that the baby implanted in my cervix.
  I was due to begin IVF treatment as my husband and I have been trying for over 3 years when i fell pregnant my cycles are regular but are odd and i do occasionlly get spotting throughout the month.
  I dont have anyother medical problems. when i went to the hospital for an early scan they admitted me straight away but they did not know how to handle the situation due to it being so rare i felt like a guinea pig having tests done

   

• At Wed Nov 07, 05:43:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To fryerfairy Nov 6: By your history and symptoms, it is highly likely that you have not only endometriosis, but ADENOMYOSIS as well. Adenomyosis is endometriosis in the muscle wall (myometrium)of the uterus itself. It can cause pain, anytime throughout your cycle, but especially with menstruation - if you can imagine bleeding into a muscle - by the irritation and inflammation that results. I am not an expert in Reproductive Endocrinology, but when very young women have severe endometriosis/adenomyosis they can have a great deal of difficulty conceiving and getting through first trimester and may have other underlying risk factors (autoimmune, hormonal, thrombophilic, and anatomical) that further increase their risk for recurrent early pregnancy loss. Some will have defects in the production of cell surface structures called 'integrins' as well. Integrins help the early embryo attach to and implant in the endometrium. Implanation defects seem to be a big problem in women with endometriosis who have recurrent early pregnancy losses. Treatment varies but, it is my understanding, the first step is to surgically ablate as much of the endometriosis as possible. Many REI doctors will then place their patients on a course of Lupron to suppress the hormonal production that supports the endometriosis. Then, controlled ovulation induction, the use of Femara, and even IVF may improve your chances for successful implantation and 'survival' through first trimester. We used to say that getting through a pregnancy is the best 'cure' for endometriosis. I don't know if that still holds, but I have had many women with a history of endometriosis return within a year of a successful pregnancy having then conceived again spontaneously! Good luck and thanks for reading. Dr T

   

• At Wed Feb 13, 09:29:00 PM 2008,  Anonymous said…

  Hello Dr. Trofatter,
  
  I apologize in advance for my question being posted late and slightly off topic. I am an MSTP student and I arranged to take next year off before starting residency in part so that my husband and I could have a baby. We became pregnant in Nov. and I was dx with an ectopic in late Dec. I was tx with lap. salpingotomy and my betaHCG quickly returned to normal. My OB/GYN, who I highly respect, has told us to take at least 6 months before trying to conceive again. If we wait this long and were successful within the first few months, then the baby would be born at the same time that I start my internship, something I had hoped to avoid. In your opinion, is 6 months necessary after a lap. salpingotomy? I've done a literature search and can't find any scientific studies evaluating risk of ectopic recurrence in relation to post surgical recovery time. Thanks in advance, CNZ

   

• At Fri Feb 15, 10:09:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To CNZ. the answer really depends on the extent of your surgery and the findings at the time of the operation. Your doctor is really in the best position to make recommendations on that point. I will say this, from many year's experience with residents...it is very difficult on both you and your feloow residents to be pregnant during your internship year. You might want to think about holding off on that for awhile in view of teh ectopic pregnancy. Remember, too, once you have had one ectopic, you are at greater risk for having another for whatever reasons the first one occurred! Best wishes and I hope you have a great time in residency! Dr T

   

• At Wed Mar 05, 07:30:00 AM 2008,  Anonymous said…

  Hi I had a ectopic pregnancy and I had gone through the methotrexate treatment just this past Sunday. How long roughly should my cramping and bleeding last? I also just started to have today pressure in my very lower abdoman region and also my bum region is this normal, its not extremely painful but is quite annoying? Also today I had a almost like a blood clot come out when I went to the washroom but it was more mucussy like, dont mean to be gross but ya it is. Is this something that will happen? This is my first pregnancy ever and well this whole thing is scary cause I have gotten no definative answers on anything. Basically what should I be going through while this drug does its thing? What is considered normal and how long does it last?

   

• At Wed Mar 05, 10:32:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Mar 5: Many women who receive one or more doses of methotrexat for medical treatment of an ectopic pregnany report cramping abdominal pain during the first 2 to 3 days (sometimes longer) of treatment. This is one of the most common side effect of therapy. However, more severe and diffuse pain should be reported to your doctor because this can be asign of abdominal pain is also a sign that the ectopic pregnancy has ruptured. pain to your health professional. Vaginal bleeding such as you describe is also quite common and occasionally women will develop nausea, vomiting, indigestion, and feel tired, lightheaded and dizzy. However, if you were selected by standard criteria for receiving medical therapy with methotrexate, there is a 90-95% chance that you will not require surgery. Do not take any vitamin supplements that contain folic acid while you are undergoing treatment because the methotrexate works as a folate antagonist and you do not want to decrease its effectiveness. Report any unusual side-effects to your doctor and return for appropriate follw-up. Remember, that for whatever reason you had an ectopiv pregnancy this time, you are at increased risk for another one with a future pregnancy, so always seek out early prenatal care when you think you might be pregnant and inform your provider that you had an ectopic pregnancy in the past. The greatest risk of an ectopic pregnancy is not being aware that you might have one and ignoring the typical signs and symptoms that usually accompany it. Best of luck to you. You will probably feel much better within the next 7-10 days. Dr T

   

• At Tue Mar 11, 06:05:00 AM 2008,  Anonymous said…

  hello,
  i am 26 yr old. just had ectopic pregnancy on my first pregnancy. 2nd dose of methotrexate starting to work. hcg levels dropping.
  I had no suspected causes / reasons that normally are associated with why ectopic pregnancy occur.. just wondering why it happended? will i beable to have a normal pregnancy?

   

• At Fri Mar 14, 03:15:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Mar 11: Some ectopic pregnancies occur by vhance alone and there is never any explanation. Others occur because there has been previous damage to the tube as the result of an infection, such as chlamydia that can be totally asymptomatic, or even endometriosis. For whatever reason you had the first ectopic, you are at increased risk for another one, but the odds are in your favor that someday you will have a "normal" pregnancy. Thanks for reading and let us know how things turn out in the future!
  Dr T

   

• At Mon Mar 17, 01:41:00 PM 2008,  Anonymous said…

  I am 45 years old and was recently diagnosed as having a cervical pregnancy although not definitively (no sac etc after a weekend of heavy bleeding). Beta HCG levels have declined although not as fast as my doctor expected and she is now recommending a shot of methotrexate. I am concerned about the relative risks of having the drug and not.

   

• At Wed Mar 19, 06:55:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Mar 17: A single dose (or even two) of methotrexate places you at VERY low risk for complications. The half life is also short and should not affect another attempt at pregnancy in the near future if that is something you want to try, but please discuss this with your doctor first. Dr T

   

• At Thu Mar 20, 11:01:00 PM 2008,  Anonymous said…

  Hi Dr.,
  I had an ectopic pregnancy in Nov, 2007. I have been given 3 shots of Methotrexate till date and my hcg level has recently dropped as follows since the third shot: 17, 9, 5, 8, 8. So, it has plateaued at 8 over two successive weeks of tests. My OBGYN has referred me to GYN-ONCOLOGY. Is this situation a cause for concern? Or can this happen? How will this be managed henceforth? I am very scared at the moment.
  
  Thanks,
  bunch_o

   

• At Fri Mar 21, 06:26:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To bunch_o: The hCG levels are not very high, more consistent with a chronic ectopic pregnancy, or perhaps an ovarian neoplasm that is (producing hCG or something that cross-reacts with it), rather than choriocarcinoma, but I definitely agree with the plans to have you see a GYN Oncologist. Sit tight until you talk with him/her and please let us know what you find out. Best wishes and thanks for eading! Dr T

   

• At Thu Mar 27, 01:05:00 PM 2008,  Anonymous said…

  Hi Dr.,
  
  I am diagnosed with PCOS and my RE started a clomid treatment with 50mg dose which did not work. So it was increased to 100mg. It helped me in conceiving.
  Initially the HCG level started quite low (28). Later it increased to 70 -> 145 -> 836 -> 1333. By the end of 6th week it reached 1700. RE did u/s scans in 6th week and found that my uterus is tipped backward. RE didn't see any sac in uterus. There was no sign of any swelling / bleeding inside my abdomen. I did not experience any abdominal pain / bleeding. After repeating scans and blood work, RE concluded that it's an ectopic pregnancy. Not sure if this diagnosis was correct.
  1. If we do not see any sac in the uterus by end of 6th week and if the HCG levels are around 1700, is this a valid ectopic case?
  
  Then to end the ectopic pregnancy, RE gave me 81mg Methotrexate dose on 3/24. Again I am not experiencing any pain / bleeding. Based on internet reading, most of the women reported these symptoms. I am worried if I will have to go for surgery.
  2. Is it normal not to experience pain/ bleeding after MTX shot? Does this mean MTX is not working?
  
  Thanks,
  Aai

   

• At Thu Mar 27, 06:14:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Aai Mar 27: You either have an ectopic pregnancy or you have a nonviable intrauterine pregnancy based on what you have told me. I doubt you will need surgery. Sometimes it takes several days and more than one dose of methotrexate, but your doctor will simply follow your hCG levels to ensure that they continue to fall. Sorry for your loss and let us know what happens. Dr T

   

• At Fri Mar 28, 12:11:00 PM 2008,  Anonymous said…

  Hi Dr.T,
  
  Thank you very much for your prompt response.
  
  After MTX shot, I got blood work done today (28-Mar-08). The HCG level increased from 2104 to 3484. RE had mentioned that the level normally increases by 15% but mine increased by around 65%. I am little worried now.
  
  I have 7th day blood work scheduled on Monday. I will write back again on Monday.
  
  Kind Regards,
  Aai

   

• At Sun Mar 30, 07:52:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Aai: I hope this wasn't an intrauterine pregnancy that just wasn't as far along as expected. Your doctor may want to repeat the ultrasound. Best wishes and do let us know what is found out.
  Dr T

   

• At Mon Mar 31, 03:11:00 PM 2008,  Anonymous said…

  Hi Dr.T,
  
  Today I got my 7th day HCG levels tested. Instead of decreasing, the levels increased from 3484 to 3531. Since yesterday I am experiencing very light occasional bleeding.
  
  The RE has advised to repeat the blood test tomorrow. After checking tomorrow's levels, they will give the second (and probably higher) MTX shot.
  
  Doctor has not yet mentioned about u/s scan. Will that help? In my case is there any way to find out the root cause (whether it is ectopic / nonviable intrauterine)? Will that help us in planning or taking some precautions the next time?
  
  Thanks for your support.
  
  Regards,
  Aai

   

• At Tue Apr 01, 01:21:00 PM 2008,  Anonymous said…

  Hi Dr. T,
  
  After the MTX shot, my HCG levels came as follows:
  4th Day - 3484
  7th Day - 3531
  8th Day - 3243
  
  As you had correctly guessed, my RE has scheduled a u/s scan tomorrow. He mentioned that they will give second shot of MTX after the scan. I am experiencing very light bleeding, weakness and body ache.
  
  I am quite scared with the way things are turning out. Is there any way to confirm if this is an ectopic pregnancy or an intrauterine?
  
  Thanks and Regards,
  Aai

   

• At Fri Apr 04, 07:23:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Aai: At that hCG level, if there is an intrauterine pregnancy, they should be able to see evidence of that by ultrasound. regardless, the hCGs are now beginning to fall, so hopefully, you will not need an operative procedure. Good luck again and let us know how things turn out. Dr T

   

• At Mon Apr 07, 02:07:00 PM 2008,  Anonymous said…

  Thank you for responding to my post of about 2 weeks ago. I am the 45 year old woman whose doctor thought she had a cervical pregnancy and was inquiring about methotrexate.
  
  I have a follow on question. I never got the shot of methotrexate and my Beta HCG levels have since declined to 17 and then to 3. My last ultrasound which was the 3rd I had since the miscarriage no longer showed any suspicious area in my cervix which was the source of the concern that it was a cervical pregnancy. The ultrasound person indicated that this seemed to rule out an ectopic pregnancy although my doctor seemed to think that it still could have been cervical but resolved itself naturally. Does one or the other seem more likely? Does it matter to know for sure?
  
  Thanks again for responding.

   

• At Mon Apr 07, 05:14:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Apr 7: Sorry, but I really can't tell from what you have told me, but in the end, it probably doesn't matter. Everything appears to have resolved spontaneously and now you don't have to worry about the potential effects of the methotrexate. Thanks for letting us know how things turned out and best of luck to you. Dr T

   

• At Fri Apr 18, 08:18:00 AM 2008,  Anonymous said…

  Hi,
  
  I had a heterotopic pregancy and my BETAhcg levels went back down to zero on 26th March. I have just found out that I'm pregnant again (would have been conceived around the week of 22nd March) and I've read that there's a much higher risk of me having another ectopic. Please can you tell me what the percentages are? I know that there would usually be about a 10/15% chance of having an ectopic again if I waited for three months, but I've heard that the risk is increased again as I got pregnant so soon after the last one. Is this correct? Thanks for your help

   

• At Sun Apr 20, 06:36:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Apr 18: Your risk may depend on which tube picked up the egg this time. You will be at higher risk if it is in the tube that recently had the ectopic, but rememeber, conditions that increase risk for ectopic pregnancies often affect BOTH tubes. Hopefully, that is not your case! Best wishes and let us know how things turn out! Dr T

   

• At Mon May 12, 09:27:00 PM 2008,  Anonymous said…

  Hello Dr. Trofatter. I have read your comments on ectopic pregnancies...thank you for your wealth of knowledge on this subject. I had an ectopic (first pregnancy) a couple months back & was adminstered 2 methotrexate injections. In one of your comments, you mention waiting until 1 cycle to try again is sufficient, however, in another post, you told a woman to wait 3-6 months after she received the drug. Am I reading this wrong? How long should one wait after 2 shots of methotrexate to try to coneive again?
  Also, is it standard medical protocol to perform an HSG test after having 1 ectopic or is that not always necessary? Thank you in advance.

   

• At Thu May 15, 06:51:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous May 12: From the standpoint of MTX toxicity, the half-life of the drug is such that it should not affect a baby conceived a month or so after 1-2 injections, HOWEVER, I really do believe it is better to wait awhile longer to give time for the inflammation to die down and the tube to heal. This might reduce your risk for another ectopic although the risk is still significant that you could have one anyway. Not everyone recommends that you have an HSG, but if that is your doctor's standard of practice, it is not an unreasonable thing to do. Dr T

   

• At Fri May 16, 05:28:00 AM 2008,  Anonymous said…

  Hi Dr T,
  
  I posted a comment a while ago about my previous heterotopic pregnancy. I'm pregnant again and although it's been confirmed it's the right place I'm still worried about how the previous pregnancy will affect this one. Basically they left the last one for conservative management, so i miscarried the normal pregnancy but the ectopic (cornual) one is still there and shows up on the scans although it isn't active. I'm still waiting to see a consultant but am worried as i'm bleeding again. Could the old pregnancy affect this one?

   

• At Fri May 16, 05:45:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous May 16: I doubt it unless there is still some inflammation associated with it. The spotting might have nothing to do with that other pregnancy. Best of luck. Dr T

   

• At Thu May 29, 04:10:00 PM 2008,  Anonymous said…

  Hello Dr. I had an ectopic pregnancy in March and had two doses of methotrexate...the second one being March 17, 2008. This past Tuesday my HCG was 5 (negative?) and this past Sat. I had my period. I just started taking my prenatal vit and an extra 400 mg of folic acid. should I be okay TTC after my next period? thank you! ( I did not have to have any surgery)

   

• At Thu May 29, 05:50:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous May 29: You should be okay from the standpoint of the methotrexate being out of your body. You are and will always be at increased risk for another ectopic pregnancy for whatever reasons set you up for the first one. So, be sure to let your doctor know as soon as you are pregnant again. Best wishes! Dr T

   

• At Mon Jun 09, 09:33:00 AM 2008,  jenn78 said…

  I had an ectopic pregnancy in the left tube removed surgicaly on May 22. The tube was removed but I still have my right tube. What are my chances of getting pregnant again and when can I start trying again. Thank you

   

• At Tue Jun 10, 07:30:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Jenn78: Your chances arevery good unless there has been damage to the other tube by whatever conditions might have led to the ectopic pregnancy. I usually tell my patients to wait 2-3 months before trying to conceive again to give some time for all of the involutional changes and inflammation to die down after the ectopic pregnancy. Remembre, you are still at risk for an ectopic pregnancy in the remaining tube. Best wishes! Dr T

   

• At Fri Jun 20, 11:46:00 AM 2008,  Bargon said…

  Hello, I have a question. I had an ectopic pregnancy diagnosed at 4weeks, how long should I keep off foods with folic acid after treatment with methotrexate?
  Thanks, Barbara G

   

• At Sat Jun 21, 02:24:00 AM 2008,  Bargon said…

  Dear Dr.T I had a question earlier on, but below is some background information to assist me to get the proper advice.
  I have undergone ART procedure in form of an IUI on 12th May,2008. I underwent IUI on a stimulated cycle using FS.The pregnancy test performed on 26th May, 2008 confirmed pregancy. The scan performed on 10th June, 2008 indicated there was no evidence of a gestational in the uterus, despite the fact that the BHCG levels are in excess of 2000mul/ml. My doctor suspected it could be a leaking ectopic pregnancy. My HB is 13.5g/dl
  MY husnabd and I were counselled thoroughly regarding the treatment options being;
  1.Laparoscopic treatment
  2.Medical treatment in form of methotrexate.
  we opted for methotrexate treatment and I was given an Intranuscular Injection of 50mg(my weight was 60kg. Iwas advised to return after every 5 days to check my BHCG levels.
  At 4 weeks what are the chances that I might return for laparoscopy? I had stomach cramping for 4 days and light bleeding.I sometimes have pain in my legs, right from the hip level down to the ankles.
  I wonder how long I should keep away from foods with folic acid? Could you please also advise on which foods are not so rich or are completely free of folic acid, I have been searching for the same and am not quite clear.
  Thanks Dr.

   

• At Sat Jun 21, 07:46:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Barbara: Just avoid EXTRA folic acid in vitamin supplements for the week or so after the injection. Wait til the hCG levels have begun to fall significantly. Dr T

   

• At Sun Jun 22, 05:59:00 AM 2008,  Jacqueline said…

  I have a question. I had a shot of Methotrexate on April 18, 2008 for an almost 5 week ectopic pregnancy in the left tube near the ovary. I had a normal menstrual cycle on May 16th. I found out on June 19th that I am pregnant and my beta HCG was 7818. My question is the methotrexate out of my system and if not, could it cause a birth defect? Thanks...

   

• At Sun Jun 22, 04:55:00 PM 2008,  Arabee72 said…

  Dr T, I had a Mirena IUD and found out I was pregnant with an ectopic. I underwent MTX injection on June 1/08 and had my IUD out on June 3rd (hubby and I were planning to try in Aug/Sep). Levels have continued to fall, but other than to make sure we us contraception, when is it safe to start having sex again. I am still having some spotting/bleeding, but it is darker. Is there a reason for the pelvic rest? Does sex add to inflammation? I don't see the Dr. for 2 more weeks (july 4) but am getting weekly HCG readings. As well, when I'm able to supplement with folic acid again,is there any contraindication to Folic acid injections. I've had mouth ulcers as well as a hemmoragic beula in the left cheek that has recently come up. I'm guessing this is from the methotrexate. Sorry for the long post

   

• At Fri Jul 04, 09:19:00 AM 2008,  Bargon said…

  Dear Dr T, I sent a question about the methotrexate injection for stopping ectopic pregnancy.Below are my BHCG readings,
  10/06/2008 2328
  14/06/2008 4974
  17/06/2008 2793
  24/06/2008 2087
  01/07/2008 718
  
  I got bleeding on 2nd July to date and stomach cramping, and terible backache, does this mean the pregnancy has dissolved? Now can I resume foods with folic acid?
  Thanks Dr.

   

• At Fri Jul 04, 09:26:00 AM 2008,  Bargon said…

  Dear Dr T, I sent a question about the methotrexate injection for stopping ectopic pregnancy.Below are my BHCG readings,
  10/06/2008 2328
  14/06/2008 4974
  17/06/2008 2793
  24/06/2008 2087
  01/07/2008 718
  
  I got heavy bleeding with thick brownish clots on 2nd July to date and stomach cramping, and terible backache, does this mean the pregnancy has dissolved? Now can I resume foods with folic acid?
  Thanks Dr.

   

• At Tue Jul 08, 10:26:00 AM 2008,  Kirsty5 said…

  Hi Dr T, I was diagnosed with an ectopic pregnancy 3/52 ago following 6/52 bleeding. My betahcg was 990 & 48hrs later was 900. Methotrexate was given & next betahcg was 1100 & then 1500, another dose of methotrexate has been given, levels have fallen to 1100 & finally 1060. According to consultant i either require a 3rd dose of methotrexate or surgery. Can i ask from your experience which you recommend as my consultant has never given a 3rd dose before & is apprehensive. Thanks

   

• At Sat Jul 12, 05:05:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Kirsty5: As long as the hCG levels are falling (at least not rising) and you are not symptomatic, I would suggest not giving the third dose of methotrexate or operating and just waiting things out. Dr T

   

• At Sat Jul 12, 08:09:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To arabee72: Sorry, for some reason I did not get your comment until now. Intercourse may increase your risk for infection, especially while you are having bleeding. There is also a small chance that intercouse could cause the ectopic pregnancy to rupture before it has regressed and the tube has had a chance to heal. Hold off on the extra folic acid until yor hCG levels are undetectable. Dr T

   

• At Sat Jul 12, 08:12:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To bargon: You can resume foods with folic acid, but just don't use extra folic acid in a vitamin supplement. Your hCG levels are falling, but they still have a way to go and there is still a possibility you will need a second dose of the methotrexate. Dr T

   

• At Sat Jul 12, 10:18:00 PM 2008,  Bargon said…

  Dear Dr T, thanks for the advice, You wrote back that I might need another dose of methotrexate, can this one more reading of BHCG taken on 8th July,08 determine something? Thanks Dr.
  
  Date Levels
  10/06/2008 2328
  14/06/2008 4974
  17/06/2008 2793
  24/06/2008 2087
  01/07/2008 718
  08/07/2008 67

   

• At Sat Jul 12, 10:19:00 PM 2008,  Bargon said…

  Dear Dr T, thanks for the advice, You wrote back that I might need another dose of methotrexate, can this one more reading of BHCG taken on 8th July,08 determine something? Thanks Dr.
  
  Date Levels
  10/06/2008 2328
  14/06/2008 4974
  17/06/2008 2793
  24/06/2008 2087
  01/07/2008 718
  08/07/2008 67

   

• At Tue Jul 15, 10:21:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Bargon: I doubt you will need another dose of methotrexate

   

• At Sat Jul 26, 04:17:00 AM 2008,  Donchaknow1969 said…

  Doctor,
  I had a tubal reversal on 2/08/08. My fertlity spec. could only repair my rt. tube and advised w/my age 38, that my chances to conceive were reduced to 30% to conceive. On 4/10 my pregnancy test was positive with low hcg levels. On 4/19/08 I was gvn 1 dose of Methotrexate and on 4/26 I passed the remaining cells. My question to you is, could the injection cause damage to my rt. ovary? A previous ultrasound showed a healthy ovary with visible 4-5 egg producers. Just have a concern of if I can still ovulate and do I need to consult my fertility specialist with my concerns of becoming pregnant again?
  Thanks for time and response

   

• At Mon Jul 28, 04:56:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Dochaknow: The MTX should not harm your ovaries. However, the real question remains...what are your chances of actually conceiving normally? At your age, it will probably be best to move to IVF sooner than later. That's what you need to talk with your REI doctor about! Good luck. Dr T

   

• At Tue Aug 26, 04:44:00 PM 2008,  Anonymous said…

  Hello Dr.
  
  I had MTX due to ectopic pregnancy My HCGs from 1650 then 990 then 595 then 355 iM going for another appointment 3 days from now. Its been exactly 12 days after my injection and im still bleeding. I started bleeding 3 days after the injection. I am also experiences hot flushes and headache. Are these normal side effects of the drug? Can i take advil for my headache? its been 24 hours now and doesnt resolve thanks so much

   

• At Tue Aug 26, 05:32:00 PM 2008,  Anonymous said…

  Hello Dr.
  
  I had MTX due to ectopic pregnancy My HCGs from 1650 then 990 then 595 then 355 iM going for another appointment 3 days from now. Its been exactly 12 days after my injection and im still bleeding. I started bleeding 3 days after the injection. I am also experiences hot flushes and headache. Are these normal side effects of the drug? Can i take advil for my headache? its been 24 hours now and doesnt resolve thanks so much

   

• At Thu Aug 28, 05:30:00 AM 2008,  Anonymous said…

  Dr. T:
  
  I was diagnosed with an ectopic pregnancy on 8/25th, based solely on low hcg levels. I had had some light bleeding over several day prior, but was not examined in any way other the the blood test.
  
  The doctor wanted to give me the methotrexate, but I asked for more convirmation that it really is an ectopic preganancy.
  
  If they can not find evidence of ectopic pregancy on the ultrasound, should I still take the drug or wait to see if I'm not as far along as I thought?

   

• At Sun Aug 31, 09:38:00 AM 2008,  The Lady said…

  Hello Dr, I was diagnosed with an ectopic preg on Aug 29th, after having a series of three hcg level test and two sonos. My hcg levels were 59, 32 and 35. Inital (8/14) sono showed no preg in the uterus or tubes. 2nd sono (8/29) showed small mass in right tube. I was given an injection of methotrexate on 8/29. Today is 8/31 and I'm not experiencing any abdominal pain like the dr sd i would. I'm wondering if it's working??? I don't know if this matters or not but i got preg while taking OCP's.

   

• At Tue Sep 02, 05:33:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Aug 26: It may be several weeks before all the bleeding os over and you may also have some lower abdominal pain as well. You can take ibuprofen for the hot flushes and headaches that may be due to either the MTX or to the drop in the pregnancy hormone levels. Let us know how things turn out. Dr T

   

• At Tue Sep 02, 05:37:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Aug 28: How low were the hCG levels? If they are low and dropping on their own (and you are not symptomatic), there may be no need for the MTX regardless of where the pregnancy is. If they are slowly increasing, but not consistent with a viable pregnancy, then it is probably better to go with it sooner than later. At low hCG levels, it may be difficult to ascertain where the pregnancy actually is by ultrasound. Good luck and thank you for reading. Dr T

   

• At Tue Sep 02, 05:39:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To the lady: You have very low hCG levels, so you may get out of this with minimal abdominal pain and bleeding. Those symptoms may not begin for 7 to 10 days after the injection anyway. It takes awhile to work. Good luck and thanks for reading! Dr T

   

• At Thu Sep 04, 06:57:00 PM 2008,  April said…

  Hello Dr. Trofatter.
  
  I had an ectopic pregnancy in August and had one shot of methotrexate on August 10th (87mg). My HCG levels went down from 178 on 8/10 to zero on 8/22.
  
  I was using OPK sticks and detected an LH surge on 8/27 (5 days after hcg hit zero - is this possible?). If this is accurate then I would expect my first period to arrive on 9/11 (my cycles are exactly 28 days).
  
  I started taking prenatal vitamins as soon as hcg hit zero. I have no other health issues that I know of. I eat very healthy and have never smoked. Can I start TTC right after my first period?
  
  Thanks so much!
  April

   

• At Sat Sep 06, 06:32:00 PM 2008,  Kari said…

  Hi, I was dx with an ectopic pregnancy sep 3, per us there was no intrauterine pregnacy and there was a 1cm mass in the right tube. My hcg was 1650, I was given mtx 100mg IM. Its now Saturday and I have very light bleeding, but i feel miserable. I am very weak, get sob with anything i do, eating makes me feel with lots of nausea. When will all these symtoms go away. I am scheduled to go back tomorrow for another hcg test. If this shot does not help I dont think I could handle another and think I would prefer surgery instead of feeling this way. What do you recomend?

   

• At Tue Sep 09, 09:22:00 AM 2008,  Anonymous said…

  Dear Dr. Trofatter,
  I had a MTX shot 5 weeks ago. I had a very heavy period this last week. When I went in for follow-up blood draw and ultrasound my hcg was 525. It seems to be decreasing very slowly. How can I have a period if I still have hcg floating around in my system? On ultrasound they still see the sac sitting in the fallopian tube at a size of "6 weeks and 2 days" - no change from my previous ultrasound that was 3 weeks before.(no yolk sac can be seen) I also have a healthy follicle sitting on the other ovary ready to go (10 days after start of period). So now the question is how can I ovulate if I still have hcg floating around? The doctor wants to wait another 2 weeks and do another blood draw. What is to happen to the sac that is sitting in my tube? Will my body just absorb it eventually? And if thats the case how long will that take? Will it eventually float out and into my uterus? Is it still attached to the tube and if so with what type of tissue? Is surgery inevitable? Thanks for your time.
  
  -KA

   

• At Tue Sep 09, 04:53:00 PM 2008,  little1 said…

  Dear Dr. T
  I was diagnosed with an ectopic on 8/19 and given 1 shot of MTX. I had constant bleeding during the entire pregnancy. Levels increased, but slow. As of 9/3 beta HCG level was 137.6. On 9/4 bleeding stopped. When blood work was done on 9/8 beta HCG levels increased, but no exact number was given. What should I expect when I see the doctor again. I am was told to repeat the blood work on 9/10.

   

• At Sun Sep 21, 06:13:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To April: I apologize for the delay in answering, but I JUST got your comment delivered to my mailbox today. It is advisable to wait 2-3 months after treatment of an ectopic pregnancy before trying to conceive. That may slightly decrease your risk for having another ectopic. Dr T

   

• At Sun Sep 21, 06:16:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Kari: I apologize for the delay in answering, but I JUST got your comment delivered to my mailbox today. By now, you probably have your answer. But, I bet that the one shot will be successful - it just takes awhile for it to work. Some of those symptoms may have been related to the pregnancy hormones you still had floating around in your body. Good luck and let us know how things turn out. Dr T

   

• At Sun Sep 21, 06:19:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To KA: I apologize for the delay in answering, but I JUST got your comment delivered to my mailbox today. Based on what you told me, you probably need a second shot of MTX. I am not sure the bleeding was the result of ovulation (although it could have been) - more likely from the ectopic. You are perhaps at gretaer risk for still needing surgery. The longer that mass remains in the tube, the greater the likelihood the damage to that tube will be permanent. Good luck and let us know how things turn out. Dr T

   

• At Mon Sep 22, 11:44:00 AM 2008,  Anonymous said…

  I was given Methrexate for an ectopic on 8/13 - my HCG was 3,300 and i was a good candidaye. However I ended up having laparascopic surgery on 8/13 due to internal bleeding. The tube did not rupture and teh pregnancy moved but the tube swelled and bled. the surgeon said there was no detectable damage but I will schedule a HSG test at the start of my third post ectopic cycle.
  
  I am now 5 weeks and 5 days post surgery and my HCG was <5 when I had blood drawn on 9/6. Should I get my period soon? I just want to get to my third cycle but I feel like it is taking forever to get to my first one. Thanks, JB

   

• At Tue Sep 23, 12:24:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To little1: If the hCG rises or does not continue to fall, you should receive a second dose of MTX. At that low hCG level, it is very unlikely that you will require surgery. Dr T

   

• At Thu Sep 25, 12:42:00 PM 2008,  Gidget said…

  Dr. T,
  
  I was diagnosed with an ovarian ectopic on 9/14 after I went to the ER with severe abd pain and they didn't find an intrauterine pregnancy. They did see something on my ovary. My beta was 6300 that day, and they gave me a shot of MTX because the pain went away.
  
  I had my beta re-checked on 9/22 and it was around 14,000. That's a much bigger increase than I expected. The dr. has told me not to worry. I go back in for a re-check tomorrow. I'm worried because I have a backache and have been spotting lately--but the doctor's office tells me not to. Is there something I'm missing or do I just need to calm down?

   

• At Thu Sep 25, 01:02:00 PM 2008,  Anonymous said…

  Hi. I also have a suspected ectopic, but wish there was a way to confirm for sure. It is a moot point now, though, since I took the MTX shot, but I'd still like to know. I had a slight short period on Aug. 30 of 4 days with lighter than normal bleeding. A week later I had 2 days of brown spotting. I found out I was preg. on Sept. 8. I resumed brown spotting on Sept. 12. Light but long mucousy things in it. I went to Dr. and got sonogram since I thought I was farther along and worried about ectopic due to brown spotting. They found an empty uterus. They monitored my HCG on and off and it was 198, then 286, then he took another to make sure it wasn't viable. That one went to 626. So he says it might be OK. I took another HCG and it was 1187 2 days later. I did a repeat sonogram 3 days past that and it still showed nothing in uterus. He said the lining was thin and the uterus looked un-pregnant. He also saw nothing abnormal in the tube. They did see a corpus luteum cyst both times in the R ovary, but he and the hospital sonagrapher both said it was a cyst and not the ectopic. My HCG was 2856. He said it was rising abnormally. So, he advised me to take the shot. I did. I had a repeat HCG today, but don'/t know the result yet. I get another sunday. What I want to know is was this truly an ectopic, even though they could find nothing anywhere? I have had only normal pregnancy symptoms so far- hunger, stretching aches and breast tenderness. The only remotely close to pain sensation I have had is in my left groin, where the thigh meets the pubic bone. This comes and goes, but has only been sharp a few times, and on and off achy otherwise. I don't know if that even means anything- could the pregnancy be implanted in my groin? If it is even ectopic? I would just like to know if you think my numbers and case seem like an ectopic, or will a live baby show up in a few weeks in the uterus and have to be further terminated like in the orignal thread starter's case? thanks.
  ab1974

   

• At Tue Oct 07, 11:28:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To JB Sept 22: If you had regular cyclic periods before the ectopic, you should expect to start again within the next 4-6 weeks. Remember, you could get pregnant again unless you use some form of contraception BEFORE you even have another period! Best wishes. Dr T

   

• At Tue Oct 07, 11:30:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To gidget: With that rise in your hCG following a dose of MTX and your current symptoms, you SHOULD be worried. If this is indeed an ectopic pregnancy, you are at very high risk for needing surgery to take care of the problem (if you haven't already had it). Let me know how things turn(ed) out. Good luck! Dr T

   

• At Tue Oct 07, 11:34:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To ab1974: I hope no pregnancy shows up in your uterus now that you have gotten the MTX. Usually by the time the hCG is in the range yours was in, evidence of an intrauterine pregnancy can be seen by ultrasound. So, if nothing at all was seeen, there is a reasonable chance you have an ectopic somewhere even if it is unclear where that might be. Under those circiumstances, a single dose of MTX is sufficient to take care of the problem Hope things turn out okay. Please let us know what happens. Dr T

   

• At Thu Oct 09, 11:59:00 AM 2008,  Gidget said…

  Dr. T,
  
  The backache went away and I immediately started bleeding. I passed what I think was the embryo 3 days later. It makes me wonder if it was ectopic at all. My betas were 4000 one week ago, and I go back for a recheck tomorrow.
  
  My current worry is that all of my pregnancy symptoms have returned in the last three days (after being gone for one month). I spotted once last night and I am slightly worried that I have somehow become pregnant again. The doctor initially told me that I couldn't get pregnant while my body still thinks I'm pregnant, but I don't know what to make of the sudden return of symptoms. I guess I'll know if my betas increase?

   

• At Sat Oct 11, 01:44:00 PM 2008,  Anonymous said…

  Help. I am really confused. I was told that I was 5 weeks pregnant due to the dating of my last period. I have had an ectopic pregnancy before so the Dr. checked my HCG to make sure things were ok. two days apart the levels were 200, then rose to 400 only. I received two shots of methotrexate. Other than light cramps I have not had any bleeding or other symptoms. How long does it take to expereince the symptoms? If you don't bleed what happens next?

   

• At Thu Oct 16, 03:02:00 AM 2008,  paula said…

  Hello, I was treated with a single dose of methotrexate in May 2008 after a suspected ectopic pregnancy of 6 weeks. I resumed my normal cycle within a month and have had 3 subsequent cycles since. I am now 7 weeks pregnant again,(conceived Sept. 10 2008) so it has been 4 months since I received the drug. I have had two early scans, one at 6 weeks which showed a fetal sac in the uterus (1cm)and a yolk sac. I received another yesterday (7weeks) to hopefully detect a heartbeat and the doctor revealed that the heartbeat was not detectable yet and that the fetus had not grown enough for her liking (1.5cm). She explained that perhaps the Methotrexate had affected my folic acid stores and this was affecting the fetal growth. She asked me back next week for another scan, and said that if she could not detect a heartbeat then, the fetus would not be viable and she would recommend a d&c at that point. Can Methotrexate linger in the system to that effect where folic acid stores are diminished? What are the chances she is right?
  She indicated the fetus has about a 50/50 chance of progressing at this stage. I haven't found any evidence in my own research on the subject that this could be true. Look forward to your comments, Thank you.

   

• At Thu Oct 16, 06:14:00 PM 2008,  Anonymous said…

  I have a unique situation. I miscarried (found no heartbeat on ultrasound/no heartbeat) in July and had a d and c on July 24 (pathology indicated turner's syndrome). My doctor shared he/she did not remove all tissue as he/she wanted to avoid damaging my cervix as it was too small (and he/she didn't want to create more of a risk that I could not have children in the future). Within a week, I was cramping and the first u/s indicated I had tissue remaining. Doc prescribed miso...and it did not yield much. He/she said not to worry as all else would exit in my next period. On sept 26 I had a second u/s and still no period (and 2 cm cyst on left ovary). He/she prescribed provera. Went to second opinion. Second doc asked if i had a blood test to test hcg levels. I did not. option was to get a 2nd d and c or try methotrexate. hcg has been 52, 49, and 52 within a week's time. It's stable. Not growing. Had 3rd u/s and uterine lining very thick now (also the 2 cm cyst is now 4 cm on the left ovary). Trying methotrexate now (1 small dose--injection) in the hope it will lower my hcg, enable me to have a peiod, and I can avoid a 2nd d and c. Since this time my uterine lining has thickened substantially and I now have a 4 cm cyst on my left ovary (doc indicates due to hcg remaining...). It's been almost 3 months. As I've lost faith in my first doc and am hopeful I am now doing the right thing, can you comment on this current approach? I've also lost interest in trying at this point. First time trying and I'm almost 40. Candidly, I'm truly interested in being normal and fearful this can turn into something else...

   

• At Fri Oct 17, 12:23:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Oct 11: Although an hCG of 200 at 5 weeks would be low, the rise during the two days was normal. Why did your doctor think you might have another ectopic? It may be 10-14 days before you have any bleeding following the MTX. Dr T

   

• At Sat Oct 18, 10:32:00 AM 2008,  Anonymous said…

  Thanks for replying... I am not really sure what is going on, I think I should have asked my Dr. more questions. I still didn't experience any bleeding. it has been 9 days since first injections, I had another set of injections yesterday after HCG levels were still rising, they were at 1,000. She said that was still low. What happens if this was not an ectopic pregnancy and two injections of methotrexate have been adminstered? Will a misscarriage still happen?
  Thanks for your advice.

   

• At Tue Oct 21, 07:00:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Oct 18: There is a high likelihood a miscarriage would occur under those circumstances. If it did not, there is also a high likelihood the baby would have birth defects secondary to the MTX. Dr T

   

• At Sat Oct 25, 06:40:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Paula Oct 16: No, the methotrexate you had in May should not be afecting this pregnancy. Folic acid is not readily "stored" in the body. You lose it or you excrete what you don't uses. If You are really 7 weeks and no viable pregnancy is seen, then I am afraid this will not be a good pregnancy. I am so sorry. Kind regards, Dr T

   

• At Sat Oct 25, 06:43:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Oct 16: I do not know what to tell you at this point. When we usually do a D&C, once we get past the cervix and into the uterus, there should be little risk to the cervix. Perhaps your doctor couldn't get through the cervix the first time. Regardless, if he/she knew they could not complete the procedure, you might have been a candidate for methotrexate at that point. Now you will be at greter risk for Asherman's syndrome if another D&C is necessary. Best wishes. Dr T

   

• At Sat Oct 25, 05:26:00 PM 2008,  Defiantmuse said…

  Hi Dr. T. I was diagnosed w/ an ectopic pregnancy on Friday Oct.17th, my hCG levels were around 12,000. That next day (on sat. the 18th) I was given a shot of methotrexate. My hCG levels were re-checked on Day 4 and they had only dropped to 11,800 and then were re-checked on Day 6 (not the 7th day as it normally the case) and they had dropped to 9700. My OB decided not to administer a second dose of MTX since they had dropped so much in two days he said he felt "encouraged". Around Day 4 I began bleeding fairly heavily (enough to warrant wearing a pad) and it's very bright red and a little bit stringy with very small clots. I'm also having some intense cramping, mostly on my left side. Should I be worried? My OB has not given me much information and is very vague when I ask questions. As long as my levels are dropping I should be okay, right? I'm just worried about something rupturing. This is my first ectopic pregnancy with no past history of STDs, PID or endomitriosis. I have also read that usually good candidates for MTX treatment have hCG levels under 5000 and since mine was more than double that when we began I'm concerned. Thanks so much!

   

• At Mon Oct 27, 04:59:00 AM 2008,  paula said…

  Hi, Paula here again from October 16, just to let you know that the following week's scan showed a heartbeat and everything should be fine. Perhaps our initial dates were too early? Thanks for the advice anyway.

   

• At Fri Oct 31, 06:30:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To gidget Oct 9: It is more liekly that you hadn't yet passed al the pregnancy than that you had gotten pregnant again. How did things finally turn out? Dr T

   

• At Tue Nov 04, 10:42:00 PM 2008,  Meg said…

  Hi! I have a question. I am 31 and have had a tubal reversal. I have 4 children 1 after the reversal, and 2 months ago I had what I thought was a pregnancy that wasn't developing. Due to my reversal, as soon as I think I'm pregnant, my doctor has me come in for HCG monitoring. My first was 28 at 3 weeks, 5 days and then 40 two days later. Another test 2 days later showed it at 14 so I assumed when I started bleeding that I was miscarrying and that was that. I never went in for repeat HCG levels as I just assumed they had dropped to normal when I started bleeding. I had a "normal" period and NO sex during that time and a week after my period ended, I started hurting on my left side and was bleeding again. I went in for another HCG and it was up to 48. I received 97mg Mtx IM and my 7 day level was at 52. I just rec my 2nd 97mg IM dose. I love my doctor, but I'm not getting very good answers. I'm just frustrated as I'm on lovenox due to clotting and I am ready to get this over with. She said that the only way to surgically remove anything was to remove both tubes as my levels weren't high enough to actually see a pregnancy. I was just wondering if this is normal. I just don't think I can go through another dose of MTX if this one doesn't work. The side effects are really getting to me. Thanks so much for your time.

   

• At Thu Nov 13, 11:07:00 AM 2008,  Gidget said…

  I ended up bleeding again 4 weeks after the initial bleed. My RE told me this was my period, however my beta was around 1000 at the time. I am currently still going in for weekly beta checks as my beta is still not back to zero. Last check, it was 21, so I hope to be "out of the woods" soon. I am anxious to start ttc again soon, but I am very much afraid of this happening again as I was clearly not prepared for the outcome! Thanks for all your help and answers.

   

• At Sat Nov 22, 06:37:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To defiantmuse: Sorry for the delay in my response, but I just got your comment in my mailbaox yesterday. Even after the fact, I also was worried about your situation from what you have told me, but it's probably a little late for me to help. Starting at such high levels of hCG, you can still rupture the ectopic and require surgery even if the levels are dropping. If you happen to get this response, please let me know how things turned out. Best wishes. Dr T

   

• At Sat Nov 22, 09:26:00 PM 2008,  Anonymous said…

  Hi im new to this so bare w me.
  July 06 i had a ectopic pregnancy at 5 weeks.I was only 16 when this happened and alot of things were kept from me.I just found out that the doc that was caring for me gave me methotrexate and all in that weekend aslo gave me the depo shot. Since than my cycles have been few far and between.By that i mean i have had 3 cycles since the day i was giving the shot. And i and my husband are having trouble conceiving.Every doctor i go to tells me im fine and in time.It's getting harder and harder to deal with seeing every one else with babies and so happy.Do you have any info or advice for me please? i can't keep going to doc after doc to be told the same thing.

   

• At Sun Nov 23, 08:39:00 AM 2008,  Anonymous said…

  Hello,
  
  This site has been the most informatitve I have found on the internet and I appreciate all of the responses. I am in the process of going through an ectopic pregnancy. I was diagnosed on Oct. 29th with low hCG levels (498) and was treated with methotrexate. My levels went up initially (into the 700's) and then by the day 7 draw had gone back down but only into the 500's. Subsequent bloodwork showed the levels decreasing but not very rapidly. About 10 days ago my levels were in the 200's. So my dr.suggested another methotrexate treatment to speed things up and I had that on Nov. 18. I had my blood draw on Friday 11/21 but with it being the weekend I do not know my resutls yet. My concern is that I stopped bleeding on 11/21 and thought that my #s must have been at zero. The dr. that gave me the shot in the hospital (not my dr.) told me that the shot should bring my #s to zero in 48 hrs. I don't think that is the case. I am mostly concerned about my bleeding. Throughout this entire situation I have been bleeding. I started bleeding before I knew I was pregnant (10/13) and have been bleeding since then aside from maybe 2 days. My dr. said it is normal to bleed until the numbers are zero. Is this correct? This weekend the bleeding has increased a lot and I have some cramping, but no severe pain. My ectopic was small, 1.3 cm and my #s low, so I know that my chances for methotrexate working were very good. But any thoughts on the increased bleeding? How long does that last and is it normal to have it take so long for numbers to decrease when they started so low to begin with?

   

• At Sun Nov 23, 12:50:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Paula: Thanks for letting us know and best wishes for the rest of the pregnancy! Dr T

   

• At Wed Nov 26, 10:02:00 PM 2008,  Defiantmuse said…

  Hi Dr. T,
  
  I never did get another shot of methotrexate, thankfully, and my hCG levels continue to drop. They are down to 760 as of last week. It has been 5 weeks since this whole thing began, I'm ready for it to be over. I still have the occasional sharp pain in my left side. Sometimes it's so strong it takes my breath away. All bleeding stopped weeks ago. We have decided to wait for another year to try to get pregnant again.

   

• At Thu Nov 27, 06:03:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Nov 22: It can take 4-6 months, if not longer in some cases, before you begin ovulating regularly again following DepoProvera. The bleeding you are now having may not even be the result of ovulatory cycles. If you are only 16, be a little patient, there is a good chance things will eventually be alright, although you will be at increased risk for another ectopic pregnancy when you do conceive. Best wishes. Dr T P.S. Next time do not let the doctor give you a DepoProvera shot unless you want it for contraception!!!

   

• At Thu Nov 27, 06:06:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Nov 23: In my experience, no two patients follow the exact same course with MTX therapy for ectopic pregnancies. I doubt the second shot is going to get your hCG levels down to zero in 48 hours, but I also do not think you are at very high risk for a serious complications at those low levels. Let us know if you are not doing any better within a week. Best wishes. Dr T

   

• At Tue Dec 02, 07:18:00 AM 2008,  Anonymous said…

  Thanks you for maintaining this site Dr. Trofatter!! I have been searching for answers and it has been very comforting to read through the posts on your site. I have not had a normal period since Sept. 27th. Mid-October I began feeling some lower abdominal pain and suspected that I might have an ovarian cyst, since I had recently gone off the pill in an attempt to conceive. The pain subsided after 2 days and so I dismissed it. My period was late and so I took an HPT and the result was VERY faintly positive. I began bleeding Oct. 27th but the bleeding only lasted one day and was very dark. I took another HPT Nov. 1st and it was clearly positive. I called my doctor and went for a Quantitative HCG test Nov. 3rd and another Nov. 5th my levels were very low but doubled going from 10 to 23. The conclusion was that I may have ovulated late and was just very early in the pregnancy. Then Nov. 25th I began spotting again and was experiencing some intense abdominal cramping. I went the ER because I was away on vacation. My HCG levels were tested again and a trans-vaginal ultrasound was performed. No intrauterine pregnancy was found and my HCG levels were only at 288. A thick-walled cyst with a fluid center was found in my right ovary that measured 2.2 cm (my ovary was slightly enlarged) it was suspected to be a corpus luteum cyst but an ectopic pregnancy was not ruled out. My HCG was checked again on the 27th and my levels were 314. I was sent home for further evaluation and nothing was done because I was out of state. I safely traveled home with little minimal pain. My OBGYN has been out of the office and is back today. The covering physician ordered another blood drawl yesterday and I am waiting for results. I know my levels are very low, but I am frustrated because in my 8th to 9th week of pregnancy I still have no answers. The doctors keep telling me not worry because the HCG levels are so low. They don't believe there is a huge threat to my health. My body has not felt right from the beginning of this pregnancy I often get light-headed and I have experienced strange lower abdominal pains throughout. I have a constant dull aching in the area of my right ovary that hurts more on movement. I know ovarian ectopics are extremely rare, but I think that is what I am experiencing. I have never experienced this type of pain in my ovary before and I know that I am extremely fertile. I have been pregnant three times prior to this and all pregnancies have occurred within a month of going off the pill. One pregnancy ended in miscarriage at 6 weeks and I have 2 healthy children. Is MTX an option for treatment with an ovarian ectopic?

   

• At Thu Dec 04, 07:40:00 PM 2008,  Anonymous said…

  Hi Dr. T.
  
  Thanks for your response. This is anonymous from 11/23. My update is my most recent blood draw (last week) was down to 16. I am waiting for results from today's blood work which hopefully will be negative. But I have one more question. I finally stopped bleeding last week after 6 weeks of bleeding. But today started spotting again (red spotting, not really heavy). There is no way this could be my period right? It is way too early I think.

   

• At Sun Dec 21, 11:03:00 PM 2008,  Anonymous said…

  Hi Dr. T. My LMP was on Nov 20, 3 days late. At that time, I did a home preg test which came back neg. On Dec 6 though, I woke up with vag bleeding. I was suspicious and did a home preg test again which turned up positive. I immediately went to emerg. They confirmed the positive test and indicated BHCG level of 137. No IUP on sonogram however, two visible cysts on L ovary; one clear cyst and one complex cyst. I was followed up 2 days later and BHCg was 158. I was informed I may be having miscarriage. The vag bleeding continued for a week. I was scared and not comfortable with the clinic and did not return (bad move on my part, I know!) I followed up again at another hospital one week later from my last appt due to worsening cramps. My BHCG was 139. Doc asked me to return 2 days later since different lab hence perhaps different BHCG levels. My BHCG yesterday was 139 again. No change in level whatsoever. I was given MTX this afternoon :( I am terribly scared that the level will not drop. My questions to you are this:
  1. Could this have in fact been an ectopic pregnancy located at the L ovary?
  2. Could this be a tumor causing this low level BHCG production?
  3. How soon should my level drop to zero?
  4. My previous period was Oct 20. Could I infact have been pregnant since then and the bleeding on Nov 20 been implantation bleeding?Thank you for any and all your information.
  -Terribly Scared

   

• At Mon Jan 12, 09:01:00 AM 2009,  yasmin said…

  dear dr
  
  I had ectopic pregnancy 4 months ago which resulted in laproscopic surgery which removed my right tube, 4 months down the line I have fallen pregant again, again I have another ectopic pregnancy in my left tube. it has been caught early as there is no fetus, I have been given 2 shots of MTHX, first shot my hcg levels were at 2900 4 days later blood draw showed a rise in levels at 6000, my gyno did an ultra sound which shows the sac begining to collapse and the yolk sac loos abnormaly large in the sac, she felt another dose was required, this was 2 days ago, im getting period pains but no bleeding my question is if the second shot will be successful and no need for another op as I have one tube left which I want to preserve..thanks y

   

• At Thu Jan 15, 11:10:00 PM 2009,  Anonymous said…

  Hi, Dr. T: My last period was Dec. 4 and I was tested pregnancy on Jan 4. I had very light spotting from Jan. 3rd to 5th and it stopped afterwards. On Jan 11, I had two pieces of discharges at night with very minimum blood. Slight cramping after it. It happened on Jan 12 and 13 as well. Other than above, there were no other negative symptoms. My HCG level was
  Jan 7, 480
  Jan 9, over 1000
  Jan 12, 3584
  Jan 14, 8400
  I went to hospital on Jan 12th and 13th for my discharges. Bloodwork and u/s were performed. The doc told the sac was too small comparing to my HCG and there was no evidence of yolk and fetus pole. Nothing was found outside of the uterus either. The doctor believed I had the Ectopic and gave one a shot of MTX.
  on 14th, I went to another hospital. again, nothing out of the uterus but there is only a 5.5 sac with definite yolk or fetus pole. They cannot rule out Ectopic or threatened abortion. Since MTX was already given the previous day, there was nothing left for them do.
  My husband and I got confused. Though to lower the big risk of going to surgery, we did the shot, we still would like to learn your thoughts of my case. Is it more like ectopic or a pregnancy in uterus with a slow-growing baby?

   

• At Wed Jan 21, 10:35:00 PM 2009,  Anonymous said…

  Hello Dr.Trofatter, I had my last period on the 08/12/08 and on the 03/01/09 I started bleeding, wich initially I tought it is my period.Medium flow, nothing heavy. On the 08/01 I started experiencing pain on my left side, low back ache, bleeding hasn't stopped. Did an early pregnancy test which came out pozitive. Went to ER, they did HCG, was 225 and I was diagnosed with a suspected ectopic. Went back to the early pregnancy center on the 12/01, ultrasound could not detect any pregnancy, HCG 211. On internal ultrasound they seen a septated cyst,3 cm, corpus lutheus on the right, no pregnancy could be seen. On the 13/01 I was given a shot of MTX, went back on the 16/01, HCG 343. Back again on the 20/01 (7 days later), no pregnancy seen on ultrasound, cyst 4.5 cm, HCG up 545. I'm still bleeding continously and experiencing pain on my left side, back ache. I was given a second shot of MTX on the 22/01 and I'm due to have HCG on the 27 and the 30/01. My tummy it is tender on both sides on palpation, still experiencing back and leg pains on and off, on both sides. My question is, since they could not localize any pregnancy is it possible the pregnancy to be located where the cyst is? Is it possible for the cyst to rupture? Is the laparoscopy the only option for the cyst to be treated?

   

• At Fri Jan 30, 12:57:00 AM 2009,  Anonymous said…

  Dear dr T. Are there any precautions to take before trying to get pregnant again after an ectopic pregnancy?
  Thanks.

   

• At Tue Feb 03, 11:59:00 PM 2009,  Anonymous said…

  hi Dr. I was diagnosed with ectopic pregnancy on 13jan2009 with beta HCG 1193. Took methotrexate 50mg on d same day. beta HCG went down only 1123on 15th jan. took 2nd shot on 16jan coz the mass size in right tube was same 2by 2 cm. no increase no decrease.beta hcg went down to 823.took third shot on 22jan. beta hcg went down frm 600 to 532 to 55 now. but the size is same. i have bleeded and ultrasound shows empty uterus. no pain. juss a mass of same size in right tube. what should i di now doc?

   

• At Tue Feb 24, 09:00:00 AM 2009,  lilysr1 said…

  Hi Dr T
  I had an ectopic pregnancy 1 week ago this is my first pregnancy Im 30 yrs old I went though IVF treatment to get pregnant because my husband had cancer.the ectopic pregnancy was in my left tub I was 3 weeks pregnant.I had methotrxate shot.Well my question is do I need a cleaning of my uterus and fallopian tub? like an DNC I going to have another IVF treatment 3 to 4 mos.i want to make sure everything will be ok. thanks

   

• At Wed Feb 25, 02:44:00 AM 2009,  Anonymous said…

  Dear Dr T.,
  I need your expert opinion. I had a miscarriage around week 8 in late November 2008. I bled the night before my first OB appointment.
  
  No sac was seen in the US. My HCG was 10,000. I received a dose of Cytotec a week later and passed many clots and dark blood, and my HCG dropped to 200 the following week.
  
  I checked my HCG 4 weeks later because I was out of town, and it rose to 1300. Had a D & C a week later. The HCG went down to 800 the week after. They tested the material from the D&C and said it was not chorionic villi.
  
  The following week, it was 2000. My OB could not confirm if I had an intrauterine pregnancy that ended, or an ectopic pregancy. They decided to give me a shot of Methotrexate. The HCG level dropped 18% between the 3rd and 6th day post MTX (around 1000). Today, 2 weeks post MTX, it was 860.
  
  How fast should I expect my HCG to drop? Do you recommend another transvaginal US? Have you seen cases like mine? It has been 3 months and we have tried everything, yet my HCG is still high. I'd like to know what your thoughts and recommendations are. Thank you.

   

• At Wed Mar 04, 11:35:00 PM 2009,  Anonymous said…

  Hello, I have a question. I started having vaginal bleeding last Monday 02/23 that has lasted about a week. When I went to the ER I was given a blood test hcg came back at 67 and on transvaginal ultrasound nothing could be seen. I was told I had a miscarriage. Two days later on 02/25, I was asked to completed another blood test and my hcg came back at 123. I was told the pregnancy might be viable. A blood test two days later 02/27 showed an hcg of 177. I was told that they now believed that it was a miscarriage and that I should expect my levels to go down. My regular doctor repeated a blood test three days after this, hcg came in at 241. Went for transvaginal ultrasound 3 days later and still nothing. They have suggested methotrexate as treatment but I am hesitant with not being able to locate anything outside the uterus and specifically at these levels being below 1,000. WOuld it be prudent to monitor levels a bit before going ahead. This is torture.

   

• At Sun Mar 15, 05:29:00 AM 2009,  Bargon said…

  Dear Dr T, It is now 10mths since I had an ectopic pregnancy at 4wks.I have been trying to concieve but I am not yet successful.Would you please advise me on the necessary precautions and medical check ups to take to avoid it from happening again.
  thanks dr.

   

• At Wed Mar 18, 09:30:00 PM 2009,  Anonymous said…

  Hello
  I had an ectopic pregnancy.It was detected on 18th jan 2009.the size was 10.7mm fter and beta hcg was around 9000.i had Methotrexate immediatelyafter that. my beta hcg has declined to 25.15 after 58 days.The follow up usg report of the right adnexal ectopic pregnancy reveals irregular but well defined thin walled cystic structue measuring 24*14mm in right adnexa supero-medial to right ovary showing smalll fetal node about 7.0mm in size and the impression is resolution of the sac size and complete absence of the sorrounding decidual reaction and vascularity.
  I had my periods on 19th feb but it hasnt come yet.
  My doctor says that now I am all right and there is no need of follow up usg or Beta hcg as such.
  She has prescribed folic acid.
  As my beta hcg level is still 25 and a fetal node is still there is it okay to start folic acid tablets?
  And my periods have not come even after the due date.Is it a cause of concern?

   

• At Thu Mar 26, 03:40:00 PM 2009,  Anonymous said…

  Hello, I would like to know more about the use of Methotrexete. How long does it take for the HCG to drop to 0, would it be possible to happen within 1 week? And soon after knowing that the HCG drop to 0 the patient need to on contraceptive for 3 months?

   

• At Tue Mar 31, 12:02:00 PM 2009,  Anonymous said…

  Hello. I had an ectopic pregnancy in Jan of 2008 and had to have my right tube removed. In Feb of 09 i found out i was pregnant again and that it was a miscarraige but with continuoous bleeding for the months of Feb and March and urine test still positve for the pregancy, I was told it was another ectopic. My doc's opted to give me methotrexate instead of having the surgery to remove my left tube. I was wondering what could be the possible cause for 2 back to back ectopic's? at such a young age, I am only 22. If the methotrexate does what it is supposed to what are my chances of having a normal pregnancy? If it doesn't and i have to have my left tube removed, does this effect me ever having kids in the future thru invetro fertilization? My doc's haven't given me any definite answers and I feel like i am at a loss b/c I don't know what is going on.
  Thank you in advance

   

• At Sun Apr 19, 01:31:00 PM 2009,  Anonymous said…

  hello, i have a couple of questions, i found out i was pregnant 3 weeks ago, 1 hour after doing the test i started bleeding slightly, had an ultrasound and bloods taken, my hcg levels were 128, i had bloods repeated 48hrs later, they dropped to 108, 48 hrs later they rised to 151, i had MTX treatment on 15/04/2009, i've had no pain and no bleeding my HCG levels have dropped to 84, i'm having bloods tested again on tuesday (21st).
  i'm worried this will happen again, and how long till me and my husband can have sex again?
  many thanx gemma

   

• At Tue May 12, 12:20:00 AM 2009,  Anonymous said…

  Hi ive just been in and out of hospital with an ectopic pregnancy, ive had one dose of the methotrexate and am due to to my gyno for an appointment in 6 days, but my biggest concern is that im still bleeding??? But not onto a pad just if i go to the toilet and wipe? if i cough the bleeding is worse, i occassional get a tiny clot but its smaller then half your pinky nail, but i am in a tiny bit worried about it but, its normal to bleed afterwards right???

   

• At Mon May 18, 01:03:00 PM 2009,  Anonymous said…

  Dear Dr Trofatter
  Having read the initial posting in the chain of comments about receiving methotrexate for suspected ectopic pregnancy and then a viable interuterine pregnancy being uncovered afterwards, is my biggest fear! At what I thought was 6wks gone I had some pain and spotting - USS revealed no interuterine pregnancy, BHCg level was 324. Four days later my levels were 581 and no change in USS. There is now talk of methotrexate but what I want to know is how long can I safely leave it before consenting to this treatment? Providing my levels continue to rise I would like to wait to at least be re-scanned when my BHCg is over 1000.

   

• At Tue Jun 02, 02:44:00 PM 2009,  sheworks said…

  I have a question. I have had three miscarriages and was just told my pregnancy was ectopic. I was given a does of methotrexate and am now waiting for that to start working. I know that with any ectopic pregnancy your risk is greater for it to happen again. My question is does my risk increase my chance of miscarriage in general because of it and do the prior losses play into my current loss at all?

   

• At Fri Jun 19, 05:45:00 PM 2009,  Melissa O. said…

  I was told I had an ectopic pregnancy and was advised I was in need of a Methotrexate shot. I got it. One week later my hormone level was continuing to rise. Low and behold 4 days later my ultrasound showed I was carrying twins. The Dr.'s had presumed ectopic to early. Getting the shot caused me to loose Twin A and to give birth to a very much underwight 28 weeker. This experience has changed my life forever. My son faughtto survive...he continues to today now 13 months old. I would hope anyone who is told they have an ectopic pregnancy would be cautious when it comes to this shot. Yes I agree it helps if your life is in danger due to an ectopic pregnancy. Just take time to ensure there is no doubt that's what it is. My Dr couldn't see the baby so assumed ectopic, however carrying twins like I was your not able to see as early as a single pregnancy. My son is paying everyday because of my mistake and doing as one Dr. said make sure you have more than one confirmation, it could cost you a perfectly healthy baby in the end.

   

• At Fri Jul 03, 11:15:00 AM 2009,  Anonymous said…

  Hi can someone help me? My husband and I were trying for a baby and i fell pregnant (good news). I started having a few brown spotting and slight cramping which i was advised by my gp to go to the hospital for a scan. Whilst there I had many tests and the doctors thought it might be ectopic and said he was foing to keep me in for a few days to monitor my blood levels. I had a scan but being only five weeks it was hard to say. I was referred to another doctor on the ward and he told me it was ectopic. I trusted his knowledge and he said he needed to give me methotrexate now as it was Friday so the pharmacy would be shut. I was shocked but agreed of course. 3 days later I was told the baby is still alive and is in my womb. My blood levels increased after 3 days and then decreased from 7000 to 6000 on the 7 days. How long will it take to lose my baby as its hard to know its alive?

   

• At Tue Jul 07, 04:07:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Melissa O and Anonymous July 2: I am SO SORRY for both of you. This is a failing of the medical system and is a growing concern of mine due to the ready accessibility and simplicity of use of methotrexate. My feeling is that it should never be used in an asymptomatic or minimally symptomatic patient until either an ectopic pregnancy is seen or no intrauterine pregnancy is documented (by a competent sonographer) at hCG levels where an intrauterine pregnancy should readily be seen. My heart goes out to both of you.
  Regards,
  Dr T

   

• At Sun Jul 12, 04:06:00 PM 2009,  Kim said…

  I was given a shot of Methotrexate at 10 weeks. After receiving the shot we had an ultrasound done and we found a perfect baby measuring right on track. We proceeded with the pregnancy and were watched very closely. All of my level 2 ultrasounds came back good. When my daughter was 15 months she started to decline on the growth chart. We did some blood work and found that she had a low growth hormone. We were sent to a specialist and had a more detailed blood work done and we just got the results that she has SHOX DNA Mutation. Whenever we have asked our specialist if the shot that I was given while pregnant of methotrexate could have caused this he seems to just skip over it and says no. I am wondering if we should have a second opinion and what you think. Is the Shox DNA a side effect from the shot? Since she has this we are going to start giving her growth hormone shots for probably the next 12 years. I hope to hear back from you soon! Thanks for your time.

   

• At Fri Jul 17, 07:31:00 AM 2009,  Anonymous said…

  Hello.. One of my friends was diagnosed with a ectopic pregnancy and was given a methotrexate shot a week ago. She had slight bleeding and cramping during the week and last night she had unbearable pain in her lower abdomen.. i'm very concerned! Is this normal or should she go back to the Dr and get checked out. If the tube does rupture because of the ectopic pregnancy will she be able to walk cause she's working today? I can use some advise please.

   

• At Tue Jul 28, 08:07:00 AM 2009,  Anonymous said…

  hello, my wife was diagnosted with an ectoptic pregnancy and recieved the shots to remove it.I'm assuming it was about 8 weeks ago She was going to the gyno so her levels could be checked every other day. a couple of weeks after, the bleeding stopped and her levels were at zero. So we had sex and now 2 months later we found out that she is pregnant again and she is 6-1/2" weeks along. Should we be alarmed of anything?

   

• At Thu Aug 13, 12:29:00 PM 2009,  Jess said…

  Hi Dr.T
  I was told last week that my pregnancy is ectopic. I chose the methotrexate option and have felt terrible ever since I got it last Tuesday. I know it comes with side effects, but I am constantly nauseated and often times cant finish a meal. I have had some severe diarrhea and soreness in my lower back. I also get tired very quickly and feel dizzy after getting up from a nap. What can I do to ease these symptoms and feel more comfortable?

   

• At Mon Aug 17, 11:44:00 AM 2009,  Anonymous said…

  hello, given methotraxate for ectopic on July 9, 2009 (6wk gestation), bleeding since end June 09, and 6 wks after shot, pregnancy test still positive, but i dont feel pregnant no enlarging belly (that i can notice). Could I still be pregnant with living embryo? I would be 12wks today, in no pain, but dark brown vag bleeding continues.

   

• At Tue Aug 18, 09:10:00 AM 2009,  Anonymous said…

  I am having an ectopic pregnancy, confirmed through a state of the art ultra sound machine. I was given the MTX injections last Thursday (8/13/09) and as of 8/17/09 my HCG levels have not lowered (which is to be expected on the first blood draw). My question is, I just read on a website that the drug is not very effective if the fetus is over 6weeks, has a heartbeat, and/or the HCG levels are >5000. I am experiencing all of these things. I was 5 weeks and 4 days when I received the treatment but the doctor said that he DID see a heartbeat on my last ultrasound. Also my levels are well into the 12,000's. Have you heard/read anything similar to this? Have you seen the treatment work on other women with similar criteria? Have you seen the treatment NOT work for someone with these types of "issues"?
  
  I plan to continue trying to conceive a child after this and thus do not want to have surgery for this.

   

• At Wed Aug 26, 12:32:00 AM 2009,  tubal reversal said…

  Every woman has right to dream of having a baby. Tubal reversal allows a woman the ability to conceive naturally without any harm. Although tubal ligation is considered a permanent method of birth control,

   

• At Thu Sep 03, 02:47:00 PM 2009,  jasmin said…

  This blog has given me so much information.
  
  Hi Dr Kenneth T,
  
  i had a metho shot on 9/1 evening 8 PM.
  
  History : ..i have had periods exactly on 25th of each month.
  
  June 22 -> had a pap smear..eveything was normal.
  July 2nd had my normal periods (4 -5 days) however i din't get it on june 25th.
  
  July 18 -> my husband came home from abroad
  
  July 25 th -> severe back ache..pain from hip to ankles. im thinking its symtoms of periods..as i usualy get backache one day prior to period
  
  August 4th -> spotting...severe back aches. Went into ER. ER doctors perform pregnancy test (urine) ..turned out negative. CT scan, Xray, couple of blood tests - all normal.. repeated something like pap smear - again normal.Once doctor removed his hand from inside my vagina..gloves had blood and he said ..maybe its my normal period symtoms.
  
  August 5 -> period started around mid day and continued till august 10
  
  August 11, 12, 13 -> clear..no bleeding
  
  August 13th night -> dark brown spots.
  
  August 14th to 24th bleeding every day 2 pads..bright red blood. tired of bleeding and back ache. Noticed when i get stressed at work, i bleed more
  
  August 20th -> finally got appointment with GYN.. found out i was pregnant. HCG 335 or so. Was bleeding. Ultrasound ..nothing to be seen. Doc thinks im too early in pregnancy.
  
  August 24th -> GYN - blood work. Bleeding starting to stop. HCG 560
  
  August 27th -> GYN - blood work.HCG 870. No bleeding..did not do ultrasound.
  
  August 31st -> Blood work.
  
  September 1st -> HCG result- 770. went down from 870 to 770 or so. Ultrasound shows 5 cm adnexal mass in left tube or near ovary. Looked like a small sac with fluid and a tiny piece of tissue on one side of the sac.
  Doc prescribes metho. i had a methotrexate shot of 84 mg at 8 PM. On August 31st night i had a 800 mg folic acid pill. Doctor said it is fine and not to take any more folic acid supplements.
  
  on 1st night nausea and severe abdominal pain around 2 -4 PM
  
  September 2,3 -> very very light blood clot passing. No abdominal pain.
  
  From august 5 - 10 or from 14 -24th with all the bleeding i never had abdominal pain. No pain on left or right.
  
  
  Another point : i had an abortion 4 years back. It was at 9 weeks..abortion was done due to personal reasons. Not due to ectopic or other health related reasons.
  
  Dr T,
  
  1) is it normal to not have cramps and heavy bleeding after metho shot
  
  2) how can i make sure my tube is healing after the metho works and hcg die down.. how can i check and make sure my organs are healthy in 2-3 months before i start trying again.
  
  Thank you again for reading my question. i really appreciate it.

   

• At Sat Sep 12, 03:32:00 AM 2009,  cpsingh said…

  what happens to gestational mass after treatment with single dose methotrexate. its size reduces or not . if yes, when and at what speed. hcg level is declining.

   

• At Tue Sep 29, 06:26:00 AM 2009,  Anonymous said…

  Hi there... I know this is probably sounding like yet another case like this but we've been trying to conceive for 2 years w/ my husband. We didn't want to do fertility drugs and so did acupuncture, chinese herbs (which by the way cured my HPV). I am also being treated for Hashimoto's thyroiditis. Finally we decided to try IUI, and my response was very good (no side effects, plenty of eggs).
  
  Then my period came 3 days early and was very painful. My reproductive endocrinologist suspected a miscarriage so they started testing my levels. Even after the period though I had rising HCG levels (going from 16 on 9/15/09 to 79 to 606 to 580 to 642 yesterday 9/28). I've started bleeding again but have no pain and only a slight sensation where the ovaries are. My last ultrasound last week showed no sac or embryo so now my doctor wants to administer this drug methotrexate and I am panicked about it, after reading what people have gone through. I'm almost 38 years old and don't have much time left to have children.
  
  What would be your advice?
  
  
  Anonymous in New York

   

• At Wed Sep 30, 10:04:00 AM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To jasmin sep 3: You may or may not have craping after the MTX but most women with an ectopic pregnancy will have bleeding without passage of pregnancy tissues. They get absorbed by your body after the tissues die. You might not have an optimal response to the MTX on the first go-around because of the folic acid therapy. Several months after this is all over, you might ask for a hysterosalpingogram to see if the tube(s) are open. Even if they are, that does NOT mean they are completely normal and you will still be at increased risk for another ectopic pregnancy. Best wishes!
  Dr T

   

• At Wed Sep 30, 10:08:00 AM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous in NY: Unfortunately, you have not had a normal progressive rise in the hCG levels. They should be expected to double every 48 hours at this time in pregnancy. This suggests either a blighted intrauterine pregnancy or an ectopic pregnancy. At this point you are not in any grave danger. You can choose to go with the MTX now or wait and see what happens. If the hCG gets up to 1500-2000 and nothing is seen in the uterus, then this is probably an ectopic and the MTX is usually the best way to go. If an intrauterine pregnancy is seen, then you don't need the MTX. Best wishes and let us know how things turn out.
  Dr T

   

• At Wed Oct 14, 07:23:00 AM 2009,  Anonymous said…

  Hi Doctor, to cut a long story short, I found out I was pregnant at the end of July this year and had a suspected miscarriage on holiday on 16th August and thought that was the end of it. However, I went for a scan on my return from holiday at the end of august and was told my HCG levels were still high (over 10,000), they could see a complex mass near my right ovary and they suspected the pregnancy was actually ectopic. I have had no symptoms and have been waiting for HCG levels to fall (which they have been doing slowly). I was finally offered methotrexate when my HCG levels fell to around 300 and I had the MT on 1st October via injection and my HCG levels are still falling but no quicker than they already were (they are now around 50)! This was my second pregnancy and the first was completely normal. My questions are: Was MT needed if my HCG levels were already falling on their own? If I did miscarry on holiday, can HCG levels still take this long to fall and what else could the mass be which can be seen on scan? Is it possible it was never an ectopic? What are my chances of a future, normal pregnancy after this treatment(I am 25 years old)? Sorry to ask so many questions but not getting many answers at the hospital! Thanks. Naomi

   

• At Thu Oct 15, 06:00:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Oct 14: I think the overwhelming likelihood is that this was an ectopic pregnancy. A miscarriage would have been accompanied by a more rapid drop in your hCG levels. I am very surprised your doctors didn't use the MTX sooner, but you were stable and the hCGs were falling. Once you have had an ectopic pregnancy, there is a 15-25% risk of another one for whatever reasons set you up for this one. I would recommend not trying to get pregnant again for at least 3 months. Best wishes....
  Dr T

   

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