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PUL... methotrexate or surgery???

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LJC-87
Posts: 14
Joined: Sun Mar 07, 2021 8:54 am

PUL... methotrexate or surgery???

Post by LJC-87 »

Hi,
Has anyone had experience with Pregnancy of unknown location and being given the choice of methotrexate or surgery?
I had an ectopic last November which resulted in emergency surgery and removal of my right tube. It all happened very quickly and we didn’t really have a choice in the matter as the ectopic was close to rupturing when it was found at my first early scan at 7 weeks.
This time round I’ve known pretty much as soon as we had the positive test that something wasn’t right again. The same bleeding and cramps on and off.
We’ve been backwards and forwards to EPU over the last 2 weeks, nothing at all found on several scans but hcg levels continue to rise very slowly so we’re being told it’s PUL.
Today we went in for one more check on hcg levels expecting to then start methotrexate.
Hcg levels have risen again 600 and something currently but the consultant has basically told us it’s our choice what treatment we have.
We talked it through, the pros and cons of methotrexate vs surgery.
I am just so tired of it all and want it to come to an end so I can process it and grieve properly, so worried about there being an ectopic that we can’t see and the risks entailed and so worried about losing my other tube.
We know methotrexate is least invasive but there are chances of it not working, also of it is k. The tube the tube is damaged regardless. I Just wish I knew where it was and what was going on without having to make the choice.
So confused right now and due to go back tomorrow with a decision!

Esb27
Posts: 28
Joined: Thu Oct 29, 2020 9:45 pm

Re: PUL... methotrexate or surgery???

Post by Esb27 »

Hi LJC-87,

So sorry to hear you are going through your second ectopic, sending lots of love and hugs your way.

Totally understand how you feel. I had surgery or methotrexate options presented to me when my pregnancy was diagnosed as ectopic on 1st April this year (after previously having an ectopic which ruptured and therefore removed my right tube in 2019). It was SUCH a hard decision as you just don't know if you will end up having another next time or not. Can I ask if you've ever had any successful pregnancies or miscarriages before this? I've had two miscarriages (both very very early) but the last one was in December 2020, so 3 months before my 2nd ectopic. This is probably the main reason why I decided not to have the surgery. I'm clinging to the tiniest bit of hope that I did get pregnant in the right place (it just obviously wasn't meant to be) fairly recently, even though I know the chances have risen for having another ectopic next time. I decided that I was still young (30) and that we were a healthy couple, minus the ectopics obvs, so going to give my tube one last go. What is frustrating is that we don't know how damaged the tube is and there's not much in the way of finding out (except doing a dye test but that only shows blockages - plus you can't get that whilst you have a PUL so pointless for you right now). Do you know for sure that your tube is really damaged? It might be that it's only got a bit of scaring which is what caused the ectopic, and that next time you MAY be okay.

I think the chances of methotrexate working are fairly high, even if you had to have a 2nd dose, plus as you say it's not as invasive. My experience was quite positive with it, felt awful for a total of two days (not consecutively) and my levels (which started at 1500) we back down to 1.8 3 weeks after having the injection. It depends if you think you can mentally and physically go through another ectopic in the future though. I feel like i've built up a wall so willing to risk it again before removing the final tube and only getting pregnant via IFV but it's not for everyone. Was very tempted to remove mine though just so I could move on and just try IFV but tbh IVF scares me a bit so wanted to give it one more try. Even though I fear that i'm probably going to be in this situation again whenever I get pregnant again, which is actually getting to me more than anything :(

What surgery options did you get? Was it to either to go in and remove the pregnancy OR remove the tube? The first option scares the life out of me as ectopics are caused by scaring, and surely taking it out and patching the tube back up would cause scaring then therefore an ectopic the next time! I don't get it!! For me the only option was methotrexate or tube removal. The latter just felt SO final but it's not like I didn't consider it.

Since my all clear i've got my doctor to refer me to a fertility specialist to find out what the [heck] is going on. Still waiting to hear from them about an appointment but hoping I can get my ovaries/womb/my partners sperm tested as well as maybe a dye test to see how blocked my tube is so i'm not stumbling into yet another ectopic in future with no idea about anything. Very tempted to also start conversations about IFV, but very nervous doing that with a tube still there (you can still have an ectopic with no tubes but I think the risk is really really low, much lower than what we have right now with one tube intact so would prefer to try that when I have no tubes)

I feel for you as it's a hard decision to make, especially when all of this is fresh plus you have pregnancy hormones in you making it feel 1000x worse. Ultimately only you and your partner can make this decision but I thought I would share my experience and thoughts just in case it would help you or put you at ease during a bloody horrible time.

Berecca_1384
Posts: 10
Joined: Wed Apr 21, 2021 5:11 am

Re: PUL... methotrexate or surgery???

Post by Berecca_1384 »

Hey LGC-87

Really sorry to hear you’re going through this and sending positive energy your way to help you make the decision that feels right for you.

Since my ectopic pregnancy diagnosis (although I wonder if it is more a PUL...who knows..) I have done so much reading but I still ask myself questions.
From the research I’ve done googling away on medical records etc.. an Hcg below 2000 and in some cases below 5 or 6k, is safe for a methotrexate injection. Basically the lower the better chance of it working.

I had my 1st dose of methotrexate last Monday and I’ve gone down form 107 hcg (day of injection) to 88 hcg (today on 7th day).

I don’t think there’s any right or wrong, you have to do what feels right for you.

Take care of yourself and come back here to speak anytime. I have found this board so so helpful ❤️ xxx

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