Please Help - Previous Methotrexate and Ectopic.

[alynch201]

Hi there,

I hope that this community can give me some information.

In October, my first pregnancy with my husband was diagnosed as Ectopic at around 7 weeks. We were gutted. I was treated with a 1st dose of methotrexate and then a 2nd the week later because my HCG was still rising. I had my second and last injection on 23rd October 2017. In all our conversations with the medical team and in all the literature we were given, we were told to wait 3 months "after treatment" before trying to conceive again which we took to mean three months from 23rd Oct, i.e. 23rd Jan 2018.

So now I'm pregnant again, 6 weeks + 4 days today and we were at the hospital for an early scan. All in the right place, which is obviously the first relief BUT they were chiding me for getting pregnant so soon after the methotrexate. I told them I'd waited the requisite 3 months and they told me is was three months AFTER your HCG returns to normal - that's when treatment is considered over. The first negative HCG tests I had was on 23rd November which means, by their standards, I've only waited 2 months and after a double dose of methotrexate.

I have several questions and would welcome any experience or knowledge anyone has.

1) Are they right and is it 3 months from injection or 3 months from first negative HCG reading. I know a little about medicine and it seems strange to base the three months time limit on a date which is so arbitrary. For example if two women with two ectopic pregnancies are given Methotrexate, one who's HCG is 100 and one who's HCG is 5000 then doesn't it stand to reason that the first woman will get down to <12 points faster than the second. Why, when the drug dose is the same and given at the same time can the first woman be considered "safe to conceive" sooner than the second. Why not call it 4 months from the known and fixed date of "drug administered"?

2) Let's say they are right and an error has been made. I've conceived too soon, by one month from the point which is considered safe, is there any good and academic data on how likely I am to a) miscarry or b) carry to full term but the baby will have birth defects?

3) is there anything I can do to mitigate these risks. For example, I've been taking Folic Acid (400mg) every day since Nov 2017. Should I be increasing my dose while I'm in the crucial 4-8 weeks stage.

We have a next scan on Friday 9th which they're hoping will allow us to see the fetal heart beat. But for me, the concern isn't just the viability of the pregnancy but also the condition of the baby. No one wishes for a child with health problems but I feel like this is a choice that we've be making - going into the pregnancy with our eyes wide open to that as an increased risk... it's a future my husband and I would actively avoid and we don't seem to have any trouble conceiving so I guess the final question is...

4) In my position, would you terminate the pregnancy now and start again fresh?

Any thoughts would be great. Appreciate it.
Alynch201

[EPT Host 20]

Dear Alynch201,
Whispered congratulations on your pregnancy, I can understand your having concerns and this is perfectly normal after everything you have been through recently.
Sadly I am not medically trained so cannot give you specific advice on your pregnancy and concerns, I would raise these with your GP, midwife or doctor in the early pregnancy unit.

Generally with Methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor advises you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the methotrexate may have reduced the level of folate in your body and cause problems for any baby during pregnancy. It is good however to hear that you have been taking folic acid suppliments.

There is a strong likelihood that speaking to medical professionals they will say it is fine to do nothing but, as we have limited access to your medical information, we would hate to suggest what the right course of action is in your personal circumstances. We would therefore recommend you speak to your GP to discuss whether they are happy that your folate would be high enough to not worry. Hearing this would also give you peace of mind.

Generally following methotrexate injection it is advised that you should wait until your hCG levels have fallen below 5mIU/mL and then take a folic acid supplement for 12 weeks before you try to conceive. It is advised to wait until your hCG has fallen rather than from the date of your injection as it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. It is also important not to take folic acid at the same time as methotrexate as it can interfere with treatment. Waiting until the hCG has fallen to pre-pregnancy levels ensures the treatment has worked.

I hope you manage to get further answers from your GP/doctor's,
Sending much love,
Karen x

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