MTX and subsequent ovarian reserve

[Irina]

I got my eggs milked out from my tube on the 31st December. Since then my HCG has dropped from 2000 to 290 and pleteaud.

My doctor says it is a persistent trophoblast and suggests to administer MTX 1mg/kg.

I am significantly worried about my ovarian reserve as it is already diminished (my AMH is 0,3), 2-4 follicles in two ovaries, high FSH and I don’t have children (36 yo).

My question is if you have had a single dose of MTX due to ectopic, how did it affect the subsequent ovarian reserve afterwards (AMH, number of follicles, FSH)?

[EPT Host 22]

Hi Irina,

I'm afraid I'm not medically qualified to answer your question. I encourage you to follow up with your GPs on MTXs interaction with ovarian reserve. I have not come across that situation or question on these boards as of yet.

With good wishes,


Michele

Michele

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

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[Irina]

Hi Michele,

Thanks for answering me. I believe the subsequent ovarian reserve can be also interesting for some women as well.

I know that checking only one person is not reliable enough but I think I might share my observations here for those who are interested.

My AMH level after surgery was 0,38 (I am 36, it was my first pregnancy). Then I was prescribed 50mg MTX. In one month I will share my AMH again.

Also my doctor suggested I would take coenzyme Q10 and alpha-lipoic acid to decrease oxidative stress caused my MYX (it can affect ovaries).

[Irina]

I am in despair. 2 months passed after my 1 dose of MTX (50 mg).

My hormones before ectopic:
FSH = 11 (norm up to 9.9)
AMH = 0.38
E2 = 300 pmol/l

After MTX (the second period after MTX):
FSH = 34 (norm up to 9.9)
AMH = 0.09
E2 = 95 pmol/l.

I have hot flushes now, wake up every day at 4-5 am and am emotionally very unstable.

I am 36 years old and I still don’t have children.

Does it mean I am in a pre-menopause now? Does it mean I don’t have eggs anymore and will not be able to have children? Can my reproductive system recover after MTX so the hormones levels are back to previous pre-MTX levels?

[EPT Host 20]

Dear Irina,
I am afraid we are unable to give individualised medical advice on these forums. I would therefore advise speaking to your GP or medical team who will be able to discuss your results in detail.
Sending much love,
Karen x

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information
*************************************************************************
If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.
Further information is available on our website.
Email us: ept@ectopic.org.uk
We provide a call-back support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.
Take a look at our newsletters and subscribe to our mailing list.
Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team
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[Skizii]

Hi Irina,

I’m not a doctor but I just wanted to let you know my experience.

I had my first ectopic in 2019 (I was almost 34yrs) in my left tube. I was treated with 2 doses of methotrexate as the first dose didn’t work.

I then conceived my son the following year in 2021 (almost 35yrs) most likely from my left tube.

I have since unfortunately had 2 more ectopics, both in my right tube - the first managed conservatively & the most recent via surgery to remove my right tube.

Whilst my journey thus far has been challenging at times, both times I have managed to conceive quite easily albeit my poor babies have gotten stuck in that tube.

I pray now for smooth sailing with my left tube & pray also that there will be good news in store for you too.

Lets both try to have hope Irina xx

[Irina]

Hi Irina,

I’m not a doctor but I just wanted to let you know my experience.

I had my first ectopic in 2019 (I was almost 34yrs) in my left tube. I was treated with 2 doses of methotrexate as the first dose didn’t work.

I then conceived my son the following year in 2021 (almost 35yrs) most likely from my left tube.

I have since unfortunately had 2 more ectopics, both in my right tube - the first managed conservatively & the most recent via surgery to remove my right tube.

Whilst my journey thus far has been challenging at times, both times I have managed to conceive quite easily albeit my poor babies have gotten stuck in that tube.

I pray now for smooth sailing with my left tube & pray also that there will be good news in store for you too.

Lets both try to have hope Irina xx

Dear Skizii, thanks for sharing your story. I am so sorry to hear you had two ectopics. You had really hard times including both surgery and MTX not to mention loss of two babies.

It is encouraging to hear that you were able to conceive easily. How are things now? I really hope for the best for both of us and for all women here.

As for me, I had 2 periods after MTX and surgery. For now periods have stopped for 38 days. The previous cycle was just 13 days and ended with brown spotting for 10 days.

I really worry it might be a menopause but deeply inside I hope my body will recover despite some doctors say the ovarian reserve and AMH levels cannot restore (my AMH dropped to 0,03)