methotrexate experiences please

[Headspace2020]

Hi all,

I was recently disguised with suspected ectopic although nothing has really been confirmed via scans.
I’m now 9 weeks pregnant but at 6 weeks I was scanned as severe one sided pain, cramping and spotting. Scan was PUL and hcg was only 141 - nothing seen in tubes.

2 days later I experienced excruciating cramping, back pain, heavy bleeding for 24 hours only, and the passing of large clots. As soon the last clot was passed, most pain subsided.

My HCG dropped to 50 in the days after but then started to creep back up. Next scan revealed a growth/clot in my right tube, and hcg still rising.
I waited over a week hoping by body would deal with it, but this week I decided on the methotrexate after another scan gave conflicting findings (nothing in tubes but cyst in ovary) and rising Hcg once again.

Day 4 after the methotrexate was today. I’ve had the usual and consistent tender abdomen and some lower back pain but no other symptoms or bleeding. My HCG has risen again by 53%.

Although I was informed about a rise being normal the nurse seemed concerned by my lack of symptoms and asked if I would be rescanned on Monday (day earlier than the 7 day bloods) by another consultant. She didn’t assure me with my results and I now feel them asking me to come in early to monitor me is an indication this isn’t working and they’re concerned.

I’m so fed up, this has been going on 3 weeks and this is the 10th lot of bloods I’ve done and will now be the 4th scan on Monday. Every time I have a scan it’s a different opinion and perspective and just feel like no one knows what’s going on.

I’m now thinking there’s something more sinister going on and this is just never going to end. I chose the methotrexate to try and have some control and certainty over this situation and just feel like even this is failing .

Any experiences of symptomless methotrexate + rising day 4 but successful outcomes would greatly be appreciated right now.

Thank you. Xxx

[EPT Host 20]

Dear Headspace,
I am so sorry to hear of your ectopic pregnancy loss and all the sorry you are going through, It is so hard when we do not know what is going on with our bodies.
It is honestly really common for the hCG level to rise on the day four blood test because the action of methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of methotrexate or surgery.
I was treated with methotrexate, had a rise in day four and then a slow decline. I hope this helps to reassure you. I don have to remind you to seek urgent medical advice with any worsening bleeding or tummy pain, but I will be keeping everything crossed for a reduction in your next blood test.

Sending much love,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
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[Sunflower89]

Hi,

Hopefully this offers you some reassurance - I just had my day 7 blood test yesterday and my levels have started to come down. I was convinced they would have gone up as I'd had hardly any spotting since my injection, and while I've had some pain and a lot of bloating and discomfort I haven't really had cramps (and certainly not worse than my usual period pain).

As others have said, day 4 results always tend to go up as it days a few days for the methotrexate to take effect. My nurse said that if they were going down on day 4 it was a sign they would probably have gone down anyway rather than methotrexate kicking in quickly. They expected my day 4 levels to have gone up, and weren't concerned when they did. She said to view day 4 as a baseline, with the day 7 results more important. Obviously that's not to say that yours definitely won't go up on day 7, but hopefully offers you a bit of reassurance that your levels may still be going down even if you're not experiencing a lot of symptoms!

[Headspace2020]

Just to keep any future readers updated, my day 7 bloods following MTX is static so it’s been unsuccessful.

Day 1: MTX injected (141 hcg)
Day 4: 221 hcg
Day 7: 224 hcg

So back to the drawing board of waiting, a second shot of MTX, or surgery.

I had a further scan and they are certain they can see the ectopic between my
Ovary and Uterus so are leaning towards operating as I’m now technically 10 weeks ‘pregnant’ and I have been in and out of the EPAU since I was 6 weeks.

I think I’m going to have some bloods done at the end of the week and if a miracle hasn’t happened; book in for the surgery.

dont feel like this nightmare is ever going to end xx