Ectopic Pregnancy Day 4 number increase

[Mercedes1291]

Hi all,

I was advised to go to the emergency room Friday August 11th by my OBGYN as she suspected I had an ectopic pregnancy but she wasn’t able to find it. They did locate it in my left fallopian tube and gave me a dose of methotrexate. I was under the impression that they gave me 2 does but the hospital said it was actually considered one does just spilt and injected into each side of my upper hip. So I may be eligible for another does as long as my liver enzymes are normal and I haven’t ruptured.

I went for my day 4 blood work yesterday Monday August 14th and my levels went from 400 Friday to 600 so naturally I’m very concerned. I read that the success rate of methotrexate working is lower if your levels increase on day 4 even though the most important testing day is day 7. I deal with a lot of anxiety and this situation has doubled my panic and I feel very uneasy and restless. I also have not been experiencing much bleeding and yesterday it seems to have stopped or lessened significantly. I go for blood work again on Thursday the 17th but I’m very worried. Also my breast were extremely tender and swollen yesterday not so much today but still look bigger than normal.

Any thoughts?

[Deerdancer]

Try not to worry too much, easier said then done! It's actually extremely normal for the hcg to rise Day 4 and they really are only interested in seeing at least a 15% drop between Day 4 & 7. In my case my hcg went down a little Day 1-4 but it didn't count because between Day 4-7 it didn't decrease by 15% so had another jab. Take 1 day at a time, take it easy and try and distract yourself- I did a lot of walks and podcasts! Hope Thursday reduces well for you

[Mercedes1291]

Thanks so much for your reply. My main concern is breast soreness. If my hormone levels were dropping they would for sure be going down and not be sore but idk I haven't experienced this before. I have miscarried in the past so that's why the soreness is concerning. They would typically go down very quickly once the hormones starts dropping.

[EPT Host 20]

Dear Mercedes,
I am so sorry to hear of your ectopic pregnancy loss,
As already mentioned, It is normal 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

If you were given the methotrexate on the same day, just in different limbs, this is one dose. Some hospitals split the dose due to the volume given.

Bleeding is very different following methotrexate and some women do not bleed at all. Is long as your bleeding isn't becoming a lot heavier or your pain isn't significantly worsening, this is normal. I would imagine the breast tenderness will settle as your hCG levels reduce, but if they do not, seek medical advice just to out your mind at rest.

Please be kind to yourself and allow time to grieve and heal both physically and emotionally.
We will be here for you for as long as you need.
Sending much love,
Karen x

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
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[Mercedes1291]

I went to the emergency room at around 12:30am because I was feeling too anxious to wait until I got my day 7 test taken in the afternoon and not find out what my numbers were until Friday. Sadly they went up and I opted to take another dose.

Aug 11th Day 1: 400
Aug 14th Day 4: 623
Aug 17th Day 7: 761 (second methotrexate dose given)

This entire situation is so emotionally and physically draining. I’m still not bleeding and have had some stomach pain but that just feels like constipation. Breast tenderness seems to have subsided but they still larger than normal and my numbers have gone up since day 4 so not sure it that means anything.

Any success stories with a second dose?

[Deerdancer]

Yes! Mine came down after the 2nd jab! Crossing everything for you It is exhausting, make sure you rest and look after yourself, so important! I also had lots of green tea and tried to avoid food with folate...a horrible diet but I saw on here some other women did that so decided to follow suit. Don't know if it helps but I was willing to try anything!

[Mercedes1291]

Thank you!! I was up late last night and read that green tea can help so definitely will try that today. I also read unripe papaya and pineapple could help cause contractions in the uterus. Did your number start to go down on day 4?

[Deerdancer]

Yes! I went from 1408 to 157, which I was quite shocked but extremely relieved about! Hope it decreases for you

[Mercedes1291]

Wow! That’s a huge drop. Were you bleeding and cramping? Also what was your diet like? My doctor recommended fasting because when you fast, your healthy cells go into a dormant state, and the rapidly dividing ones get more affected by methotrexate. But I will need to eat something at some point, this medication has made me feel very lethargic and weak.

[Headspace2020]

Hi

I just wanted to share that my bloods also went up day 4 and only decreased by 3% on day 7. I was offered surgery so I went home to think about it and 2 days later my bloods dropped 30%.
I’m back Monday to check still dropping.

Just wanted to offer my experience as I was also panicking and had basically no symptoms apart from being a little tired!

Your body may be a litter slower at responding as mine was. Hopefully you’ll start declining after the second dose. Sending you a big hug xx

[Deerdancer]

I had started bleeding as I went into hospital to have investigations to whether it was a viable pregnancy or ectopic, so before I took Methotrexate. I bled for 2 weeks, so for me it stopped a week after my 2nd jab and I have now had my first period which came about 4.5 weeks after I had stopped bleeding.
I was largely ok cramp wise, although it became very uncomfortable to go to the toilet every time I needed No2 which I found odd but I preferred that to any pain around the tube because I wanted to avoid surgery if it were possible!

My docs said nothing about food, I only followed what I had picked up on here, so I had 3 normal meals. Often yog & blueberries, cheese & crumpets, then pasta/pizza/salmon etc + some veg but no greens! And lots of green tea!

I felt exhausted for about 4 weeks, so 2 weeks of jab and 2 weeks after, so do take it easy - you're going through a lot emotionally and physically.

As Headspace says, we aren't all textbook so levels can take time to decrease & if you're not in pain & docs not worried, I would say take your time. But main thing is you're safe.

Take it easy

[Mercedes1291]

Thank you all for your replies, this forum has been extremely helpful. I just had my level’s checked again and they have finally started to go down!

Aug 11th Day 1: 400
Aug 14th Day 4: 623
Aug 17th Day 7: 761 (second methotrexate dose given)
Aug 20th Day 4 (after second dose): 454

Some things to note. I started drinking blended pineapple, papaya, and fresh aloe mixed with some water on day 2 as I heard this will help the uterus to contract I also started drinking caffeinated green tea a few times a day as this helps to decrease folic acid absorption. I started spotting late Friday night and officially started bleeding early Saturday morning.

I can’t say for sure doing all this helped but I’d like to think it did because my numbers have gone down. Going to continue this regimen until I get to zero.

[Sunshine_17]

Hello,

Currently I'm going through ectopic pregnancy. Done with two doses. Below are my values

July 29th - 3614
July 30th - Methotrexate
August 1st - 776
August 8th - 1265, Methotrexate
August 13th - 906
August 18th - 593

I started bleeding a week after 1st dose. Had extreme cramping for 2 days after 2nd dose. Cramping is getting better now but every 4 days once I wake up around 2.30am with moderate cramping and bleeding. Sometimes I feel constipated at times it's like diarrhoea heard it's one of the side effects of methotrexate. I started taking green tea from August 13th and I think it helped to bring down my levels to an extent.

Also I notice a pattern like if I travel or eat heavy meal before bedtime it triggers bowel moment which leads to cramping and bleeding.

Hope your levels go down too. Keep me posted as we both are sailing in the same boat

[Mercedes1291]

UPDATE***

Aug 11th Day 1: 400
Aug 14th Day 4: 623
Aug 17th Day 7: 761 (second methotrexate dose given)
Aug 20th Day 4 (after second dose): 454
Aug 23 Day 7 (after second dose): 396
Aug 31st : 85

A few things to note. When I received my day 7 results after my second dose I felt very defeated as I received them in the waiting room through the health portal before my doctor had chance to explain them to me and I determined that the second dose had failed because there was not a 15% drop but I thankfully I saw wrong. A second dose is not normally required but when it is I believe how it was explained to me is that any drop between the 7th day of the fist dose and the 7th day of the second counts into that percentage so I technically had over a 40% drop during this time and was cleared to move forward with weekly testing. This has been a truly emotionally experience as I'm sure you all know and I have mixed emotions/feelings about it but overall I am happy that my numbers are dropping.