Methotrexate for ectopic pregnancy — my experience

I know I’ve been updating you throughout my ectopic pregnancy but I’ve decided to write a summary blog post about my methotrexate experience as a reference for anyone who might be going through a similar experience now or in the future. When I was going through my ectopic I found a few blogs that were very helpful, so I wanted to share my experience too.

I found out on August 28th (12dpiui) that I was pregnant for the second time (my first pregnancy was a chemical pregnancy). Although my HCG was very low I was highly optimistic that I had a late implanter and that everything would be okay. Over the next two weeks I continued to have regular blood draws and my HCG was appropriately doubling every 48 hours, although when looking at Beta charts online my numbers still seemed low compared to most healthy pregnancies. I continued to be hopeful and excited for our baby.

On September 10th we had our first prenatal ultrasound. They didn’t see anything on the ultrasound, but reassured us that since I was just 5 weeks 5 days pregnant that this wasn’t too out of the ordinary. They took more blood from me to test my HCG again and scheduled me for another ultrasound 2 days later and sent us on our way. I got a call later that day with the results of my HCG test, and for the first time my levels hadn’t doubled. My HCG had gone up from my previous test, but since it didn’t double appropriately they were really worried and mentioned that it could be an ectopic pregnancy.

At that point I was praying for a miracle, just praying that I was one of those outliers you read about, and that everything would be okay. At my next ultrasound they still didn’t see anything and urged me to take the methotrexate shot because they felt more confident it was ectopic. But since they weren’t able to definitively tell me that my pregnancy was in my tubes I just couldn’t do the shot, I believed in my heart that they were all wrong and that by my next ultrasound my baby would be there on the screen. That was a Friday, I couldn’t go back to work after hearing that news so I just went home and cried most of the weekend, it was such a terrible feeling. On Monday morning, September 15th I went in for my third ultrasound.  My worst fear was confirmed…my pregnancy was ectopic, they could see it in my left tube.

My husband & I decided at that time that methotrexate was the best plan for us (the only alternative at this point would have been to have surgery to remove the pregnancy, but there would have been a risk of losing my tube, which would have been horrible for our fertility going forward). I was 6 weeks 3 days pregnant with an HCG level of 1,768.

Methotrexate stops the growth of rapidly dividing cells, such as embryonic, fetal, and early placenta cells. It is also a chemotherapy drug used for cancer patients, some pretty potent stuff. You have to avoid alcohol and most medications for several weeks after each dose of methotrexate or you risk damaging your liver pretty badly (which made the timing of the cold I got the same day as my first dose REALLY BAD because I really couldn’t take anything for it). Also, you have to avoid folic acid and prenatal vitamins until your HCG returns to 0 because it kind of counteracts what the methotrexate does. As far as TTC again after the methotrexate shot my RE said that once my HCG returned to 0 I would need to have one regular cycle after that then we could try again.

First I had to have blood drawn, they wanted to be sure my liver and kidneys were fully functioning, next it was time for the shot. I was given 2 shots, (the number of shots you’ll need is dependent on your weight) one in each butt cheek to rid my body of my ectopic pregnancy. The nurse told me that between no pain at all and a lot of pain most people reported the methotrexate as middle of the road as far as stinging when it was injected. My first shot went fine, didn’t hurt much…but the second shot stung A LOT. After my shots they had me lay there for about 10 minutes to be sure I didn’t have any adverse reactions to the medication (I was in the emergency room, that’s the only place in the hospital that’s allowed to administer the methotrexate since it’s a chemotherapy drug). I hadn’t cried much that day, I think I had already had my main breakdown a few days prior, but after the shots as I was laying in my hospital bed my heart just started breaking. I knew that my baby had no chance, and that the pregnancy was very dangerous to me too since it was in my tube….but I knew at that point it was all over, or at least it would be soon. After my 10 minutes was up I was allowed to leave. I went home and rested the rest of the day.  The nurse told me to monitor my symptoms carefully over the next few days/weeks because there was a chance that the methotrexate wouldn’t work quickly enough and my tube could still rupture. She told me once I started to bleed if I soaked through more than 3 jumbo pads/tampons in one hour to call immediately….and they would likely need to see me again right away. I never experienced much bleeding, just a bit here and there.

One of the worst parts about this whole experience was having to go for SO MANY blood draws after the shot. At first they were 3 times per week, then twice a week, next once a week, then once a month. It was a LONG process. My RE said he would need to monitor me until my HCG was 0.5 or lower. From what I’ve read there is a large variance in how long it takes women’s HCG levels to return to 0, for me that time was 20 weeks.

Sept 15 – HCG: 1,768. Methotrexate dose #1.

Sept 18 – HCG: 2,632

Sept 21 – HCG: 2,512

Sept 22 – Ultrasound went great, my RE said he was checking for blood in my tube….he didn’t find any. He said he did see some blood in my uterus, so I may start to bleed soon.

Sept 23 – HCG: 1,995. Started to bleed, bright red blood….but not very much.

Sept 24 – Some spotting.

Sept 26 – HCG: 1,693

Sept 29 – HCG: 1,290. HCG was still dropping a little slower than they wanted at this point.

Oct 1 – HCG: 981. Ultrasound went great, no fluid or cysts.

Oct 3 – HCG: 825. HCG still not dropping like they wanted, but since I was in no pain he said it wasn’t urgent that we do anything else at this point.

Oct 6 – HCG: 513. HCG finally started to drop off appropriately. I also had an ultrasound on this day, and it went fine.

Oct 9 – HCG: 393

Oct 10 – Developed my 2nd cold since the Methotrexate shot…..it really does a number on your immune system.

Oct 11 – Some brown discharge. {my birthday}

Oct 13 – HCG: 255. Some spotting.

Oct 15 – HCG: 224. At this point my RE decided I needed another dose of Methotrexate because my levels were starting to plateau, and at all costs we wanted to avoid surgery on my tube.

Oct 16 – Methotrexate dose #2. My RE did an ultrasound before the shot, everything appeared normal.

Oct 20 – HCG: 137

Oct 24  – AF type bleeding (light).

Oct 25 – Some spotting.

Oct 27 – HCG: 70

Oct 28 – Follow up appointment with my RE to discuss my levels and how to proceed with TTC after this miscarriage was over.

Nov 3 – HCG: 33

Nov 10 – HCG: 20. At this point they said as long as it was still dropping we were doing okay, but it still may take a few more weeks to return to 0.

Nov 15 – AF type bleeding (medium).

Nov 16 – AF type bleeding (medium).

Nov 17 – AF type bleeding (light). HCG: 21. After this test my RE suggested I may have started building up antibodies to the HCG which was why levels had tapered off. He confirmed this theory with some more blood work on Nov 19.

Nov 19 – HCG: 16

Dec 15 – HCG: 8

Feb 7 – HCG: O

If you’re reading this post because your pregnancy might be ectopic or you’ve recently been given the methotrexate shot and are wondering what to expect, my heart truly goes out to you. I am so sorry that you too have to experience this. It’s bad enough finding out that your pregnancy isn’t where it should be and that it’s not viable, but then the LONG DRAWN OUT process of your HCG returning to 0 can truly be excruciating. Many prayers and thoughts are with you. Please feel free to reach out if you want to talk, I’m always willing to talk and/or listen. ❤ ❤ ❤