Urgent: is methotrexate ever given for Intrauterine pregnancy????


#1

I have a failed pregnancy and my clinic is recommending that I take methotrexate even though no etopic pregnancy has been located.

I hesitate to take methotrexate if it is not necessary and am wondering if ladies who have experienced miscarriages/taken methotrexate can give their opinion:

  1. would you take methotrexate if you were in my situation (see facts below)? Why or why not? Would this change if you knew for sure it was intrauterine?
  2. What questions would you ask or tests might you request in order to determine whether this pregnancy is intrauterine or ectopic, and is this determination important? i.e., would another u/s be helpful here now that my levels are >1000 and its 8 days later (total of 8w5d)?
  3. If it is a failed intrauterine pregnancy, is methotrexate ever indicated?
  4. How long did it take your levels of HCG to go back to zero after you took methotrexate? Does anyone know from personal experience that taking methotrexate helped their HCG levels decrease more rapidly than they would have if they had not taken the drug? Does it help the levels decrease equally if it is intrauterine rather than ectopic?

In hindsight, I am also wondering:

  1. Might an earlier u/s (in the 5th or 6th week) have increased the chance that the doctors locate this pregnancy if it was intrauterine?
  2. Could a pathology lab help determine whether the material passed with my period was, in fact, pregnancy related and therefore indicate that the pregnancy was in fact intrauterine?
  3. Is there anything I can request or do to prevent this from happening again?

Here are the facts:

1st trimester u/s at 7w4d: IVF clinic was unable to locate the embryo that was implanted. The u/s results were reported as inconclusive. The pregnancy was not seen in the uterus or anywhere outside.

Two clinic doctors indicated that I most likely had a failed intrauterine pregnancy that has not fully expelled the placental tissue. However they note that there is a chance (small) that it is an etopic, but they cannot find it. They have ony done one u/s at 7w4d and do not plan to do any additional u/s (8 days have passed since the first u/s).

My hcg levels are low (750–>1030 over a week period and 3 blood draws) and are continuing to rise slightly even though I ended progesterone and finished my period. I swear that the period contained pregnancy-related material (grey tissue with vascularization and a kidney bean looking thing (~1.1cm) that was attached to the grey matter by a chord.) The doctor did not want me to bring the material in for pathology to examine it. But I wonder: Could the pathology analysis have answered the question of whether it was IU or not?

I am not having severe cramping, and the bleeding has largely stopped. I feel occasional cramps which are sometimes followed by additional spotting.

Thank you kindly for your thoughts… I have learned a lot from you ladies out there and appreciate hearing your experiences.


#2

I don’t have answers on a lot of the stuff, in terms of the pathology report, etc. I’m mainly just answering question 1. My answer is that I wouldn’t take the methotrexate if you feel a lot of time pressure in TTC, since you have to put it on hold for at least three months afterwards (six if you need a second shot.) But you might need to be prepared for a hysteroscopy, D&C, or lap surgery if you don’t want the shot.

With my first MC in March, we were afraid it might be ectopic since I had quite a bit of bleeding. My betas were OK but not great and were not quite doubling. Since I’m 38 already, I had decided that it if it were ectopic, I would opt for surgery to remove it rather than do methotrexate. I ran this past an OB and my rheumatologist (since it’s originally used for autoimmune treatment at well as chemo), who both felt that was an appropriate decision. 20% of women require a second shot, so I really didn’t want to risk being one of the people who has to lose six months waiting before starting to try again. It turned out not to be ectopic, but I was positive I was not doing methotrexate even if it was.

Sorry that you’re going through this. It’s definitely hard having these situations drag on in some sort of uncertain state. I hope it’s resolved quickly for you.


#3

I’m sorry you are going through this. I recently experienced what sounds like a very similar pregnancy. My hcg levels continued to rise slowly for eight weeks, but nothing ever showed up on the ultrasounds.

I went ahead and had the methotrexate since I was ready to start ivf and didn’t want to wait for months longer – there is no way to know how long it would have taken my body to realize the pregnancy wasnt developing.

Even with the methotrexate, it took a week before I started bleeding. My cycle didn’t resume for almost another six weeks after that. Also, my RE doesn’t make you wait for three months after methotrexate. I just had to wait for my next cycle. I’m pretty sure the months long wait times is outdated info…

With respect to your questions, here are my thoughts:
1)it depends. Do you want to try again soon? If so, do what you need to end the pregnancy sooner rather than later. I had lots of nausea and couldn’t wait to feel like myself again.

2)why does it matter where the pregnancy is at this point? The only thing that matters now is that it isn’t developing normally. If it is in your tube, you want it out before it gets big enough to rupture.

3)methotrexate will end the pregnancy irregardless of where it’s located. It’s a good choice when you aren’t completely sure where it is, since a d & c wouldn’t work if it is actually in your tube or even your abdomen.

4)it took eight weeks for my hcg to get back to zero. It dropped as slowly as it had risen. There’s no way to answer the second part of your question since every pregnancy is different. I suspect it would have taken way longer though.

5)I had ultrasounds starting at five weeks. We never saw anything ever. You typically can’t see anything until hcg is over 2000, which mine never reached.

6)I saved some of the contents of my miscarriage to see if we could get pathology on it, but my doctor said it was too contaminated and you can only do pathology via a d & c.

7)you did not do anything to cause this, and there is nothing you can do to prevent it from happening again. If you have had multiple losses, you should ask for recurrent pregnancy loss testing to see if you have an immune or clotting issue.

Good luck and hang in there,
Eirlis


#4

thank you

Thank you… your responses have been helpful. I suppose it is also important to note that I did a single embryo transfer.

I am supposed to take the methotrexate this morning. This process has been particularly confusing because my doctor has been out of town for the past week and I have never met the doctor that is telling me to take the methotrexate. My doctor called me yesterday and said he could go either way on this issue.


#5

You can always ask for another u/s. It is your right to verify the findings from over a week ago before you make a final decision.

I am so sorry you are going through this.


#6

I’ve asked

Thank you Amy: I too feel that your response is a logical one…

I have asked the attending doctor (not mine) twice whether I could get another u/s (asked on Monday, Wednesday, and then asked a nurse again today): they doctor just said “you will not see the ectopic unless it is large” and the nurse said “with a HCG level of ~1000 they will not see anything if it is ectopic.” So basically I have been denied three times.

I suppose I could ask my doctor again today, but I feel like I am being a problem patient for asking the same question over and over. I am not supposed to see my doctor today (and the last three times I talked to a doctor it was only because I requested it so I could try to figure out what to do) --the nurse gives the injection.

Yesterday I finally talked with my doctor by phone: he feels that this was a failed IU pregnancy (but no way to be sure based on the information we have) and therefore he felt ok with letting me decide: either let my levels float down, postpone the decision, or take the metho today.

If I decide to postpone the decision, it would be nice to see clear tubes going into the weekend. That said, because I am now nearly 9weeks, and my last level was >1000 I feel pressure to make a decision rather that postpone… I understand metho is most effective if administered when HCG <1500.

[quote=AmyK]You can always ask for another u/s. It is your right to verify the findings from over a week ago before you make a final decision.

I am so sorry you are going through this.[/quote]


#7

Took metho

Just thought I’d post an update in case it is helpful for any ladies who encounter similar situations:

I took the methotrexate. It is dosed by height and weight and is intramuscular. I’ve felt a little dizzy and tired this afternoon but nothing significant so far. I understand this drug stays in the system for a while.

I am unsure what to expect now: The drug halts the placental growth, but I don’t think it helps me expel the remaining tissue.

If my pregnancy is IU, I think the doctor said there is a chance I still may have to have a D&C. Does anyone have experience or knowledge about this?


#8

Side effects 2.5 days after

Methotrexate side effects 2.5 days post shot: Headaches the past two days, initial dizziness,
Lymph nodes are now painful to the touch.

I’m still nearly certain that this was an IU pregnancy (my initial betas rose appropriately and I believe that I expelled a large amount of pregnancy related material in my period after progesterone was ended). The occasional cramping (in the middle- not either side) and spotting has continued. I’m afraid I’m on track for a d&c too.