TTC After MTX for Ectopic

SeaParrot

I'm getting a bit ahead of myself, but I'll be seeing my OB this week and want to do some reading ahead of time. I've been scouring pubmed and found a few pubs I'll be bringing up with him when discussing where to go from here. It seems the 3-6 month conception avoidance period was rather arbitrarily selected based on a few samples that showed trace amounts of MTX in the liver up to 116 days following treatment. But the modest evidence that does exist doesn't seem to support this blanket recommendation for single doses for EP.

ANYWAY, I intend to discuss this with my OB on Thursday when I see him, and I was wondering what recommendations others received, along with the rationale, if I might ask. I intend to abide by my OB's recommendation, but I prefer to discuss things with my doctors when there might not be strong support for recommendations. If you could share your stories with me, that would be appreciated.

I really dislike arbitrary limitations and I want to have a really well-informed discussion on the subject with my OB. The one in emerg said 3 months, but I haven't talked to my OB himself (same one who dx the PCOS and saw me through multiple losses) yet to see what he says. I've seen others who have been told everything from 1 month to 12 months, so it seems professional opinion varies widely. I know he may have us take some time off just to let my body heal, and I'll be okay with that, but I don't want to be benched from the MTX unnecessarily, based on something lacking evidence. I don't want to lose time. My cycles are 6-8 weeks long, typically, and I am usually mostly anovulatory, so we really only get a few chances a year to conceive and I'd rather not miss one unnecessarily. With the progesterone piece sorted out, I'm really just anxious to get back to it once we've got the medical all clear.

PinkCamino

It's not arbitrary. The metho shot destroys your reserves of folic acid. As a result you need to TTA to build them back up.

SeaParrot

PinkCamino said:

It's not arbitrary. The metho shot destroys your reserves of folic acid. As a result you need to TTA to build them back up.

I know that part, but the actual time it takes to build them back up or whether extra supplementation can affect that isnt something I found any information on. Everything I found said that the 3-6 month deferral was a precaution suggested to be extra safe because of there being little information. But if there is information that supports a shorter deferral, I want to discuss it with my OB.

buggirl72

SeaParrot said:

It's not arbitrary. The metho shot destroys your reserves of folic acid. As a result you need to TTA to build them back up.

I know that part, but the actual time it takes to build them back up or whether extra supplementation can affect that isnt something I found any information on. Everything I found said that the 3-6 month deferral was a precaution suggested to be extra safe because of there being little information. But if there is information that supports a shorter deferral, I want to discuss it with my OB.

To the bolded - why would you want to take the chance? A three month bench to make sure that you are 100% healed and that you had plenty of time to rebuild your folic acid stores are nothing. Even if research showed you only had a 5% chance of severe birth defects after one month, would you really want to find yourself in that 5% knowing that avoidance was all you had to do?

I get wanting solid answers but MTX is a chemo drug that is incredibly strong. A lot of the studies I have seen talked about birth defects related to MTX being in your body, not birth defects caused by low folic acid which is a known side effect of using MTX.  Those are two different issues.

I also would encourage you to wait the three cycles even without the MTX. According to your intro this is your third loss in a row and happened when you were supposed to be TTA. Give your body a chance to recover from everything it has been through.

PinkCamino

SeaParrot said:

It's not arbitrary. The metho shot destroys your reserves of folic acid. As a result you need to TTA to build them back up.

I know that part, but the actual time it takes to build them back up or whether extra supplementation can affect that isnt something I found any information on. Everything I found said that the 3-6 month deferral was a precaution suggested to be extra safe because of there being little information. But if there is information that supports a shorter deferral, I want to discuss it with my OB.

3 months is really not a long time. Why not spend that time researching to find an RE to discuss your losses and your AO cycles?

Having said all that, are you really willing to take that chance?

SeaParrot

@buggirl72‌ I want to know because recommendations change over time as better information becomes available. *IF* there is no increased risk after one month deferral, why wait three? I want to know if that is the case. Alternatively, if the risk isn't at baseline until 6 or 12 months, I want to know that too. Recommendations often start out very conservative and change as time goes on.

I haven't expressed any intention of barrelling ahead without regard to safety - I just want to know whether or not this is a case where providers are continuing to use outdated recommendations which is very common.

FWIW, we were not TTA on doctor's orders, it was our own decision. Had I not been testing early I'd have not even been aware of the CPs and I already know my OB doesn't recommend "time off" for CPs because I discussed the issue with him last time it happened. He wasn't concerned that we had conceived so soon after this time either and doesn't feel it contributed. We are going to be a lot more careful during avoidance this time, obviously.

PinkCamino

SeaParrot said:

@buggirl72‌ I want to know because recommendations change over time as better information becomes available. *IF* there is no increased risk after one month deferral, why wait three? I want to know if that is the case. Alternatively, if the risk isn't at baseline until 6 or 12 months, I want to know that too. Recommendations often start out very conservative and change as time goes on. I haven't expressed any intention of barrelling ahead without regard to safety - I just want to know whether or not this is a case where providers are continuing to use outdated recommendations which is very common. FWIW, we were not TTA on doctor's orders, it was our own decision. Had I not been testing early I'd have not even been aware of the CPs and I already know my OB doesn't recommend "time off" for CPs because I discussed the issue with him last time it happened. He wasn't concerned that we had conceived so soon after this time either and doesn't feel it contributed. We are going to be a lot more careful during avoidance this time, obviously.

You really need to follow doctors orders. Really. Like for serious. You seem to have a habit of ignoring what your doctor tells you but because of the MTX you really really really need to listen this time.

MSU_Girl1202

First, I'm so sorry for your loss. The ladies above are 100% right, I especially agree with what @buggirl72‌ said...why would you want to chance it? Say you decide to not follow the "arbitrary limitations" and get pregnant again...then say your baby is born with spina bifida or even worse, anencephaly (missing portion of brain, incompatible with life). You'd have to live with the guilt of not following a physician (who's job it is to know the updated reommendations ) instructions. These three months are a great chance to speak to an RE about your anovulation.

SeaParrot

@PinkCamino‌ I do not have a history of disobeying my doctor's orders around TTC at all. I specifically stated above, repeatedly, that I have no intention of doing so and I want I discuss it with him. What recommendation have I disobeyed? I am going to speak to my doctor to see if his opinion differs from the first because I do respect his judgement.

Just to be very clear, we don't intend to go ahead without regard to safety. I just don't want to be delayed longer than is actually necessary for safety. IF there is no risk waiting a shorter time - and I'm not saying that's the case I am saying I want to know because I've read some things that may cast doubt - I want to know so I can discuss it with him and see what he, in his professional opinion, feels is appropriate.

I AM NOT INTENDING TO IGNORE MY DOCTOR.

rslh10

I had an ectopic, was given one dose (two shots- 1 in each butt/hip area), and my OB told me I didn't need to wait. So onward I pressed with medicated cycles....that all failed. I came here and took the ladies advice about seeing an RE. Best decision of my life.

The things I learned from these women about my folic acid, effects of the shot etc blew my mind. I had no idea. Looking back I'm very very upset at the fact that my OB just told me "hey no big deal" and to keep trying with medicated cycles. I shouldn't have. I should have waited. I should have taken the extra folic acid after hcg reached zero.

I am doing all of that NOW. But like the PP have stated...why even risk it? You've had back to back losses. Does that not concern you? Maybe your body needs more time to heal than you're allowing it. Everyone wants a baby like, yesterday, but seriously.

What does your H think about waiting? I'm just going out on a limb here and assuming you ended up telling him you were KU?

buggirl72

SeaParrot said:

@buggirl72‌ I want to know because recommendations change over time as better information becomes available. *IF* there is no increased risk after one month deferral, why wait three? I want to know if that is the case. Alternatively, if the risk isn't at baseline until 6 or 12 months, I want to know that too. Recommendations often start out very conservative and change as time goes on. I haven't expressed any intention of barrelling ahead without regard to safety - I just want to know whether or not this is a case where providers are continuing to use outdated recommendations which is very common. FWIW, we were not TTA on doctor's orders, it was our own decision. Had I not been testing early I'd have not even been aware of the CPs and I already know my OB doesn't recommend "time off" for CPs because I discussed the issue with him last time it happened. He wasn't concerned that we had conceived so soon after this time either and doesn't feel it contributed. We are going to be a lot more careful during avoidance this time, obviously.

I think the reason that people thought you were not following doctor's orders was you said you were supposed to be TTA and, because you ovulated earlier than you thought, accidentally did not avoid.

My big concern in the bolded is it sounds like you did not actually talk with your OB after CP #2 to see if they did want you to TTA before deciding to either TTA or not. While many OBs are fine with proceeding like normal after one CP that opinion does change when you have a second one the following cycle. It's an entire new set of facts.

At this point, even if they think the ectopic is not related at all, you have had 3 losses in a very short time. You also don't know what caused the EP. Make an appointment with an RE.

Finally, you also need to be prepared that one dose of MTX may not work. For some reason I'm thinking you said your were prescribed this by an ER doc? I may have read that wrong so I apologize if that is the case.

Good luck with your followup and I hope you get all of your questions answered.

Puglife83

Hi there. I was much like you after I had my ectopic and methotrexate. The day after I was in the ER was filled with denial and extreme impatience " I just lost a baby and ontop of it have to wait 3 months to try again, are you f*****g kidding me?" I tried to find every article I could that went against the 3 month waiting period my doctor told me. (What does he know right? ) I read stories of women getting pregnant right away with healthy babies, blogs saying methotrexate leaves your system in 2 weeks, all kinds of stuff that made me say " see!" Then 4 days later I knew why he told me to wait. It says you had methotrexate yesterday according to your siggy. I'm not trying to scare you but 4 days after my shot was the worst pain I've ever been in and I slept on the bathroom floor crying, passing clots the size of like apricots. There was no way I was going to ttc with even the faintest trace of something so powerful in my body. Waiting 3 months sucked, but during that time I let my body detox it out. Trust me, just listen to your doctor. I'm sorry you are going through this.