Miscarriage/Pregnancy Loss


I was diagnosed with a likely ectopic pregnancy and had to get a methotrexate injection on Tuesday. I'm the type to read every word of the drug fact sheets that come with prescriptions, but since this was done in office, I got zero written information. I did get a few verbal warnings (stop taking prenatals, no sex until the bleeding stops, no TTC until betas are less than 5, and no Tylenol), but if any of you have experience with MTX I'd like to hear about it. Here's what I'm wondering right now:
1. How long after the injection did you start bleeding? 
2. What were your beta numbers at baseline and how long did it take you to drop to 0?
3. Did you need a second MTX shot? Surgery? 
4. What were you told to avoid? Foods, medications, activities? 
 5. When were you told you'd be able to TTC again?

Thank you for sharing your experience! 

Re: Methotrexate

  • I was diagnosed with an ectopic pregnancy three weeks ago and got the methotrexate shot. This a link to the sheet the hospital gave me when  I took the shot. https://myhealth.alberta.ca/Alberta/pages/Methotrexate-for-ectopic-pregnancy-after-your-visit.aspx I only know this is the same sheet bc I google everything I could after I got home. I feel like I got very few instructions, but the whole things feels like a blur now. 

    1) it took about a week and half for me to start bleeding and lasted less than 4 days. It was pretty light for three of those day (this maybe different for you. My pregnancy was in my ovary). 

    2) the highest my numbers got was 515. In 15 days my beta was 2. 

    3) I only needed the one shot.  

    4) I was told to not take my prenatal pills, avoid spicy food because of the possible mouth sores (which I did get),  and to come back in if I had severe abdominal pains

    5) I was told I would need to wait at least two to three cycles before we ttc again because it can take a that long for your body to totally process the medicine. which feels like forever. 

    @everyhingsbetterontheoutside I hope everything goes well. In my internet searchs it seems like people are told a lot of different things. I hope that things go well for you and that you do not need a second shot. Please be sure to take care of yourself. I felt exhausted and extremely nauseous for the first three days. Let me know if there are any other questions I might be able to answer. Hugs!
  • *TW - siggy*

    I got MTX for an ectopic pregnancy back in Sept.  

    1. How long after the injection did you start bleeding?  I was already bleeding when I got the injection.  I started bleeding heavier pretty much right away.  I bled off and on for about an entire month, and THEN got what seemed to be a period (coinciding with when my beta was finally zero).
    2. What were your beta numbers at baseline and how long did it take you to drop to 0?  I think it was around 600 when I got the shot.  It took 4 weeks to drop to zero.
    3. Did you need a second MTX shot? Surgery?  No, I didn't need either.
    4. What were you told to avoid? Foods, medications, activities?  No prenatals or any supplement with folate, no tylenol, no alcohol (there was no specific timeline for this, after like 2 weeks I asked my doctor and she said I could drink alcohol again), no sex until HCG was less than 5, nothing that would increase intraabdominal pressure (which I took to mean limited gym activities like crunches).  I will be honest, I did limit some "healthy" food that has folate in it (like spinach) even though no one told me to, because I was terrified of the numbers not falling and needing a second shot.
     5. When were you told you'd be able to TTC again?  I was told 3 months after the shot.  But then when I went to see my doctor for a follow up, she told me it was really 3 months after my HCG was zero (which was 4 months for me).  I had a thyroid issue come up at about that time so we actually waited 5 months to start TTC again.  I did not have any further medical workup; my dr told me that if we started TTC and I didn't get pregnant after 3 months to call her.

    *TW - we got pregnant right away, baby is in the correct place!  I even ovulated out of the same side, so it seems like the tube was clear.*
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  • Thanks, ladies. The information I Google seems conflicting... Some places say absolutely do not take Ibuprofen -take Tylenol if you need it, others (including my doc) say avoid Tylenol -Ibuprofen is OK. Grrr. And my doc said to expect period-like bleeding in 24-48 hours, but my bleeding had tapered off before the shot to very slight spotting only with working out. It hasn't increased since the shot, so I'm worried it's not working. I get my Day 7 bloodwork today, so then I should know if I need more. 
  • Good luck on your day seven blood work. I hope you don't need a second shot and that everything is going well. 
  • I had it about 6 months ago and I cant remember my betas, but I did need the second shot, and wound up having surgery after. But I will say my case was weird as I had a cyst blocking everything from coming out, so the shots worked, my body just didn't cooperate. 

    I was told to pretty much avoid everything, sun, foods with folic acid (which are pretty much all foods I soon found out), sex, and drinking. And they told me to wait 3 months to try again.

    I'm sorry for your loss. I hope your first shot works out and you heal soon!
  • I'm an extreme case and still currently going through it so my answers are a work in progress....

    1. How long after the injection did you start bleeding? Took me a few days to start bleeding and I'm currently still bleeding 8 weeks later
    2. What were your beta numbers at baseline and how long did it take you to drop to 0? I started with a beta of over 12,000 last week I was down to 537 I had a fetal heart beat even after 3 shots! Stubborn little bean :( 

    3. Did you need a second MTX shot? Surgery? I actually got 4 sets of shots in total...

    4. What were you told to avoid? Foods, medications, activities? No leafy greens, no vitamins, and I was told Tylenol was ok for pain, no gym, when I was in immediate danger of my tube rupturing I had to be careful with bending etc no alcohol for 2 weeks after injection and you are more sensitive to the sun for 2 weeks post injection 

     5. When were you told you'd be able to TTC again? They are going to build me back up with tons of folic acid once I'm in the free and clear I honestly forget how long they told me to wait, I'm mentally not even there yet I just want to get my body back to normal! They told me they would recommend IVF since your chances after having an ectopic are much higher 
  • Oh and my bleeding has gone back and forth from heavy to barely anything and varying in color 
  • @laur1212 I am so sorry you are going through this. It sounds heartbreaking 
  • @laur1212 I'm sorry, nobody wants to be the extreme case :-( I hope your body returns to normal soon and you get a stubborn little bean in the right place in the not too distant future. Interesting they would recommend IVF... from what I've read, IVF (and previous ectopics) increase the chance of ectopic. I have read, a while ago and i don't remember where, that the chances of conceiving are much higher the months after a miscarriage. I'm not sure how that changes if you're benched waiting for MTX to clear your system and folic acid to build back up, though
  • @Hopefulmommy1980 and @EverythingsBetterOutside thanks! 

    The RE I see said because it's in the right tube that increases the chances on that side to 25% and because of having an ectopic in general that now puts my left side at a 15% chance. IVF would put me down to a 1-4% chance...if I were his daughter he would say go straight to IVF because my eggs are great and respond almost too well and my husbands sperm is good. 

    I think with general miscarriages it's true get right back on the baby making train because you are super fertile after but ectopics are just a different animal. Or at least that's my understanding. I'm not sure what we plan to do next, my husband won't make that decision because it's my body etc and he can't take do the physical aspect of anything which is hard for him (as I'm sure with most our SO). We are lucky to have fertility coverage but I don't think we have enough left to cover the costs of IVF. ***TW**** we are also in a diff situation than most in that we are already blessed with a 5 yr old. 

    Wishing everyone luck on their next chapter!
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