When I meet with a new OB after my epiotic resolves, what should I ask?

justsuzie · October 2016

I had my first pregnancy in August which ended in an epiotic. I have been waiting for my levels to get to 0 with my current dr (assigned to me in the ER when I went in with pain and bleeding). I really don't like this doctor and I am just finishing up with him until I get to 0. Blood test yesterday (1374 down to 876..on my way) I have no idea what comes next.

Do I ask my current doctor to do any tests to check to see if the epiotic left any scarring?
Do I ask for a prescription for folic acid because I took methortrexate which depleted all of it?
Do I go to a new doctor and meet with them before I ttc?
What questions do I ask?

Anyone with any insight please give me some advice. The internet is a black hole. I know I won't be able to ttc until at least January but I would like to know what comes next to quell my anxieties. Any help is much appreciated!

ladipale · October 2016

I think finding a doctor you trust and get along with is so very important- especially after a loss! What are the reasons you don't like the doctor assigned? (You don't need to answer - just something to consider). I would ask friends who live near you? Or do you have a primary care doctor you trust? That's how I found my amazing OB.

And then- you go and make an appointment with an OB and go have a pre conception appt- totally normal appt to have. I would lay it all on table with doctor. The questions you asked above are reasonable - start with those. You could also ask what will happen next time you get pregnant. Will doctor track your levels early and give you an early ultrasound?

stephann85 · October 2016

Another good question to ask if you need to do anything different next time? Having an ectopic might be (probably is) different than my experience but I had to start progesterone with my second pregnancy and if/when there is a third I will do progesterone and aspirin.

brooklyngirl18 · October 2016

@justsuzie i think you mean ectopic? I had an ectopic back in february and basically i had weekly betas drawn until 0, about 6 weeks. I had a follow up where they checked for stds (I'm married and std free but it was just to rule out since stds are a risk factor of ectopic). I was told to wait for 2 cycles and then I was free to start trying. I think part of the waiting is to build folic acid back up. I started taking my prenatals again once my levels were back to 0. my main questions for my dr were how long did I have to wait and what were the chances of having another ectopic. i switched dr's during this process because i was unhappy with the care i was receiving but they both agreed to wait 2 cycles and there was a heightened risk of having another ectopic but since I had no risk factors, i could still try naturally.

edit to add I also had a HSG done to check that my tubes were clear.

EverythingsBetterOutside · October 2016

Here are things I asked or learned from my doc without asking (and the answers I got):
-when can I ttc again? (My OBGYN said 3 months, RE said 1 month from methotrexate shot)
-when can I have sex again? (Both docs said after HCG is below 5)
-what are the chances of getting an ectopic again a miscarriage? (No greater risk of miscarriage but there is a much greater risk of another ectopic)
-are my tubes clear or blocked? (Doc should order an HSG to check)
-should I take extra folic acid? (Obgyn said no, RE said "you can" if i tried to ttc at 1 month, but didn't say it was necessary)
-is there anything I should do next time? (RE and obgyn said call as soon as I get a BFP for an early ultrasound to watch for another ectopic)
-when should I expect AF/what should I expect with my next could of cycles? When should I call if AF doesn't show in the expected time frame?

I'm sorry for your loss. I hope your levels drop quickly.

justsuzie · October 2016

ladipale said:

I think finding a doctor you trust and get along with is so very important- especially after a loss! What are the reasons you don't like the doctor assigned? (You don't need to answer - just something to consider). I would ask friends who live near you? Or do you have a primary care doctor you trust? That's how I found my amazing OB.

And then- you go and make an appointment with an OB and go have a pre conception appt- totally normal appt to have. I would lay it all on table with doctor. The questions you asked above are reasonable - start with those. You could also ask what will happen next time you get pregnant. Will doctor track your levels early and give you an early ultrasound?

I don't like the doctor I was assigned to because I have never met with him. He just looked at my ultrasounds and gave me a prognosis in the ER. After that I haven't seen him once in the past month. I got all 6 shots from nurses and after a blood workup I get a call from a nurse saying, "you're levels are trending downwards so the Dr says to come in next week for another blood test.

Thanks for the tips.

justsuzie · October 2016

brooklyngirl18 said:

@justsuzie i think you mean ectopic? I had an ectopic back in february and basically i had weekly betas drawn until 0, about 6 weeks. I had a follow up where they checked for stds (I'm married and std free but it was just to rule out since stds are a risk factor of ectopic). I was told to wait for 2 cycles and then I was free to start trying. I think part of the waiting is to build folic acid back up. I started taking my prenatals again once my levels were back to 0. my main questions for my dr were how long did I have to wait and what were the chances of having another ectopic. i switched dr's during this process because i was unhappy with the care i was receiving but they both agreed to wait 2 cycles and there was a heightened risk of having another ectopic but since I had no risk factors, i could still try naturally.

Yah, ectopic.... oops. I am 4 weeks out with high levels still unfortunately. Thanks, I need to ask about the wait time because I haven't actually ever spoken to the dr because he doesn't "need" to see me until my levels are at 0. I have heard all different wait times from the different nurses I have dealt with.

justsuzie · October 2016

EverythingsBetterOutside said:

Here are things I asked or learned from my doc without asking (and the answers I got):
-when can I ttc again? (My OBGYN said 3 months, RE said 1 month from methotrexate shot)
-when can I have sex again? (Both docs said after HCG is below 5)
-what are the chances of getting an ectopic again a miscarriage? (No greater risk of miscarriage but there is a much greater risk of another ectopic)
-are my tubes clear or blocked? (Doc should order an HSG to check)
-should I take extra folic acid? (Obgyn said no, RE said "you can" if i tried to ttc at 1 month, but didn't say it was necessary)
-is there anything I should do next time? (RE and obgyn said call as soon as I get a BFP for an early ultrasound to watch for another ectopic)
-when should I expect AF/what should I expect with my next could of cycles? When should I call if AF doesn't show in the expected time frame?

I'm sorry for your loss. I hope your levels drop quickly.

Great questions! I was wondering about the HSG, does everyone with an ectopic get one? When would someone go to an RE? Sorry for all the questions but I am going at this blind because I can't get answers from anyone treating me.

ladipale · October 2016

@justsuzie - that is really frustrating. I am so sorry you are not getting answers from the doctor! Does he have email services? Can you email him? I have better luck emailing my doc than calling - but if you want to hear from him - you could just keep calling.

Do you have a primary care doctor? That might be another place to start - he or she could help you find an OB and be able to address some of your questions or point you to a person who can.

NewMommyCoop · October 2016

@justsuzie I had an ectopic last summer and I did not have a HSG. My OB did a couple u/s and did not see any blockage on those. She told me that my risk of having another ectopic was not increased, although I read just the opposite online. I have had two pregnancies since and neither were ectopic. So who really knows.

justsuzie · October 2016

ladipale said:

@justsuzie - that is really frustrating. I am so sorry you are not getting answers from the doctor! Does he have email services? Can you email him? I have better luck emailing my doc than calling - but if you want to hear from him - you could just keep calling.

Do you have a primary care doctor? That might be another place to start - he or she could help you find an OB and be able to address some of your questions or point you to a person who can.

Ugh, my insurance just changed so I don't have a primary care doctor yet. Worst timing. I guess I am just going to wait it out until 0. But now I am armed with some great questions. Thanks.

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