2 ectopics - experience of surgery and MXT

I wanted to post my experience as these posts and the EPT did help me when I was going through it and so hopefully someone will find my experience of both surgery and MXT treatment outcomes useful. I have had 2 ectopics, 6 months apart, the first ended in rupture and surgery to remove the tube and the second was treated with MXT.

The first one was diagnosed on the first scan I had at the EPU after going in with bleeding and pain at 5.5 weeks. I had had a miscarriage 5 months before so I felt and knew something was wrong. The bleeding was different though, it was slower, brown and more clumpy and thick than the miscarriage that was more free flowing blood. They sent us home after taking blood for HCG and we went back in 2 days for the second HCG, they were 157 and then 135. As it was decreasing they opted for the ‘wait and see method’ and I went back for a third HCG 2 days later, it was 129. By this point, I was really frustrated, I had read about what the treatment options were and so I asked if I could have the MXT, they said ok but come back for another HCG in 2 days first, so I did and it was 151 but later that day it ruptured. I was scanned again and they confirmed internal bleeding, I had to wait until that evening for surgery. I wasn’t in much pain but I felt the rupture in that I suddenly felt very sick and faint almost passing out but didn’t, then just felt very light headed and sick. I wish I had pushed for MXT more/earlier as I might have avoided the rupture and surgery. The surgery went well, I recovered quickly, I was doing most normal things by a week later and back at work 2 weeks later.

When I conceived again, I rang the EPU to book an early scan, they said I can’t come till 6 weeks, this immediately worried my because all the symptoms previously presented between 5 and 6 weeks. I had already had some bleeding that stoped and some pain but they didn’t offer anything else. I rang again 2 days later as I had more pain but again, they didn’t offer HCG testing or an earlier scan. Then the same type of bleeding started almost to the day of the last ectopic, I also had pain all on the side of my remaining tube, it felt like there was a clamp on my side pressing on me. I knew it was ectopic and finally I went to the EPU at 5.5 weeks. This time they didn’t see it on the first scan, and to my pain and frustration they were talking about how it could be too early to see a normal pregnancy so it could be fine. All the while I am saying, no, it is ectopic, I know. Forgot to mention I had another symptom in the first, that presented exactly the same, a sort of urinary retention/having to force it, so by this point, I was convinced. This was hard to cope with, I felt like I wasn’t listed to, again, and going through the pain of loosing another pregnancy and all the waiting was awful. I had to come back again for a second HCG 2 days later, the values this time were 156 then 203. So they invited me for a scan 2 days later (more waiting!) when they did actually see the ectopic and as HCG was increasing they told me I would have MXT. The consultant told me I could have it there and then, he consented me without going through any information but then I was told by a nurse that I couldn’t have it that day because I needed blood tests first, which I knew, it was a total shambles. So I went back the next day for bloods, then back again that afternoon for the MXT. I was again frustrated at the multiple 2 day waits for decisions to be made as there was a real chance of rupture again. The MXT itself made me feel very tired, achy and a bit dizzy but apart from that no real side effects. My HCG went up slightly on day 4, then went down by a lot on day 7, but that whole time it could still have ruptured, despite the low HCG levels, as I had learned from the first one! HCG values were Day 0; 126, Day 4; 272, Day 7; 165, Day 14; 7. It went to below 10 very quickly (2 weeks) so I was relieved, I believe having low HCG to start with can make MXT treatment more likely to be successful and be quicker to reduce.

Comparing the 2 treatments. After the surgery, it was over, no more waiting, wondering if it will rupture or will have more pain or issues, which in some ways is a relief, you can focus on being well again. After MXT you are still in a limbo situation, waiting and at risk of rupture so you can’t really move on or focus on being well again for some time, an unknown amount of time. This was quite frustrating as I just wanted it over. Having said this I am glad to have kept the tube as I can retain the ‘possibility’ of trying again naturally and the risks of having surgery, the recovery, the scars are a burden. I do wish I was given the choice of MXT for the first one.

As for trying again, I am told the chances of another ectopic are around 30% with one tube that has had a previous ectopic, however, I am convinced its just inevitable now so we are now doing IVF, with the chances of ectopic being lower at least, but not 0. I also do not want to be in that position again of not being listened to, and the support and early testing that comes with IVF will be better for the anxiety that now comes with conceiving.

Thanks for reading

Dear Helen,

I am so sorry to hear of your ectopic pregnancy losses. Experiencing one loss is difficult, dealing with multiple losses is heartbreaking and my heart truly goes out to you.

Methotrexate was developed to try and avoid the need for invasive surgery and preserve the tube, but as you have rightly said, it comes with the downside of having to have regular blood tests. Surgery does not have the same long wait for hCG levels to reduce but it can be a slow and sometimes painful recovery and there is commonly a loss of tube. This however doesn’t mean there is a 50% reduction in fertility. Generally, when a person has only one fallopian tube and both ovaries, they are still able to get pregnant from an egg at the opposite ovary as an egg from one ovary can travel down the tube on the other side. The fallopian tubes are not attached to the ovaries and, at the point of ovulation, some very delicate structures called the fimbriae begin to move gently creating a slight vacuum to suck the egg toward the end of the tube it is nearest to (like lots of little fingers waving and drawing the egg towards it). So, if you have only one tube then there is only one set of receptors working and one set of fimbriae creating a vacuum and so the egg is much more likely to find its way to that tube, whichever ovary it is produced from. Conservative estimates suggest that an egg produced on the tubeless side manages to descend the remaining tube around 15 to 20% of the time. While generally it is possible to conceive after an ectopic pregnancy, the amount of time it takes varies from couple to couple. Factors include age, general health, reproductive health and how often you have sex, among other things. It may be comforting to know that 65% of women are successfully pregnant within 18 months of experiencing an ectopic pregnancy and some studies suggest this rises to around 85% after two years.

I am sorry you have had such negative experiences from health care professionals and I hope you will have some reassurance with more follow up from your new team.

Making the decision to begin trying to conceive is an emotional rollercoaster compounded by our sad loss. Again, you are not alone. We here emotional support whenever you need us. There is a specific Preparing for your Next Pregnancy board you can look at too whenever feel ready.

Sending much love and gentle hugs,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards


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