Anyone had an ectopic treated with methotrexate in both tubes?

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I’m just looking for my chances of success here, really.

I’m 31 and I’ve just had my second ectopic pregnancy.

We had two missed miscarriages (one confirmed intrauterine, one was before I had a scan so presumed intrauterine)

Then, a tubal ectopic in my right tube which was treated with methotrexate. This was 2014.

I was sent for some basic bloods to check for reasons for my miscarriages but nothing was found.

We conceived my daughter 5 months later, perfectly healthy full term pregnancy with induction and then emergency c section. She was born October 2015.

I went on the mini pill and for various reasons we haven’t been in a position to try for number 2 until recently (mainly career related reasons)

I came off the pill in July 2020 and fell pregnant on my second cycle, which ended in an early miscarriage.

My cycles were all over the place from October to February, so my GP ordered 21 day progesterone checks. I was tracking with clearblue advanced tests so sure of ovulation on day 13-14. Surprisingly, my progesterone was 49 which is off the scale high.

I started testing for pregnancy at 10dpo to 13dpo, then waited for my period which didn’t show. Tested again 2 days late and had a decent positive but not blazing like I’d expect.

My tests were very inconsistent (from strong to basically non existent) so my GP agreed to a urine preg test at 4 weeks 6 days, which was “inconclusive”

I had beta hcg at 5.0 and 5.2 weeks, which were 740 and 1740, so good doubling.

I had a scan at 6.1 which showed a tubal ectopic on the left tube. Again, I was treated with methotrexate. My hcg was 4200 so it had stopped doubling by now.

The chat with the consultants were very scary, such as the fact that both my tubes may be blocked, sterilisation may be for the best, and self funded ivf is likely to be our only option.

I have an appointment with my gp booked to discuss hsg, but wondering if anyone else had this?

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I should have added, we have no risk factors of ectopics - my bmi is under 30, we don’t smoke, I’ve never had an STI, PID or endo, and we are both young.

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Hi Callie,

Sorry to hear about your pregnancy losses.

I am in a pretty similar situation to you except I dont have any children yet. I am 30 years old and had my first ectopic pregnancy in Aug 2020 in my left tube which was successfully treated with two doses of methotrexate.

I was diagnosed 3 weeks ago with a second ectopic pregnancy this time in my right tube and again was treated with Methotrexate. I was given a second dose last week so am just waiting now for my levels to go down to 0. As of yesterday, they were at 730 which was considerably down from 1650 a week prior.

Like you, a doctor at the fertility clinic i am with told me that both tubes may be damaged and i may have to eventually remove them and do IVF. I also have no known risk factors and had done an sonohysterosalpingogram (its similar to the hsg but uses an ultrasound machine instead of xray) after my first ectopic which said both tubes appeared clear.

What i plan to do after this ectopic pregnancy is resolved is look into having an investigatory laparoscopy done to assess both tubes and based on those results, i will decide if I will need surgery to repair or remove one or both tubes and if I will try again naturally or do IVF.

Similar to you, i am curios if any one else has had any pregnancy success after having an ectopic in each tube that were both treated with Methotrexate.

Please let me know how your tests go.

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Scrubsfan103:
Hi Callie,

Sorry to hear about your pregnancy losses.

I am in a pretty similar situation to you except I dont have any children yet. I am 30 years old and had my first ectopic pregnancy in Aug 2020 in my left tube which was successfully treated with two doses of methotrexate.

I was diagnosed 3 weeks ago with a second ectopic pregnancy this time in my right tube and again was treated with Methotrexate. I was given a second dose last week so am just waiting now for my levels to go down to 0. As of yesterday, they were at 730 which was considerably down from 1650 a week prior.

Like you, a doctor at the fertility clinic i am with told me that both tubes may be damaged and i may have to eventually remove them and do IVF. I also have no known risk factors and had done an sonohysterosalpingogram (its similar to the hsg but uses an ultrasound machine instead of xray) after my first ectopic which said both tubes appeared clear.

What i plan to do after this ectopic pregnancy is resolved is look into having an investigatory laparoscopy done to assess both tubes and based on those results, i will decide if I will need surgery to repair or remove one or both tubes and if I will try again naturally or do IVF.

Similar to you, i am curios if any one else has had any pregnancy success after having an ectopic in each tube that were both treated with Methotrexate.

Please let me know how your tests go.

Thanks for the reply!

From what I have read, 75% of people have clear tubes after an ectopic pregnancy with methotrexate. My mass this time is tiny -7mm- so I am hoping that helps preserve my fertility.

I know that after 1 ectopic you have a 10% chance of another, but I read that it’s now 30% chance after 2.

Are you in the UK?

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Yeah, I also read that after two ectopics, the chance of a next one is 30%.

No, I am in Canada.

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I am hoping that the fact ours were able to be resolved with methotrexate gives us better odds of future fertility.

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My 4 day hcg came back at 5200. That’s an increase of about 1000 from day 1.

My hcg looks like this:

5+0 - 740

5+2 - 1700

6+1 - 4200 - diagnosed

6+3 - 4300 - methotrexate administered

Day 4 post methotrexate - 5200

I’m really worried I’m gonna need surgery.

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Fingers crossed that things work out. I hope your levels start to go down and you don’t need surgery.

My levels were never that high. It was a little over a 1000 when I was diagnosed at 5 weeks and 5 days. A week after my first methotrexate shot it went up to 1700 so I was given a second dose.

A week after the second dose, it fell to 730. I have my next appointment on Wednesday so hoping it went down by a lot.

Please keep me updated on how things progress for you and I will do the same.

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Hi,

I got your email but don’t really like using email so I hope you get this.

My hcg plateaued on day 7 so I received a second dose. It had only decreased by 2%.

As of today, I’ve had a little period like cramping.

I have my second day 4 bloods tomorrow morning so I’m hoping I know soon.

How are you doing? Could you tell your hcg was falling? I’m still having mild pregnancy symptoms (sore boobs and prominent veins on my chest are the main ones)

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Hi Callie,

Thanks for replying.

Fingers crossed that your levels go down.

Initially after my first dose, I could tell the levels were not going down as I still had my regular pregnancy symptoms (sore boobs) and had no cramping and very little to no bleeding. After the second dose, I started to bleed more (like a heavy period flow) and experienced some cramping. My breasts also didn’t feel as sore so I could tell my levels were dropping this time. I had my weekly follow-up appointment yesterday and my levels were 59 which was a significant drop from last week when it was 730.

Good luck with your appointment tomorrow.

Nicole

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I’m so glad your levels are dropping!

Mine dropped too! They were around 5200 and dropped to around 3800. It’s still pretty high, but it’s about 25% reduction so I’m happy with that. Day 7 bloods on Monday morning, I’m hoping in the 2000s by then.

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Hi guys,

Really sorry to butt in but what is a sonohysterosalpingogram??

I’m currently going through my 2nd ectopic (right tube came out in 2019 due to rupturing) but opted for methotrexate as there was no sign of a rupture and I wanted to give my left tube one more shot. When I asked the consultant if there was any way I could check the health of the remaining tube she said there wasn’t really anything except for to see if there was a blockage but that was it and couldn’t see any possibly scarring. I nearly picked the tube removal and resigned myself to the fact that I might have to just try IVF but I’m young (30) and healthy, plus I had a missed miscarriage in December from my left ovary so it has technically gone in the right place recently, it just wasn’t meant to be. Just clinging onto that as an example that the tube might still be okay but was wishing there was a medical way of checking without surgery where they could cause scarring.

I saw your thread and you mentioning about checking the tube health with a sonohysterosalpingogram. Are you guys in the US/Canada? I’m in the UK so maybe it’s not offered here (or if it is it’s done privately and not through the NHS)

Thanks in advance and hope you are both okay/your levels are continuing to drop (I’m praying I don’t have to have a second shot of methotrexate as it made me really sick yesterday)

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Glad your levels are dropping Callie. Hope they continue to go down.

Hi Esb27. Sorry you are going through a third loss. I hope your levels go down quickly.

I am in Canada. After my first ectopic, my fertility clinic recommended a sonohysterosalpingogram. It is similar to an HSG except it uses an ultrasound machine instead of an Xray.

“The “sono-HSG” is an ultrasound exam in which saline is injected through the cervix into the uterine cavity to illustrate the inner shape of the uterus and degree of openness (patency) of the fallopian tubes.”

The results are not a guarantee that you won’t have another ectopic though as it mostly just checks for blockages but doesn’t assess the inner functioning of the tube. In my case the results said both tubes were clear but I still had another ectopic in my right tube three months after.

I have an appointment in May with the head gynocologist at my fertility clinic. I am hoping that she will refer me to have an investigatory laparoscopy to check inside of the tubes, the structure etc. This is obviously more invasive but gives more detail than the sonohysterosalpingogram or HSG. I want to try again naturally once more before going through IVF but am worried about a third ectopic especially after having had an ectopic in both tubes. If she thinks the laparoscopy is too invasive, then I probably will just have an HSG done and try again based on the results and her recommendations.

Hope this info was helpful. Good luck with your recovery.

Nicole

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Hi Nicole,

Ahh okay, thanks for this. Super helpful! I’ll have a look into if we offer it here, guessing I’ll have to go privately.

Good luck with your clinic appointment in May! I would be careful with a laparoscopy as my doc said that doing that could cause scarring which could then cause an ectopic! Such a vicious circle.

I’m also going to try again naturally before IVF, though I might start having conversations with my doctor about starting the process of IFV in the next 3 months as I know it can take a while. I’m so scared of having another ectopic too, but at least I know I tried again once more with the remaining tube and if that has to be removed and IVF is the only way then that’s the way it has to be.

Good luck on your journey, I have my fingers crossed for you!

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Yeah it is a vicious cycle. If my doctor doesn’t recommend the laparoscopy, I probably will too try once more naturally as well. I will also discuss IVF with my doctor and get her opinions.

Let me know if you discover any more tests that could be done to check the tubes.

Thank you. Good luck on your journey as well. Please keep me updated and I will do the same.

All the best,

Nicole

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Esb27:
Hi guys,

Really sorry to butt in but what is a sonohysterosalpingogram??

I’m currently going through my 2nd ectopic (right tube came out in 2019 due to rupturing) but opted for methotrexate as there was no sign of a rupture and I wanted to give my left tube one more shot. When I asked the consultant if there was any way I could check the health of the remaining tube she said there wasn’t really anything except for to see if there was a blockage but that was it and couldn’t see any possibly scarring. I nearly picked the tube removal and resigned myself to the fact that I might have to just try IVF but I’m young (30) and healthy, plus I had a missed miscarriage in December from my left ovary so it has technically gone in the right place recently, it just wasn’t meant to be. Just clinging onto that as an example that the tube might still be okay but was wishing there was a medical way of checking without surgery where they could cause scarring.

I saw your thread and you mentioning about checking the tube health with a sonohysterosalpingogram. Are you guys in the US/Canada? I’m in the UK so maybe it’s not offered here (or if it is it’s done privately and not through the NHS)

Thanks in advance and hope you are both okay/your levels are continuing to drop (I’m praying I don’t have to have a second shot of methotrexate as it made me really sick yesterday)

I’m in the U.K. (Scotland)

I’m guessing you are being treated in an early pregnancy unit? They only refer for recurrent miscarriage testing (which is really basic) - you need to call your GP and ask to be referred to a gynaecologist. I’m just waiting on my referral coming through.

There is specific criteria to meet. You are supposed to have been trying fo a year, or less if you have specific fertility troubles. IMO having a MMC and two ectopics qualifies you for that. Getting referred is pretty easy - my GP didn’t even need to see me to arrange a referral.

I came off the pill in July, first cycle August, got pregnant the second cycle and had a 5 week loss in October. They agreed to check my progesterone in March, which was just before I conceived this pregnancy. So even though I haven’t been trying for a year, they are doing some testing. I don’t know if the gynaecologist will do a HSG or just say I don’t need it.

I got pregnant with my 5 year old ovulating from the side of my first ectopic, so it definitely is possible to conceive with a “bad” tube. There is only a 25% chance of a blockage with each ectopic, which is a lot better than I thought!

NICE guidelines should tell you if you meet the criteria. I’ll post a link.

https://www.nice.org.uk/guidance/cg156/ … strategies

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Hi Calliepup,

Yeah an early pregnancy unit! That’s really Interesting that you got pregnant with a potential ‘bad’ tube. Will have a look into the referral thing, think that could be super interesting to find out more about what the FECK is going on down there lol

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P.a will do Nicole! It’s so sad we all have to go through this but I guess life isn’t always perfect ey.

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Esb27:
Hi Calliepup,

Yeah an early pregnancy unit! That’s really Interesting that you got pregnant with a potential ‘bad’ tube. Will have a look into the referral thing, think that could be super interesting to find out more about what the FECK is going on down there lol

Yes - there wa sad cyst on my right ovary at my early scan with dd so they think that’s the side I ovulated from. I think I also ovulated from that side with my chemical pregnancy. This is the first time I’ve ever had ovulation cramps at the left side so I think my right tube is dominant. Now they are both screwed though 😂

My friend hasn’t had an ectopic pregnancy but she had a cyst which ruptured one tube and she had a lap to remove it, when they did this they noticed her other tube was damaged. She got pregnant naturally first month trying with #1 and is now expecting #2 after trying for 3 months. All that with only one blocked tube! She was told she’d need ivf.

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Oh it’s such a mind-field isn’t it!

That’s very promising to hear about your friend. I guess the stressful thing is that there’s no set way these kind of things will play out for each of us, everyone is different. I hope that it happens like that for us too (obviously with our original ectopics) but you just never know.