I had methotrexate injection 14 days ago now, I’m not in any pain and no bleeding now. My hormone levels are dropping at each check.
I’m confused when to start taking folic acid again as the leaflets I’ve been given say I can try to conceive again after 3 months, but it also says to take folic acid 3 months prior to trying. I was advised today to not take folic acid for 12 weeks after methotrexate so then if I have to take it for 12 prior to conceiving then that would mean that I can’t really try for 6 months post methotrexate?
Im also unsure as to when I can have (protected) sex again?
Dear Shaw,
I am so sorry to hear of your ectopic pregnancy and loss.
We and many health professionals advise that following injections of methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood or urinary tests) and then take a folic acid supplement for 12 weeks before you try to conceive.
This is because the drug may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs, and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as cleft lip and palate, or even spina bifida or other neural tube defects.
With regards to resuming sexual intercourse, again we advise to wait until your hCG levels have fallen to below 5mIU/mL as sadly there is a chance of rupture with low and declining hCG levels and any increase of intra-abdominal pressure like penetrative sex can cause this. There are other ways in which you can be intimate without penetration though and you can explore these.
Sending much love,
Karen x