Confused about treatment / Late 30s & PCOS

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Hello everyone,

I am so happy I found this forum!

I would like to share my story in case others have faced similar treatment and have questions.

I decided I was ready for a family later in life, and I am not regretting that. Me and my partner started trying one year ago and because of my PCOS we have been using fertility treatment (clomid and later femara).

In January I had a positive pregnancy test and my first ultrasound was scheduled at 5 weeks. They had not asked for HCG levels at that point to confirm that at least the levels were normal.

At about 4 weeks I started experiencing signs of a miscarriage.

(This is a bit graphic and may be triggering so please skip this part or hover over) . I will not become too graphic but I had mild pain on my right lower side and spotting that became bleeding. I also had something coming out that looked like a sack and after it came out I felt better.

At the ultrasound they confirmed that this might have been a miscarriage and everything looked OK. They again did not test my HCG. When I asked when I could try getting pregnant again, they said at my next cycle which should come within the next 4 weeks.

A week later my period came and I called them to confirm if this was too soon to start. They gave the green light and so I took medication again. The red flag for me was that this period lasted one week more than usual (not heavy though) so I contacted them to have me checked.

Then they did a blood test which confirmed high HCG (> 3.000 UI/l). Two days later I repeated the test when I was terrified to hear for the first time that this was probably an ectopic and I may require urgent surgery.

Fortunately my levels dropped but not by too much and I had a shot of methotrexate.

Now I am not sure what will happen. I feel upset that they did not perform blood tests as prevention, that would have stopped this situation 2 weeks earlier. Also I feel that I had to have researched better and have demanded a check myself but I had no idea that this was a possibility. I also do not know if this has created any damage, this I will find out through a HSG which I have never done before. The chance of an operation terrifies me.

Thanks for reading and allowing me to share.

Lots of love and all the best to everyone reading this.

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Dear dimi,

I am so sorry to hear of your ectopic pregnancy and, and the confusion regarding your diagnosis and bloods.

Following treatment with methotrexate the hCG level often rises on the day four blood test because the action of methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of methotrexate or surgery.

We have more information regarding methotrexate on our website here

https://ectopic.org.uk/treating-an-ecto … thotrexate

It is important to not do any heavy lifting or strenuous exercise whilst your levels are reducing and it is important to wait for a while before trying to conceive again. With Methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the Methotrexate 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 hare lip, cleft palate, or even spina bifida or other NT defects. This is why the “wait” and then taking folic acid for 12 weeks before trying to conceive is so important.

Whilst I do not wish to alarm you, I do need to advise you to seek urgent medical advice with any worsening bleeding or pain.

Often the cause for ectopic pregnancy is not known, which can be frustrating, however many women go on to conceive successfully. I would advise an early pregnancy scan at around 6 weeks with any subsequent pregnancies.

Above all, be kind to yourself and allow time to heal both physically and emotionally,

Sending much love,

Karen x

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