Ectopic/Methotrexate - day 4 HCG rising - what's normal?

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Hi there!

I was diagnosed with an ectopic last week and I had the Methotrexate injection. I’ve just had my day 4 bloods back my levels have risen from 720 (day of injection) to 1040 (day 4).

It’s so disheartening to see my levels increase even though I’ve been told this is normal. But is that a big increase?

I’ve also had no symptoms like no cramping or bleeding - I’m worried it’s not working.

If I have to have a second jab does this mean we can’t try again for 6 months?

Any advice would be helpful - this is such a stressful time. Sending my love to anyone else going through this right now, it’s just horrendous and such an emotional rollercoaster :frowning:

xx

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Dear maddylouise,

I am so sorry to hear of your ectopic pregnancy loss,

I can absolutely reassure you that it is completely normal for your hCG levels to rise on day 4 and I am sorry that your medical team did not warn you about this as it can be extremely worrying.

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.

It is also normal that some women do not bleed following treatment with methotrexate.

A second dose of methotrexate does not mean that you have to wait 6 months before trying to conceive again. Some doctors (mistakenly) think that because they have administered a second dose of Methotrexate that that they must also double the recovery time for the body. However, even in a second dose of Methotrexate, the dosage is still much lower than for treatment of other conditions and is still metabolised by the body very quickly. Our medical advice is that, if you have had two injections, you should rely on your blood test results as an indicator of what is happening in your body and wait until your hCG levels have fallen to below 5mIU/mL in blood tests and then can restart taking vitamin/folic acid supplements. Also, in the first week it is important to avoid pain killers which fall into the NSAID group such as ibuprofen. It is important to take folic acid supplements for 12 weeks before trying to conceive.

We have more information on our website about methotrexate treatment which you may also find helpful

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

Please also be kind to yourself and allow time to grieve, to heal both physically and emotionally.

We will be here for you for as long as you need.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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