I was 5 weeks when my ectopic was diagnosed… emerg doc couldnt see anything on ultrasound the week before when i had fallen and went to get checked out- the following weekend i went in with terrible right sided pain, no bleeding, at 5.5 weeks i was told nothing was on the ultrasound and my hcg levels were low… he gave me my options and i decided to get a second opinion from my fertility specialist as id been working for this for 13 years. She agreed, as my lining was only 4mm and they also saw nothing and called it “of unknown location” they gave me the shot, with no explination of side effects, duration of treatment nothing… and when i asked her how long i had to wait to try again the Fertility specialist consulted GOOGLE!!! its now three weeks post injection. Thursday the Dr i was working with at my clinic actually made me go lay down… it felt like someone sucked the life right out of me, last saturday i had so much pain i was on the floor went back to emerg and was sent home 6 hours later with pain meds… and then i passed something later that evening, large, grey and red, about 3 inches by 2 inches… no wonder i was in pain…i feel so lost in all this especially being on my own as a choice mom, with no support from the clinic or hospital- someone tell me what im to be feeling after 3 weeks? Im sleeping 15 hours a day and still exhausted. Back to work walking 60,000 steps a day in a busy fracture clinic… How does this happen with ivf? Im so upset by the insensitivity of all the doctors and clinics. None of them have any answers for me! 
Dear Erinmarie54321,
I am so sorry to hear of your ectopic pregnancy and loss and of the difficult time you are going through.
Sadly I am not medically trained but can give you general information.
When we experience ectopic pregnancy we are suddenly faced with a life threatening emergency and it’s treatment, reduction in fertility, concerns about the future and the loss of our babies. Experiencing any one of these is an ordeal, putting them together is immense and your feelings are completely normal.
If no pregnancy can be seen in the uterus, or there is a small gestation sac in the uterus without a yolk sac or embryo, the pregnancy will be medically labelled as a Pregnancy of Unknown Location or PUL. It is important to understand that PUL is not a diagnosis; it is a label given until the final location of the pregnancy can be identified with certainty. In the event of a PUL, blood will be taken to measure serum progesterone and hCG and the hCG test repeated 48 hours later. The doctors would also want to repeat the scan.
Until the location of the pregnancy is known definitively or the serum hormone levels have decreased to below pregnancy levels, there is a risk of complications associated with an as yet undiagnosed ectopic pregnancy. For every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; and not all of these will need treatment.
One treatment method is methotraxate and as you have said you had a shot, I am presuming you had this.
While methotrexate is metabolised quickly by the body, it can affect the quality of your cells including those of your blood for up to three months after it has been given. One of the side effects to treatment is fatigue and many feel very tired and are shocked by the exhaustion they experience through treatment. The impacts of the drug are on top of an already immense ordeal - the diagnostic process of ectopic pregnancy, regular visits to hospital, loss of a pregnancy which all take their toll physically and emotionally and is very understandable and normal.
This method has been developed to avoid surgery. However, it does require careful monitoring and follow-up. This means that you will have to attend the hospital regularly for blood tests to monitor your hCG levels until the tests are negative. You have not mentioned whether you are having follow up. If not please contact your Dr to arrange this. It can take several weeks for your bloods to return to negative levels and this will be explained by your doctor. Your hospital will make arrangements for you to have the hormone level checked. Your doctors will usually test your hCG levels on the day the medicine is given, again on day four, and on day seven after the injections.
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.
A few days after the injection, it is usual to begin to bleed and this bleeding can last between a few days and up to 6 weeks.
Every 3-7 days, beta hCG levels will continue to be monitored to ensure that they are falling appropriately. Most women only need one injection but in up to a quarter of cases a further injection may be required if serum hCG levels are not decreasing.
Methotrexate is at least as good as surgery in terms of subsequent successful pregnancies. This may be due to the fact that medical treatment is non-invasive, whereas surgery may cause some scarring around the tube.
We have further information on treatment with methotraxate including side effects and what to expect here - https://www.ectopic.org.uk/patients/treatment/
Regarding TTC, 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.
If you are not happy with the level of advice given by your Dr, I would strongly advise going back to speak to them, take a list of questions so you can get information you require. If your Dr remains unhelpful, I would suggest talking to a different Dr.
I hope this has helped a little, it is difficult to provide specific advice with such limited information as we do not have access to your records and are not medically trained.
Sending warm hugs and much love,
Karen x
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