Hi - I had ectopic pregnancy and i got my first MTX dose on 28th Nov and second on 4th Dec. At my first dose my HCG was 9800 and at my second dose its 10000. Currently i am on 9th week after MTX and my doctor advised for lab work every MONDAY of everyweek until HCG dropped to below 15. First couple of weeks i had levels dropping about 50% everyweek but last 2-3 weeks it really slowed down. Last monday i had lab test and it was 72 and today i had lab test again and currently my HCG is 67( which is like 5 points drop compared to last week) . My doctor is suggesting if it continues this slow dropping next week also, she wants to give third MTX dose. I would like to know if it common to get 3rd MTX dose? I am really worried because first two doses were really painful.
Dear Bhavani,
I am so sorry to hear of your ectopic pregnancy loss,
In the UK, we do not offer a 3rd dose of methotrexate. We hear from many women whose reduction in hCG levels really slows down the closer they get to pre pregnancy levels. Sometimes it can stagnate and not drop well for a few weeks and then a bigger drop can be seen. As long as it is reducing, doctors usually monitor the woman and if she is well in herself, leave the drug to work, although it can be quite slow for some.
I am afraid it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. What I can say is that it can take a number of weeks and, while it can take some time, it is not as invasive a procedure as surgery. It is also encouraging that your levels are falling steadily although I appreciate that it can be a drawn out process.
As we are a UK based charity, we can only advise on usual practice from here, and as I mentioned it is not usual to have a 3rd dose. If you do not want a third dose and you levels are dropping albeit slowly, and you are well with no complications, I would discuss continuing to monitor your blood levels. It may take a few weeks longer but it will get there.
Sending much love,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
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Thank you for your inputs Karen. I am from USA and i am not sure if it is normal here to give 3rd dose of MTX. But i would like one suggestion, i really don’t want to go through one more painful process by taking one more dose of MTX . Is it okay if i say NO to my doctor that i can wait for some more time to get my HCG levels dropped rather taking one more dose.
Please let me know your thoughts.
I would definitely question it, maybe even get a second opinion before agreeing to anything. Your HCG levels are so low now too! good luck
Dear Bhavani,
You have every right to question any treatment offered to you.
I would make sure from your medical team that there are no complications from the ectopic pregnancy and if you are medically stable first. With lowering hCGs at this level, I would certainly discuss waiting.
You can also ask for researched evidence that 3 doses are necessary and the risks and benefits of having a further dose.
I hope this helps,
Sending much love,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?
Further information is available at ectopic.org.uk
Email us: ept@ectopic.org.uk
We provide a call-back helpline service: 020 7733 2653
Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters
Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team
Hi Bhavani,
Towards the end mine slowed and then INCREASED! It was so disheartening but then a week later I had a rapid drop and they discharged me from care.
When I spoke to my doctor they moved me back to 48 hour bloods and said if it was stagnant or increased they’d give me another shot but as it was low (like yours at 67) I told them that I’d want to wait just one more 48 hour period before conceding and having another shot of MTX.
Turns out I didn’t need to, and I’m sure you won’t too!
I’m manifesting that drop to 15 for your next bloods!!!
Keep us posted
Xx