Experiences with methotrexate and tubal motility issues

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Hi friends,

I’m new to this community and have appreciated all of the discussions on the forum. It’s been very helpful.

Two weeks ago I had my second ectopic pregnancy in five months. The first one in November 2020 ruptured and I had my left tube removed and was diagnosed with endometriosis during the laparoscopic surgery. The surgeon said the endometriosis looked mild and I haven’t had the classic symptoms of pain and heavy periods so the diagnosis was a surprise. I started trying again after 3 months and after an HSG scan showed my left tube was clear. The second ectopic pregnancy (a pregnancy of unknown origin as it didn’t show on the sonogram but I felt sensations and pain around my right tube) happened after my first ovulation cycle off birth control (progestin-only mini pill).

I caught it early and was treated with methotrexate at the hospital after a diagnostic D and C at week 6. My hCG was at 490 mIU/mL at the highest, and dropped down to 189 mIU/mL at day 4, 39 mIU/mL by day 7, and 6.2 mIU/mL at day 11. On day 3 I had intense pain on the right side that stretched from my thigh to my back that almost sent me back to the ER, but it subsided after an hour and I now think it was separation pain. I’m going back for one more blood test this week and my doctor says she believes I’m no longer at risk for rupture.

Of course I’m heart broken. I’m 33 years old and we’re trying for our first. I also feel hopeful considering it appears I don’t have an issue making embryos and I have an appointment with a reproductive endocrinologist in two weeks.

I have a couple of questions for folks on this board.

  1. I feel relieved my hCG numbers have gotten to a safe level, however I’m still having some sensations around my right pelvic area. The sensation feels like tightness and cramping between my thigh and lower right pelvis, and what feels like muscle soreness in my thigh and around to my lower back. It’s not intense pain but it’s enough to make me anxious. I’m wondering if anyone here has had lingering sensations after methotrexate treatment. I’m going to mention it to my doctor at our next appointment, however I have found hearing other’s experiences to be helpful.

  2. Has anyone ever been told that their ectopic pregnancies are due to tubal motility issues? My surgeon suggested that may be the issue, given the HSG scan did not show any blockages. Has anyone received treatment for tubal motility issues and hormone imbalances after an ectopic pregnancy?

Thanks, and lots of love to everyone going through these experiences.

Warmly,

Jennifer, Brooklyn NY, USA

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Dear Jennifer,

I am so sorry to hear of your ectopic pregnancies and losses. To experience one loss is difficult to deal with multiple losses is heartbreaking and my heart truly goes out to you.

To answer your questions it is normal to feel discomfort following ectopic pregnancy and treatment with methotrexate. However unfortunately I am not medically trained so always advise that if the discomfort doesn’t settle or worsens to seek medical advice and it is good to see that you are going to do so.

Sadly tubal motility can be a cause for ectopic pregnancy, unfortunately many of us who experience ectopic pregnancy never find The exact cause. We are a UK based charity so can only comment on treatment offered here and I am not aware of medications or specific treatments to help with motility. We are aware that cigarette Smoking may increase motility issues.

Research by the University of Edinburgh showed that smokers have an increased level of the protein PROKR1 in their Fallopian tubes. The protein is instrumental in helping pregnancies implant in the womb, but when present in the Fallopian tubes can hinder the progress of a fertilised egg, increasing the chances of a pregnancy being ectopic. So if you are a cigarette smoker, stopping would be very advantageous.

I am glad to hear that you have further appointments with your medical team. Above all, 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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Hi Karen,

Thank you so much for your response. The emotional support is so helpful in this healing process, and I feel comforted knowing discomfort from methotrexate is common. I will definitely still talk to my doctor anyway, but hearing discomfort is normal eases my anxiety.

I also appreciate your insight about tubal motility issues. I do not smoke (I did in the past but quit five years ago), but I am also interested in diets and approaches that may reduce inflammation and in general prepare by body for conception.

Thank you for the support and for the important work you are doing here!

Warmly,

Jennifer

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Hi Jennifer.

Discomfort after metrotrexate is normal. It takes a few weeks to be back to normal. Good luck :crossed_fingers: