Folic acid after methotrexate and surgery

Lmy19 · 2 June 2020 09:05

Hi,

Thank you for these forums, they’ve really helped me through the last few weeks.

I found out my pregnancy was ectopic at 6.5 weeks pregnant.

I was given a shot of methotrexate 3 weeks ago tomorrow but sadly it didn’t work and last Monday I had surgery to remove the pregnancy and my left Fallopian tube. I didn’t have any more blood tests following surgery to check my hcg levels had come down, but do I assume that now I’ve had surgery they are back at 0?

I know I need to wait 3 months before TTC again because I had the methotrexate, but when can I start taking folic acid again? I feel like taking that will give me a bit of hope that TTC isn’t too long away and that it will be the beginning of a new journey for me.

Do I have to wait 3 months before taking folic acid as well?

Any answers would be really helpful.

Thank you

19457 · 2 June 2020 09:51

Hi Lmy19,

Really sorry that you’ve been going through this. You can take folic acid tablets once you’re discharged and your hcg level is low enough, for me mine was 50 when I was discharged and I started taking folic acid 2 days after this. I would imagine after surgery your levels would be low enough to start taking it, but maybe call your EPU unit to double check? Others who have had both surgery and methotrexate will probably to advise better.

EPT_Host_20 · 3 June 2020 08:45

Dear Lmy19,

I am so sorry to hear of your ectopic pregnancy and loss.

Folic acid interferes with methotrexate which is why we advise you wait until your hCG levels are below 5mIU/mL before restarting folic acid for 12weeks.

As sadly the methotrexate didn’t work for you and you went on to have surgery, you are no longer needing the methotrexate to work, so you can start taking folic acid suppliments straight away.

As you have rightly said however you still need to take them 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.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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Lmy19 · 3 June 2020 08:55

Thank you very much for your detailed response. I am going to start taking the folic acid today and begin my 12 week countdown

Sanwars2206 · 5 June 2020 09:23

Hi

Similar to Lmy19 I had methotrexate & then surgery.

I’m post op 5/6 weeks but I feel exhausted like heavily & unusually tired.

Physically I’ve healed & when I was just out of hospital I was more tired & sleeping in the day etc but this feeling now is different.

I can’t remember of the side effects of methotrexate & if they last - does anyone know or have side effects themselves?

Thanks x

Sunset39 · 15 June 2020 23:06

Hi Lmy19, my story is very similar to yours. I also found out at 6.5 weeks. 2 shots of methotrexate (may 14 & May 21) but also ended up with emergency surgery - removal of right tube, just last week…

I am happy you asked the question about Folic Acid - with everything that was going on I forgot to ask that question! Do you know how much folic acid we are supposed to take? I started back on my Materna supplements which contain 600 mcg. I wonder if that’s enough or do we need a higher dosage? does anyone have input/recommendations?

I’m going to give it 4 months for the my last methotrexate, just so that I get 3 months of folic acid back in the system…

Best of luck to you and all the other ladies here! This is such a difficult experience to go through… happy to have found this forum.

EPT_Host_20 · 16 June 2020 18:21

Dear sunset39,

Unless directed by your medical team or doctor, there is no indication to take a higher dose of folic acid, so you can continue with the usual daily recommend supplement of 400 micrograms.

I have added information from the NHS regarding folic acid supplements here

https://www.nhs.uk/common-health-questi … pregnancy/