Folic acid after methotrexate

ectopic_18 · 15 February 2019 11:15

Hi, does anyone know the answer to this. I had a methotrexate injection in early December followed by ectopic surgery. I was told I couldn’t get pregnant again for 3 months as it might damage the new pregnancy. I’m thinking of starting to try again soon, following the guidelines I could start again in mid March. However, I didn’t start taking folic acid again until the end of January. I also think I read that I should have folic acid for 3 months before TTC which would mean I couldn’t start until the beginning of May. Don’t know which is best really. TIA x

EPT_Host_22 · 15 February 2019 12:24

Hi Ectopic+18,

If you have had either one or two injections of Methotrexate the Trusts recommends to 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 neural tube defects.

With good wishes,

Michele

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ssmoss · 4 June 2019 21:39

I was also told to avoid folic acid for three months by the hospital - my hCG returned to below 5 after 2 weeks. Is there a medical reason for me to not start taking folic acid again?

EPT_Host_20 · 5 June 2019 19:19

Dear ssmoss,

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

Unfortunately I am not medically trained, and as I do not have access to your medical notes, I wouldn’t want to go against advice of your medical team, so I would advise contacting them or your GP to discuss your individual circumstances.

The wait in relation to methotrexate is because the drug is a folate antagonist which means it interferes with the folate in the body and blocks cell growth. Accordingly, taking folic acid at the same time as methotrexate can interfere with treatment. Once your hCG levels have reduced to pre-pregnancy levels, the methotrexate is deemed to have worked, so there should be no reason to avoid taking folic acid supplements.

With Methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL 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.

I would just clarify with someone who has access to your medical records that it is ok for you to start taking folic acid supplements again.

Sending much love,

Karen x

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