Folic acid after methotrexate

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1

Hi All,

So I only had the 1 injection of methotrexate following a pregnancy of unknown location.

I went to hospital yesterday for my day 14 bloods and discharged with the good news my hormone level was down to 1.

I was told at the injection not to try again for 3 months which I understand however I was only told yesterday NOT to take folic acid for 3 months to make sure the injection has fully worked and out of my system.

My concern is you are advised to take folic acid 3 months before ttc… is this now forcing me to wait 6 months before ttc again?

Has anyone else been told this or taken folic acid straight away after successful methotrexate/hospital discharge?

Thanks

Leanne

2

Hi Leanne,

Sorry to hear about this. I just went through the exact same thing a few weeks ago. The midwife at Early Pregnancy phoned to tell me my HcG was below 3 and said that I could start taking folic acid from that day. I was told I could ttc 3 months from the date of injection and that I would more than likely get enough folic acid from a good diet but if I wanted to supplement before ttc, I could start from that day.

I know the Ectopic Pregnancy Trust advise to take folic acid for 12 weeks from the date of your HcG levels being down to 0 but I was told by two midwives it was from the date of injection so that’s what I’m going with.

Hope this helps!

Debbie x

3

Dear dodonnell,

I am so sorry to hear of your ectopic pregnancy loss,

I am glad to hear that your levels have reduced and you can start to plan ahead.

The advice from our medical team following Methotrexate injection remains that 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.

We would therefore strongly recommend following this advice before trying to concieve.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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During the coronavirus outbreak, The EPT team is still working hard to provide crucial information and support to women and families experiencing ectopic pregnancy as quickly and efficiently as we can.

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4

Hi Debbie,

Thanks for your post, so sorry to hear about your loss too.

Not sure why I was told to wait 3 months before taking folic acid again. I understand the not ttc but not the folic acid.

I was told the injection starts to leave your system within a couple of days of having it but the long term effect of not having the folate in your body is what is harmful to a baby if conceived in those 3 months.

My levels were down to 1 so definitely within the 5 as advised.

5

Hi Leanne,

Yeah I feel the same. I didn’t really understand it either.

It’s such a minefield, Ive been told so many different things. On the consent form that I signed before getting the injection it said you can’t conceive within 3 months and only have to folic acid for one month before ttc. So confusing, but as Karen said if the medical research states it’s best to take folic acid for 12 weeks I’ll just follow that advice.

6

Hi,

Yeah it’s so confusing!

I don’t want to wait 3 months before taking folic acid for another 3 months before trying again.

I’ll just leave it a few days so my 1 goes down to 0.

7

I feel the same. Even the 3 months feels like a lifetime!! I keep looking at my calendar and thinking how has it only been 2 weeks, it feels like 2 months lol

8

Yeah I know what you mean. I had my injection on 1st August and thinking how is it only the 16th!! At least I’m allowed back in the sun now!

My journey following this will be very different as we have requested to go down the IVF route. I’ve lost 3 babies to miscarriage at 6 weeks in the last 15 months and then this 4th one 2 weeks ago. I’m pushing on 40 and feel like I now need the medical intervention :pleading_face:

9

Aw Leanne I’m so sorry to hear that :disappointed: that must be so hard!! Have they done any investigating into why you’re miscarrying?

This is my first loss but feeling quite anxious about trying again. I’ve not long turned 30 though so still feeling hopeful x

10

They did an investigation into my 3rd miscarriage and it was found to have trisomy 13 chromosome issue. Doesn’t really resolve things… we’ve had loads of tests done and come back unexplained fertility issues.

It’s natural to feel anxious about trying again. I remember the first time of intimacy after every loss we had I would cry! I’d cry so much because I couldn’t wait to try again and get pregnant, but also cry because of being scared of losing another.

Try talking to people, it helps so much! I’m sure the next time you fall pregnant the hospital will keep a close eye on you x