How long did you wait?

Polls
1

I am curious as to how long (for all of you ttc) you waited until ttc after your ectopic. I just had my surgery about a week ago and am already very impatient! I had laproscopic surgery and my tube was saved. I will need some healing time but not too sure how much…

How long did you wait to ttc?
  • Next cycle and had MTX treatment
  • Next cycle with surgery
  • 2 Months with MTX treatment
  • 2 Months with surgery
  • 3 Months with MTX Treatment
  • 3 Months with surgery
  • 4-6 Months MTX treatment
  • 4-6 Months with surgery
  • Over 6 Months
0 voters
2

It’s very important that people do wait

for the following reasons and if anyone would like the more technical reasons involved around the use of Methotrexate they can be found below

Why wait for 2 cycles?

Usually, we advise you wait for 3 months or 2 cycles whichever is the soonest and the first bleed that occurs in the first week or so of treatment for ectopic is not considered as a period … this is the bleed that occurs in response to falling hormones associated with the lost pregnancy. So why wait for 2 cycles?

This allows the cycle to return and there to be a clear LMP date, to date a new pregnancy from. It also allows the internal inflammation and bruising to heal and for the necessary process of grief to surface and be worked through.

Some studies do suggest that women who conceive immediately after treatment for ectopic pregnancy are more at risk of suffering a subsequent ectopic and also we need to feel ready to face whatever life is about to sling at us next. Unfortunately the incidence of miscarriage (which is not in any way linked to ectopic) is generally very high anyway something like a third of first trimester pregnancies end in miscarriage so you really do need to feel strong enough to face whatever is coming next

Of course the decision when to ttc again rests ultimately with you and it’s up to no one to tell you that you can or can’t try sooner than 3 months but there are good reasons for waiting.

3

From time to time there are requests for the Ectopic Pregnancy Trust to explain why in their literature it’s suggested that women treated with more than one injection of Methotrexate should avoid pregnancy for a period of 6 months, when there is little research based evidence of support this. And finding clinically based evidence is hard for waiting even 3 months after one injection.

It is very hard to find information to substantiate the advice, deemed mainly because of the ethics of designing a study on humans to support the theory that ‘Methotrexate may damage a future pregnancy if conception occurs too soon’. Taking a large group of women and encouraging them to become pregnant soon after treatment with Methotrexate and then seeing how many of their babies were born with Spina Biffida or other Neural Tube defects is a difficult one to justify!

The following article is an example that describes tests mainly based on animal study but does include some human research:

http://qjmed.oupjournals.org/cgi/content/full/92/10/551

This particular study discusses such areas as the importance of folic acid in embryonic development and goes on to suggest “risk of foetal exposure” in babies of mothers who have taken the drug up to 4 months prior to conception”.

To add further complication, this advice and information are given to patients who have been treated throughout the UK, across which there are widely varying protocols and follow up arrangements in each individual authority.

But we cannot know the ‘lifestyle’ of the person our literature is being provided to or who’s reading the website and, for example, the use of ‘leisure’ drugs is now widespread; many of these drugs, compromising liver function while they are being metabolised.

Each individuals metabolism is different and folate levels are restored at differing rates. It is not usual to test for folate levels at 3 or 6 months after treatment.

It takes varying amounts of time for hCG levels to drop after treatment with Methotrexate, during which time, best practice advises the patient does not supplement her diet with oral folic acid. However, it’s widely accepted that a woman planning pregnancy should take folic acid for 12 weeks prior to conception and for 6 weeks afterwards. By suggesting 6 months after a second dose of Methotrexate this allows the hCG levels to drop and the patient to recommence folic acid supplementation in preparation for a new pregnancy.

Our advice at the Ectopic Pregnancy Trust, has to be ‘all encompassing’ to preserve the best interests of the patient, her future fertility and the health of her ensuing pregnancies. Without access to individual medical records and insight into the patients’ background and lifestyle it was agreed that the 6-month wait after 2 injections was the safest way for the EPT to generalise.

At the Ectopic Pregnancy Trust, we work with a group of medical advisers who have extensive experience in the field of ectopic pregnancy and they establish ‘best practice protocols’ with ourselves. These reviews are as evidence based as possible and are, of course, peer reviewed. Our information is then be updated again accordingly. As such we are currently considering if we should amend our own advice to 4 months and not 3 after one injection of Methotrexate.

For the reasons stated above, our advisors do suggest 6 months after a multiple dose protocol - however, arranging with your doctor for serum folate levels to be done, confirming good supplies of folacin after 3 to 4 months might be a way forward for you to feel you can try again a little sooner, with confidence

4

I waited 4 months after my surgery to start ttc. The main reason was because I didn’t have insurance and wanted to do an hsg before ttc, otherwise I probably would’ve just waited the 2 cycles.

Antonella

5

The amount of girls that start TTC earlier than reccomended and then think they are pregnant or become pregnant spend that time worrying and looking to be consoled. I just think to myself…well you were told. I know that sounds blunt but I’ve seen it so many times on here.

I waited 3 months after meth, that was based on advice from my DR and adivce on here.

Tricia

x

6

I have had 2 EPs and waited the advised 3 months with both. I had been TTC for over 2 year sprior to my first EP.

I think it is our natural reaction (perhaps to help us deal with the grief) to want to get pregnant again as soon as possible after losing a pregnancy.

My second EP was just 6 months after my first (on the third month of TTC) and it was extremely difficult to cope with for me. Although it seemed hard at the time, I’m glad now that I waited the 3 months advised by the EPT. If the gap between my EPs had been closer there is no way I could have coped. Not only that but I am pretty sure I would have blamed myself for the 2nd, if I hadn’t taken the advice.

As the host has said - this is a personal choice - but please be sure that you can deal with whatever is thrown at you whenever you decide to TTC again. What Tricia says is soo true - the first 2 weeks after that BFP are hard enough!

Claire xx

7

I discussed my personal situ with the prof who operated on me who told me to TTC after 1 month of surgery. I waited until I had had one clear cycle.

PLEASE BE AWARE
That this is not the advice that is widely recognised in the medical profession whether it was delivered by a professor or otherwise
Regards
Moderator

8

Laparoscopy end Oct05, I waited three full cycles before ttc. In the grand scheme of things, waiting is a small gift to oneself to ensure physical recovery is well underway, and that mentally (psychologically), the healing process can begin.

Our first month of ttc I was scared witless at getting a BFP, excited too, but definitely scared. And over the course of our ttc history post-EP, it became increasingly apparent at how scared DH was for me to be at risk of another EP.

Yes, it’s down to personal choice, but my observation is that those I’ve seen on here who made a conscious decision to ttc earlier than the stated EPT advice, have gone to hell and back both physically and emotionally when they got a BFP so soon after surgery or meth.

Just reiterating what I said at the start of this post: waiting is a small gift to oneself to ensure physical recovery is well underway, and that mentally, the healing process can begin. It’s not something that should be underestimated.

Jill x

EP Oct05, right tube removed

HSG Jun06, left tube completed blocked

Natural conception no longer possible

9

Thank you for the information. I did not have any methotrexate treatment. I did see my surgeon/doctor today for a follow up and I asked him this very question. His response was “any time you want”. Which kind of surprised me. I would assume that if I had had MTX I would be advised to wait longer for reasons of ridding the drug from my system as well as being sure that the hcg levels were not from the ectopic but indeed from a new pregnancy. I plan on waiting for at least two cycles to pass before ttc, perhaps three. If I knew I could get pregnant easily I would wait at least 3 however I seem to have difficulty in that area as it is so if I start ttc after 2 cycles I probably won’t conceive for at least 6 to 8 anyway…but you never know I guess.

10

Absolutely second what Tricia has said. It’s heartbreaking to see but easy to remember the feelings early on of wanting to get pg again straight away. But if you don’t give yourself the breathing space physically and emotionally you run the risk of not being able to cope.

I don’t want to lecture - ultimately you do what you want to do, but don’t rush.

11

Hi,

I waited 4 months after my surgery (right tube removed).

I don’t think I woud have been either mentally or emotionally ready before this.

All the best

Hayley xx

12

I completely understand the need to wait for many people but I have had 3 losses now and it doesn’t matter if they are 2 months or 2 years apart, they still suck and every woman has a right to be consoled when such a loss occurs. Time doesn’t help me cope with future loss better I still ache over the loss I had almost 5 years ago. It is bearable but it still hurts to think, what if? I need to feel physically well and if that takes 2 months so be it, if it takes 6 well then I will wait. I also think that with a chemical like mtx introduced into your system, 3 months is probably minimal to ttc. Of course I also respect the opinion of my doctor, my midwife and my family.

I don’t mean to sound offending and I hope I don’t come across as harsh. I will console any woman who has had a loss no matter when she conceived. And what about “accidents”? Should a mama feel guilty if she accidently gets pregnant before 3 months and has something horrible happen?

13

Hey

I don’t think you sound offending and you certainly don’t come across as harsh. However it’s not the number of losses you have had in the past or how long it takes to become pregnant thats the issue here. It’s really about the evidence be that anecdotal or research based and the fact is whilst there is one respondent here who chose to try before the suggested waiting time and feels OK about that - the majority, by far are saying to you that they’ve found it to be helpful to wait or wish they had waited as the EPT suggests and so do most doctors.#

What you do or choose to do is down to you and it’s not up to anyone to tell you what you should or shouldn’t do (which is why polls like this one are rather like hot potatoes because you’ll always get the tried and tested research based answers - and then there’ll be those who want to hang on to the potato no matter how much it burns, because they can.)

You have asked a direct question and been answered by professionals and those who have very first hand experience - what you do is down to you but it’s not fair to suggest that just because you think time doesn’t help you that it’s the right way for everyone else either.

The fact is it’s not all about the emotional stuff, it’s about your immune system recovering, having a cycle that can sustain a pregnancy, being able to cope with the demands of a new pregnancy whilst managing a due date and an anniversary of loss if you were to become pregnant and much, much more.

What I am saying is - if you have decided to try sooner than the recognised authorities and the the majority of people who have answered you post suggest that’s absolutely your choice and no matter what the outcome you are welcome here - but please don’t think that because you have heard things you’d have liked not to hear that you have anything to be strong or offensive or harsh about - you really don’t. It’s about what you want - we can only give you the best practice and research based information and our users can only tell you of their experience. Ultimately the choices is yours

14

I completely understand the reasoning to wait up to 6 months when treated with methotrexate but is there any information on future complications when you have not had mtx but have had surgery “only”. From my understanding, scar tissue build-up can contribute to future ectopics in this case and the longer you wait the more scar tissue can build up. So is it advisable to try earlier with surgery than with mtx treatment? As far as a physiological issue only and not a mental/emotional one.

15

I had MTX followed by surgery, waited 3 months and two weeks to ttc again. But we only ttc casually… I have refused to watch a calendar, follow my cycles or monitor ovulation for 6 months. For me, waiting 6 months before getting serious about ttc gave me time to emotionally heal.

J

16

I had a laparoscopy and waited six months before we started TTC again. Not really due to physical healing but more to do with mental healing. I wanted to be sure I was ready for the outcome of TTC - whether I could become pregnant again, if I did - would it be another EP? When we started TTC I knew I would mentally be able to cope with whatever the outcome was and I think that is the best way to do it for your own sanity.

17

The recommendations for waiting are

3 months after one injection of methotrexate

6 months after two

3 months after diagnosis surgical treatment

3 months after expectant management

The reasons for waiting have been discussed already in this thread and it only remains for me add that you need to be emotionally and physically strong enough to deal with whatever you face in a future pregnancy

This is by no means scientific but perhaps you should examine other long standing polls here which have been developed by the EPT to give you information upon which to base your choices

Take a look at the ‘what was the outcome of your first pregnancy after ectopic?’

http://www.ectopic.org.uk/phpbb/viewtopic.php?t=5530

So far 146 have contributed to that poll and it brings in some interesting trends

nearly a third that’s one in three pregnancies was lost to miscarriage - almost a quarter that’s around one in four suffered a subsequent ectopic pregnancy. A further 6% lost pregnancies in other ways - Chemical pregnancies, molar pregnancies and so on and only slightly more than one in three resulted in a successful birth after ectopic.

These figures are fairly reflective of the national picture - on in four pregnancies is cited to be lost to miscarriage generally - here we see a slightly higher trend. Subsequent ectopic is thought to be somewhere between 10 and 20% but here we see a higher trend

The point is, you need to be ready and able to cope with whatever is coming next and the best way to cope with that is to be prepared. Allowing your body time to heal, your immune system to recover, incorporating a little healthy exercise, eating well, maybe looking at you weight and other life style issues and taking time to acknowledge you have just lost a baby, faced the possibility of your own death, that there may be conceptual or fertility issues in the future, and that the future is uncertain usually takes at least 3 months for a person who is healing and grieving normally. However, as has been said by my colleagues and other users of this service, the choice is entirely yours and if you choose not to heed the information offered by the EPT or choose to prefer someone else’s information that’s fine. But please accept that it’s not the information we give and we are not going to change our minds because we keep being asked the same question.

It really does have to be a choice made by yourself and once made, so long as you are prepared to manage the outcome and be responsible for your actions then it’s no ones place to judge you and with any luck you’ll be one of the 30 to 40% who does go on to have a pregnancy without any problems immediately after your ectopic pregnancy.

Good luck what ever you decide and no matter what we are here to support you

18

I completely understand the reasoning to wait up to 6 months when treated with methotrexate but is there any information on future complications when you have not had mtx but have had surgery “only”. From my understanding, scar tissue build-up can contribute to future ectopics in this case and the longer you wait the more scar tissue can build up. So is it advisable to try earlier with surgery than with mtx treatment? As far as a physiological issue only and not a mental/emotional one.

I know Host Three has responded, but I just wanted to say from my point of view, I had laparoscopy, so four small incisions. It took me 3 months to feel comfortable with picking up a suitcase (20kg), it took me 6 months to feel happy about lifting heavy objects, ie: heavy plant pots. Since surgery I have rarely picked up my son. That is the impact surgery has had on my body. On the outside it doesn’t look like much, but on the inside there is goodness knows what going on to get everything to heal. I have scar tissue, internally the layers hurt when the incision sites are pressed.

We waited 3 months to ttc after surgery, as recommended. We had been ttc 16 months before that, 16 months after we started ttc post-EP I had an HSG (dye test) to check the state of my remaining tube. It’s blocked. I don’t know the statistical outcome of this, but having been on these boards for n amount of time, I feel it’s a minority outcome - a large proportion of women do go on to have a healthy successful pregnancy. And my feeling is the outcome would have been the same, whether we’d waited 3 months after surgery or not. I am firmly of the view that 3 months (or 6 months, depending on your circumstances) is a drop in the ocean.

As Host Three has said, it’s your choice, but recommendations are made for a good reason. I understand your desire to ttc again, but I think you have to be ready and strong enough to cope with whatever comes your way next.

{{{HUGS}}}

Jill x

19

Nature Girl

I’m sorry if you thought that I was suggesting the closer the losses are the more painful they are. That is not what I meant to say. I won’t deny that I may not have fully come to terms with my lost before my 2nd EP, but to have another now would be devastating too. Particularly as EP effects future fertility.

I had surgery with both my EPs. My second was in the scar tissue left in the stump of the tube removed from my first. I have no way of knowing whether timimg would have made any difference to the outcome of this pg, but I do now that if I had any reason to think my actions had contributed I could not live with myself and I dare not wonder what state I would be in now.

20

Hi I waited over about 4 months to ttc. And then two months later I was pregnant in the right spot. :smiley: