How soon can you start taking folic acid after methotrexate?

Hi All,

Wondering if anyone knows for certain when you can start taking folic acid supplements again after methotrexate?

My nurse has told me twice that I need to wait 3 months… but I’ve read conflicting things online. My hormone levels were down to 4 on Wednesday, so I feel like I should be able to start taking them again?

I’m also a little doubtful as she also told me I could ttc again after 3 months, but surely I need to build my folic levels back up before I try again?

Many thanks for any advice,

Laura

Dear Laura,

Current advice with Methotrexate is 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.

As a gentle reminder, the chances of a further ectopic after a first in UK is 10%. So that’s 90% chance of the embryo being in right place next time.

While generally it is possible to conceive after an ectopic pregnancy, the amount of time it takes varies from couple to couple. Factors include age, general health, reproductive health and how often you have sex, among other things. It may be comforting to know that 65% of women are successfully pregnant within 18 months of experiencing an ectopic pregnancy and some studies suggest this rises to around 85% after two years.

I hope this helps. Sending much love,

Karen x


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