Methotrexate for very high hcg levels?

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1

Hello,

First of all, thanks to everyone sharing their experiences here, it’s been super helpful to not feel alone and completely crazy. I live in Quebec, Canada and dealing with the language barrier and the rush of everything has been really hard for us. I had my ectopic diagnosis one week ago, I was 7 weeks pregnant, and the weekend before going to the ER, I had some bleeding and sharp pain. As it was my first pregnancy and I’m 40, we decided to go to the ER. I kinda felt something was off but it could be just my anxiety…

The doctor confirmed it was ectopic - left tube - as nothing could be seen in the uterus. I was devastated. I couldn’t believe this happened after being so happy and blessed with this baby. At this point, the doctor offered me two options, surgery or an injection. Initially and totally in shock, I decided on the surgery, but she explained that it was better to try something not invasive first, and as my hcg levels were high, she would prescribe two injections from the start, one on Monday and one on Friday 25th.

I had my blood test yesterday, and to my surprise, I found out my hcg value from last week, it was over 18000… with the two shots, it decreased to 14590 over 7 days, but after really reading and researching a lot, I found it odd that my doctor suggested this as the injection is supposedly not as effective for high values. I won’t have follow up with the same gynecologist unless my hcg levels increase, so I’m feeling pretty lost and scared about how to proceed. Should I request a second opinion about this? Just waiting for my next blood test next week seems impossible, and the fear of a rupture is increasing daily.

Thanks in advance for any advice you could offer.

Nat

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Dear Nat,

I am so sorry to hear of your ectopic pregnancy and loss and of the worrying time you are going through. As we are a UK based charity, we can only compare with what we would do in the UK. You are right in that methotrexate works best with lower numbers but I have heard of women having it with higher numbers, although yours are quite high.

I think it would be worth pushing for more frequent blood tests than weekly until they start dropping significantly and of course, we would advise to seek urgent medical advice with any worsening pain or bleeding, shoulder tip pain or you feel dizzy and unwell.

I’m sorry I cannot be more specific, but we are not medically trained.

We also advise not to.complete any heavy lifting of exercise, do not take anti-inflammatory medication such as ibuprofen and avoid drinking alcohol.

We have more information on our website which I have added here-

https://ectopic.org.uk/treating-an-ectopic-pregnancy

Although we can not give specific medical advice, we are here with general advice and support as you need it.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team

3

Hi Karen,

Thanks for your advice and kind words.

Last week was a nightmare. On Wednesday, I had heavy bleeding and very painful cramps all day. I was trying to manage my pain as I supposed the injection was working, but on Thursday, I fainted; my boyfriend called an ambulance, and I spent all afternoon and evening being monitored. At night, my pressure was lowering, and they found blood in my uterus, so I had surgery, and my right tube was removed. Before the surgery, my hcg levels were at 5000, so the injection was “effective”, only not as effective as I needed it to be. After the surgery, I was at 2500, so I hope it’ll be back to normal soon.

Now, I’m resting a lot, processing all the emotions of these past two weeks and trying to work on accepting this situation, the changes, the fear and the relief.

Thanks to everyone who is sharing their experiences here. It is really helpful.

Nat

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Dear Nat,

I’m sorry to it all escalated and you needed surgery, but I am glad you sought help.when you needed it and got the treatment you needed quickly.

It will be an awful lot to process. Take it day by day. Take the time you need to recover both one and emotionally. Some days will be good, others not so and this is normal.

We will be here for you for as long as you need

Sending much love and warm hugs,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

If we have been able to help you, are you able to help us with a small donation or by volunteering or fundraising?

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team

5

Salut Nat,

I am also in Canada and originally from Quebec. I know it’s been a few months since your posts, and I hope you are feeling better by now. I had to deal with two doses of MTX recently. My levels weren’t as high as yours and it looks like the second injection did the trick, though I haven’t been discharged quite yet.

I know all about the language barrier too, so I thought I’d write to say that I’m here if you ever feel the need to chat in French, even though it’s been a few months. Prends soin de toi!

Cam X