Dear Mrsbettyrabbit,
I am so sorry to hear of your ectopic pregnancy and loss.
Sadly I am not medically trained so cannot give you specific advice on your treatment options but can provide you with a general overview.
The decision on treatment option generally rests on the results of your blood tests and scan findings, so this will be discussed with you consultant.
With surgical treatment, there are two routes: the first is known as salpingostomy where a small cut is made in the Fallopian tube and the ectopic removed; and the second is salpingectomy where the tube is removed in its entirety.
With a salpingotomy (ie removing the pregnancy and leaving the tube), there is a very small risk that some of the pregnancy remains in the tube and you will require blood tests to monitor hCG levels as they decrease and see the pregnancy is fully resolved. In a very small number of cases, treatment with methotrexate may also be required (or a further operation needed), if the hCG levels are not decreasing.
We generally advise following surgery, that you should take it very easily for about six weeks. Recovery is very commonly longer than the two weeks you mentioned. Your body will be using its energies to heal internally. It is normal to feel physically and emotionally exhausted during this time and please do be kind to yourself. Recovery can take time and some days will be better than others, one day you maybe ok and the next you maybe in discomfort or more emotional. This is perfectly usual and the healing process will go back and forth in this way for however long you need. It is important to listen to your body’s signals and pain and feeling tired are your body’s signs to tell you to rest. We suggest keeping a healthy balanced diet, drinking lots of water and resting. Once your wounds have healed, very gentle exercise such as a short walk can help, but please do take this slowly.
As a gentle reminder regarding conceiving again following surgery, we and many medical professionals advise waiting for two menstrual cycles. It is important to allow time for your body to recover and emotions to surface and be worked through. This is so that you have some comfort that your body is returning to its natural rhythm and you have a last menstrual period date from which to date a new pregnancy - key information in checking you are not suffering from an ectopic pregnancy in the future. The first bleed soon after surgery for ectopic pregnancy is not classed as a period as it is the body’s response to falling hormone levels.
Following methotraxate injection, it is correct that you will require regular blood tests until your hCG levels have fallen to below 5mIU/mL. I am afraid it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. What I can say is that it can take a number of weeks and, while it can take some time, it is not as invasive a procedure as surgery.
Regarding conceiving again following Methotrexate injection, 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.
What I would say is that methotrexate has been developed as a less invasive method of treatment than surgery. Also, studies suggest that the chances of successful pregnancy are not significantly different between treatment methods ie whether having a tube removed of methotrexate. From what I understand, the chance of a successful pregnancy is determined much more by the health of the opposite tube.
It maybe of some comfort to know that 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.
We have further information on treatment options here
https://www.ectopic.org.uk/patients/treatment/
Talk through your options with your specialist Dr, prior to making your decision.
We are all here for you for as long as you need,
Sending much love and warm hugs,
Karen x
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Further information is available at www.ectopic.org.uk
Email us at ept@ectopic.org.uk.
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