Trying after methotrexate

bre2345 · 19 March 2020 20:31

Hello,

I’ve received advice from a variety of medical professionals during my ectopic journey, including two gynecologists and a number of nurses. There doesn’t seem to be a consistent response in when I can try again. Some say 3 months after the Methotexate injection, some say 4, and I’ve heard 3 months after the HCG levels return to <5. I’m really frustrated and confused. What is standard practice?

Breanne

EPT_Host_22 · 20 March 2020 08:26

Hi bre2345,

I am so sorry to hear you’ve experienced an ectopic pregnancy and loss. It can leave us with many questions and I’ll do my best to help.

While there is no clear, researched evidence on how long a woman should wait to try to conceive after having treatment for ectopic pregnancy, we and other medical professionals advise you wait for at least three months or two full menstrual cycles (periods) before trying to conceive for both physical and emotional reasons.

Physically, this timeframe is to allow your cycle to return and for there to be a clear Last Menstrual Period (LMP) date to be able to date a new pregnancy from. The LMP date is what is used to decide when to scan a pregnancy; information that is invaluable in ensuring you are not suffering from another ectopic pregnancy.

If you have had either one or two injections of Methotrexate 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 cleft lip and palate, or even spina bifida or other neural tube defects.

I know how confusing the guidance can be, and I hope this provides some clarity. Most importantly ttc after an ectopic pregnancy can require additional time to process through emotions and should be taken in your own time.

With good wishes,

Michele

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bre2345 · 22 March 2020 20:57

Thank you, Michelle. My folate levels have returned to normal and my cycles are in sync. Does this have an effect in when I should start trying, or should I still wait for a full 3 months after HCG 0?

EPT_Host_20 · 23 March 2020 19:39

Dear Breanne,

It is good to hear that your levels have settled.

We always advise waiting 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. To ensure adequate levels of folate as suggested for all ladies TTC.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811