When can I start trying again after methotrexate?

HannahT · 18 March 2024 09:39

Hello,

I had two doses of methotrexate for an ectopic pregnancy and was discharged 1 week after my second dose with HcG at 13 that had fallen quickly after my second dose from 105.

The notes from the hospital said to wait 3 months after the last dose of methotrexate before taking folic acid, and then it stated that the advice is to take folic acid for 12 weeks before trying. This would mean a 6 month wait period before trying again.

However, we spoke to the consultant at the hospital and explained that we wanted to start trying again as soon as possible. He said we should still wait 3 months before taking folic acid and then we could take folic acid for 2 weeks and start trying again as that would be enough to build up sufficient folic acid reserves (i.e. the 12 weeks of folic acid isn’t strictly necessary).

Everything I’ve read online and on this forum says that I can resume folic acid once my HcG is below 5. Why would the hospital guidance be different to this?

We want to start trying again as soon as we can, but with so much differing advice (even the hospital notes and consultant’s view were different) we don’t know what to do.

Is anyone able to clarify this?

Thank you

EPT_Host_20 · 18 March 2024 20:38

Dear Hannah,

Some hospitals do have their own regulations, but as far as the Trust is aware on evidence available, It makes no difference whether you have had one or 2 doses of methotrexate. You wait until your hCG levels have fallen to pre pregnancy levels and then take folic acid supplements for 12 weeks before trying 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.

This also gives chance for your body to recover from the ordeal of an ectopic pregnancy, it gives your periods to return to a more normal cycle. This can be key when dating possible future scan dates.

If you would like more clarity from your medical team, you could always ask them to show you the evidence that they base their decision on.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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HannahT · 19 March 2024 10:55

Hi Karen,

Thank you for this, it’s very helpful. Do you have any idea why a hospital might advise to wait 3 months post methotrexate before resuming folic acid?

Appreciate your help

EPT_Host_20 · 19 March 2024 21:52

Hi Hannah,

I’m afraid I don’t.

Folic acid can interfere with the absorption of methotrexate, which is why it is stopped during treatment with methotrexate as we want the methotrexate to work as best as it can.

Methotrexate however is a folate antagonist which means it reduces how well folic acid works.

When your hCG levels have fallen to pre pregnancy levels, the methotrexate has in effect, done its job. We no.longer need it working “well” within our bodies. Therefore we can start taking folic acid supplements again.

We need to take the folic acid supplements for 12 weeks before trying to conceive as methotrexate stops the folic acid from working well within our bodies and we need to build up levels again within our bodies.

I am therefore not sure what the benefit is of waiting for 3 months before starting folic acid. As long as your levels are at pre-pregnancy levels, we would advise taking it. It may be worth checking with your medical team that there was no other reason why they have suggested this for you.