Why the 3 month wait after methotrexate?

Preparing For Your Next Pregnancy
1

Hey, I had methotrexate in March and was told by a doctor and a consultant at my epu to wait 2 cycles/ 3months to ttc again after methotrexate.

I wasn’t given much information as to why but done abit of research myself and have found that it depletes folic acid.

Is the risk for a new pregnancy within 3 months the methotrexate itself or the fact that it causes folate to be to low to support development of a pregnancy and that is the risk?

So can the methotrexate cause harm aswell as folate being low or isit just the low folate that causes development issues and the risk to a new pregnancy?

I am taking 800mg of folic acid daily.

I don’t know if I’ve worded this properly for understanding but hope someone can see what I’m asking :sweat_smile:

I know the Methotrexate can affect liver, blood e.c.t but I have had my liver functioning blood test and full blood count redone 2 weeks ago which is absolutely normal so in my understanding now, it is just my folate that would be the risk in a new pregnancy now if it is low?

I would call my epu and ask them but they haven’t been very helpful through my ectopic pregnancy and the nurse who actually administered my methotrexate asked ME why I needed my hcg done on the day of my methotrexate, which isn’t very reassuring.

Any info/advice would be appreciated, Tia x

2

Hi Naomi2023,

I am so sorry to hear of your ectopic pregnancy and loss. Unfortunately, as I’m not a medical professional, I do not know your specific situation and can not give specific guidance on when you should resume ttc. I would encourage you to consult with your surgeon and medical practitioners. However, generally, the Trust and other medical professionals advise you to 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. 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. The first proper period you have after an ectopic pregnancy is likely to be heavier than usual, and the second is more like your usual period. A normal period would suggest you are hormonally ready to be able to try to conceive. Having two periods can also give an idea of menstrual cycle length, which may be different for a few months after your ectopic before settling back into its usual rhythm. This wait allows the internal inflammation and bruising from the ectopic and any associated treatment to heal.

In addition to the physical aspects of ectopic pregnancy, many women also feel an intense emotional impact. Taking time before trying to conceive again enables the necessary process of grief to surface and be worked through. The emotional recovery that is often needed can be significant, and many underestimate this aspect. Some studies suggest that women who conceive immediately after treatment for ectopic pregnancy are more at risk of suffering a subsequent ectopic and, as painful as it is to think about, the incidence of miscarriage (which is not linked to an ectopic pregnancy) is 1 in 5 pregnancies, so taking that extra bit of time enables you some emotional recovery to feel strong enough to face whatever is coming next should there be further bad news.

However, it is recommended to take folic acid for at least 12 weeks prior to conception.

We understand how nerve-wracking this all can be. We are here for you, for emotional support too, and these Boards are a safe space for you. We are here for as long as you need.

With good wishes,

Michele

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information

If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.

Further information is available on our website.

Email us: ept@ectopic.org.uk

We provide a call-back support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.

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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, thankyou for your reply. Since our loss it has been very difficult and I would not put a new pregnancy at risk so would not ttc without a green light from medical professionals but I think ttc again would make us feel so much better following this ordeal and I am now coming up for my second period since methotrexate.

So if I was to get a folate test done and it was high enough before the 3 month wait was over would the methotrexate itself still pose a risk to a new pregnancy?

I’ve read it is out of your system within days and my blood tests that I have had done since mtx are normal which tells me I no longer have it in my system or that it is no longer affecting my body? X

4

Naomi2023:
Hi, thankyou for your reply. Since our loss it has been very difficult and I would not put a new pregnancy at risk so would not ttc without a green light from medical professionals but I think ttc again would make us feel so much better following this ordeal and I am now coming up for my second period since methotrexate.

So if I was to get a folate test done and it was high enough before the 3 month wait was over would the methotrexate itself still pose a risk to a new pregnancy or are the risks no longer there if my folate was to be high enough?

I’ve read it is out of your system within days and my blood tests that I have had done since mtx are normal which tells me I no longer have it in my system or that it is no longer affecting my body? X

5

Dear Naomi,

I am so sorry to hear of your ectopic pregnancy loss,

I genuinely understand the desire to ttc following loss however we and many healthcare professionals advise to wait until your hCG levels have reached pre-pregnancy levels (your doctor will tell you when this is) then take folic acid supplements for 12 weeks. 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.

We have more information on methotrexate treatment on our website here-

https://ectopic.org.uk/treating-an-ecto … thotrexate

I hope this helps, however we cannot provide individualized medical advice and I would advise speaking to your doctors if you wish to discuss this further,

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information

If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.

Further information is available on our website.

Email us: ept@ectopic.org.uk

We provide a call-back support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.

Take a look at our newsletters and subscribe to our mailing list.

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

6

Hello Naomi,

What did you do? I was also wondering this, if you felt ready after 2 periods and had your bloods done and they came back normal, surely then it would be ok ttc? After 3 losses and an ectopic, emotionally I am already used to loss, so really it’s waiting physically to recover now.

7

@Deerdancer so i had my bloods all redone by gp. Full blood count, liver function test and I paid for my own private foliate test which came back absolutely fine and was in range for a pregnancy so we went ahead with ttc again as we know our bodies and when we are ready in ourselves along with tests being fine so no obvious risks to a new pregnancy. Theys is also the view on it of it may not happen that month either anyway. We went with a very relaxed approach and no pressure, no ovulation testing e.c.t but I didn’t fall pregnant that month anyway. So I’ve just finished my first cycle that came after the 12 week wait and I fell pregnant but unfortunately started bleeding a few days later so I had an early loss (chemical) so hoping this month we will have some better luck and be third time lucky. Xx

8

@Naomi2023 Thank you so much for your reply, it’s really reassuring to hear all that re blood tests etc - makes logical sense to me! I’m just waiting on my 7 day bloods, hoping I won’t need another jab/surgery :pray: I’m so sorry you had to go through a chemical loss. I’m crossing everything and sending you lots of luck for your next cycle! Xx