Expectant Management vs Methotrexate

mel45 · Post by **mel45** » Thu Apr 27, 2017 12:54 am

I was diagnosed with a probably ectopic three weeks ago with low hcg (390 was the highest level), no visible intrauterine pregnancy and a suspicious mass on my left adnexa (2.5cm). As I had no significant pain and my levels were relatively low we opted for expectant management which I was happy with.

Over the last few weeks I have had hcg tests repeated every 2-3 days and they have been declining by at least 15% every 48 hours and there have been no significant changes to the mass seen on ultrasound. Today I finally saw my regular doctor (who has been away since this started and I have been seen by a different docs covering for him each time I had an ultrasound). It appears that my last two hcg levels are showing a slower decline then before and he now wants me to take methotrexate.

I was hoping to hear if anyone else has followed expectant management for 3 weeks and then still needed methotrexate? My levels are now 177 and I have been thinking that my silver lining to this whole situation is that things have been resolving on their own and that my husband and I can get back to TTC soon. With my levels being so low and have been declining I want to fight the injection that they want to give me on Friday (pending the blood work results that morning). Can anyone comment or help with some advice or research to back me up on continuing with the expectant management?

My understanding is that the rate of decline with methotrexate is considered successful if it is 15% every 3-4 days something that I have been experiencing already?? Do I really need to take the methotrexate which would mean 3-6 months of being unable to TTC?

EPT Host 22 · Post by **EPT Host 22** » Thu Apr 27, 2017 9:28 am

Hi Mel,

I'm so sorry to hear that you are going through this worrying time. It is good that you are continuing to seek the guidance of your Dr's and are being monitored.

Not being medically qualified, I am unable to offer specific advice on the choices between expectant management and methotrexate. However, whichever path is referred it's important to continue monitoring your symptoms. Even as your hcg levels are decreasing, unfortunately, there continues to be a chance of rupture until you are at non-pregnancy levels (below 5mIU/ml).

Please do continue looking after yourself; we are here to support you.

With good wishes,

Michele

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blinc · Post by **blinc** » Wed May 03, 2017 1:48 pm

Hello. I'm so sorry you're going through this awful experience. I am in a similar situation to you however my levels have been dropping quite quickly. Mine were 740 three weeks ago then the week later were 443 then three days later 253 then three days later 198 then three days later 65 (this was yesterday). They've dropped quite consistently and quickly without the need for treatment and I really didn't want the shot. However I had it in my mind they that if they stopped dropping consistently that I would have accepted the shot to just speed up the process as I don't feel like I can deal with the emotional side of what's going on until the physical is done and it's just going on and on. It's up to you what you do with your body but I would just suggest that you see what the next blood result is and make a decision based on that. I basically do that and wait for each blood result to decide. Considering hcg levels though my levels only dropped 20% between three days but then continued with a big drop from 198 to 65 so they can and do fluctuate. The only other thing to consider is that the longer it goes on for the risk of rupture continues. If they weren't dropping quickly enough I'd want to do what I can to make sure it resolves properly and as quickly as possible. My EPU have been amazing and i have total faith and trust in the doctors whjch i hope you have too and that makes a huge difference. Take their advice as much as possible. Have you had a scan to check the size of the sac and whether it's grown or not? If it hasn't and isn't so big to cause imminent problems maybe just wait for next blood test and go from there. This is just my experience and hope you make the right choice and get this resolved as quickly as possible. I totally get the fear and anxiety with the waiting involved with expectant management feeling but trust the doctors and look after yourself.

blinc · Post by **blinc** » Wed May 03, 2017 1:52 pm

Sorry me again. Just re read your post and saw that you've had a scan and it hasn't grown. Your sac is the same size as mine 2.5cm and mine hadn't grown on the scan. Your situation is very similar to mine and I would say definitely just see what the bloods say and go from there. Like I said my levels slowed slightly then sped up so hopefully yours will too. All the best. I'm here if you need.

pattituesday · Post by **pattituesday** » Fri Nov 24, 2017 7:53 pm

Hi-

I am just diagnosed so don’t have a specific experience to offer. Could you please tell me how your situation ended up? I’m hoping to avoid methotrexate, too