Advice on Methotrexate injection

[gldavis447]

Hi all,

Wanted to share our story with you all & ask some advice about the Methotrexate injection.

We're currently going through our 6th consecutive loss, over the last four years we've suffered four miscarriages and two ectopic pregnancies.

I had Emergency Surgery end of October and also had to have the Methotrexate injection too..

Feeling very tired still...does anyone know how long the fatigue lasts for after the injection or how long the methotrexate stays in your system? Xx

[nick1987]

Hi,

I am so sorry to hear of the losses you have had. Your story is very similar to ours. We have been TTC for the past 4 years and I too have had 6 consecutive losses (4 miscarriages and 2 ectopics). My first ectopic was 2 years ago and was treated with a methotrexate injection. I felt tired for about a month or so.
The second ectopic was September 2022, this was initially treated with methotrexate injection but it didn't work so I had to have surgery. This time it took me about 2 months to physically feel back to my normal. I know this is because of the surgery I had and the recovery from that. Emotionally this loss was really difficult for us and that in itself has been draining too. I still feel I am tired from the emotional recovery.
I have been told that the methotrexate injection takes about 3 months to leave your system and during this time not to TTC as it could be toxic for the baby.
As well as the physical effects from the methotrexate and also from the surgery, the emotional effects from the loss can be really draining too. Be kind to yourself and allow the time to rest and take it easy where you can.
I hope this helps.
Bhav x

[gldavis447]

Hi Bhav,

Thankyou for the reply. I am very sorry to hear of your losses too, it really takes its toll emotionally doesn't it?

Have you been offered/had any further testing being as it's Recurring losses? You should be able to get them now as it's more than 3 losses in a row Xx

[EPT Host 20]

Dear gldavies and nick,
I am so sorry to hear of your ectopic pregnancies and losses. To experience one is is difficult, to deal with multiple losses is heartbreaking and my heart truly goes out to you.I
I would also suggest referral to a fertility specialist if you haven't already.
Regarding 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 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.

We will be here for as long as you need,
Sending much love and warm hugs,
Karen x

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
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[gldavis447]

Hi Karen,

Thankyou for your reply.

Am still feeling very tired and teary still, but I think that's the emotional toll of it all .

Still having to go for blood tests every week as HCG levels are still up. Struggling, it's just so hard .

We have our fertility appointment on Wednesday (were referred six months ago). No idea what's going to happen next but hopefully they can help xx

[Beej11]

On the topic of ttc after methotrexate - are there tests to give reassurance that it is okay to try again?
Last time I checked my folate levels after 12 wks following a medically managed ectopic. Got pregnant straight away but was unfortunately another ectopic.
I’m wondering if after hcg is 0 and 8 weeks has passed for example - could I have blood tests to see if I can ttc earlier?
Never thought I would feel this impatient about it but here we are

[Beej11]

On the topic of ttc after methotrexate - are there tests to give reassurance that it is okay to try again?
Last time I checked my folate levels after 12 wks following a medically managed ectopic. Got pregnant straight away but was unfortunately another ectopic.
I’m wondering if after hcg is 0 and 8 weeks has passed for example - could I have blood tests to see if I can ttc earlier?
Never thought I would feel this impatient about it but here we are

[EPT Host 20]

Dear Beej11,
I am so sorry to hear of your ectopic pregnancy losses. Experiencing one loss is difficult, dealing with multiple losses is heartbreaking and my heart truly goes out to you.
In the UK, there isn't routine testing following treatment for ectopic pregnancy. 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.

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
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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
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