Low HCG and Methotrexate

Angel20

4 Posts
Reply Posted on: Mar 1, 2012 at 9:24am
I am over 40, did many IVFs and decided to go back to IUI. To my surprise I got pregnant. I knew immediately it was not a viable pregnancy. Here are my numbers:
14 days post ovulation - 78
16 days post ovulation - 110
18 days post ovulation - 138
21 days post ovualtion - 179

I go in again at 25 days post ovualation for more bloodwork. It was mentioned to me that if my numbers did not go down, I will have to take Methotrexate. Is it reasonable to put this off a bit given my low numbers? At what number do you feel I have no choice and have to take the drug? I am trying to avoid this medication injection. Also, did one sono and of course nothing was seen with these numbers and will do another, but not expecting to see anything given my numbers.

Dr. Braverman

2027 Posts
RE: Low HCG and Methotrexate Posted on: Mar 1, 2012 at 10:19am
I think you have time to watch these levels and see if they start to fall. Many of my patients choose that so they do not loose time having to wait for the MTX to clear the system before trying again. some actually choose a laparascopy at some point to treat this surgically again to avoid the 2-3 months of waiting after MTX. Please be aware I offer this advice without knowing your entire case and must defer to your current doctor for being sure you do not miss an ectopic that might rupture. With that said I think the risk of that is minimal at this stage. Sometimes we will do a D and C and if the beta falls the next day we know this was intrauterine(not viable of course) and avoid the MTX that way. Good luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Angel20

4 Posts
Reply RE: Low HCG and Methotrexate Posted on: Mar 2, 2012 at 11:55am
Thank you so much for your response. I appreciate it.

Today at 25 days post ovulation, my HCG is at 256, from 179 four days ago. An ultrasound revealed fluid in my uterus. Not sure if that is pointing more toward ectopic or uterine pregnancy. I will wait and see, but still trying to avoid methotrexate. Do you think I still have a decent amount of time before I decide? I am afraid I will never see anything in my uterus due to low numbers and would like to know I am not taking the shot when it was not needed. While I am glad my numbers didnt rise a lot, it also still makes it harder to determine my situation through ultrasound.

Thank you again.

Dr. Braverman

2027 Posts
RE: Low HCG and Methotrexate Posted on: Mar 2, 2012 at 12:38pm
Yes you are correct at low numbers you will not see the pregnancy, so all you can do is try and wait for a few more levels and see if the numbers begin to fall, then you must follow them down to zero, for any rise will be indicative of an ectopic and still require treatment.
You will generally not see an ectopic in the uterus until and if the numbers go over 1500. Most ectopics rupture between 6 and 8 weeks so it is important to come to a conclusion by then.
Once again I have to defer to the doctor caring for you for the final opinion on your care this is just for your information. good luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Angel20

4 Posts
Reply RE: Low HCG and Methotrexate Posted on: Mar 2, 2012 at 2:29pm
Thank you again.

Angel20

4 Posts
Reply RE: Low HCG and Methotrexate Posted on: Mar 4, 2012 at 5:54am
I have a question after thinking this through. My latest number was 256. I am having thoughts of having a D&C first and then check my numbers and if they don't go down, take the Methotrexate. Do patients ever take the drug Cytotec to induce contractions over D&C in a situation like this? Also, is it not the norm to want to do D&C before taking the Methotrexate? I am afraid I am not going to be given the choice. I am at a new facility.

Dr. Braverman

2027 Posts
RE: Low HCG and Methotrexate Posted on: Mar 4, 2012 at 8:22am
no cytotec is not an option here. Many have a "gentle" D and C then wait one day and recheck the levels it they fall you just continue to follow and if they go up you need either surgery or MTX whichever you prefer. Another option if you are already going to get the D and C is to have a laparoscopy at the same time to see if they see the ectopic if they do you save your self the D and C(as they would do the lap first) and they can just remove the ectopic and you can then get started right away again to get pregnant. Again I must always defer to your doctors decisions here this is just something for you to think about and as always discuss with your doctor.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.