methotrexate and possible ectopic

[Andi81]

So, on August 25th I went to the dr because I had been spotting.  I was 6 1/2 weeks at that point.  MD did US and didn't think he saw anything in my uterus, possibly something measuring 4mm (but he wasn't convinced that was a pregnancy.)  My HCG was 153 at that time.  I began bleeding heavier and passing tissue.  3 days later, my HCG was 136.  I bled for about a week and then stopped.  2 days ago, my HCG was 167.  I had a methotrexate injection yesterday and will have my HCG checked in a week.  My question is: my dr didn't seem to know whether I had an ectopic or not, but I am thinking that maybe I lost the pregnancy earlier on and that's why he didn't see anything in my uterus, but there's some retained tissue and that's why levels haven't dropped.  I have had no pain at all.  Any thoughts?  Also, does one single injection really deplete the body of its folic acid stores?  I have read conflicting information.

[Elaine Brown, MD]

Hi!
It is difficult to know whether you had and ectopic pregnancy or not, because your HCG levels were so low. The threshhold for ultrasound visualization is about 2000. Your story and your levels were very consistent with an ectopic though, and the fact that you did have some rather heavy bleeding without your levels dropping, suggests that you didn't pass the pregnancy tissue.  The only way to know for sure would have been surgery-- a D&C could have removed the tissue from the uterus, and the pathologist could have evaluated the tissue for embryonic cells.  A D&C wasn't really necessary though, and would have subjected you to unnecessary surgical and anesthetic risk.  The methotrexate injection is a significantly less risky and less costly therapy, and I would have done the same thing.  It won't deplete your entire folic acid stores--the dose used for treating ectopic is pretty low. And methotrexate works preferentially on rapidly growing tissue, not on stable tissues.
I hope your therapy works--in your case there is a very good chance that it will.
You may want to consider having a hysterosalpingogram (HSG) before trying to conceive again to check to see if there is any damage to your tubes from prior to or caused by the pregnancy.
Good luck!
Dr B

[Andi81]

Thank you so much for your answer!  Just one other thing.  Since I had the methotrexate injection, I have not had any bleeding at all, not even spotting.  Would that possibly be an indication of it not working, or can that happen sometimes?  The drs office made it sound like I was supposed to bleed, but I though it would cause my body to absorb the fetal tissue.  Thanks!