AGC and ASC after ectopic pregnancy

Dear Doctor,

I recently experienced a cornual ectopic pregnancy.  After three doses of methotrexate my hcg level started coming down from 25,900 at it's highest to 48 a week ago over a two month period.  Then last Monday it had gone back up to 61 so my RE suspects that there is some remaining tissue and I will be undergoing either a D&C or another dose of mtx.

In the meantime, I just got abnormal pap results back showing AGC and ASC.  I had a colposcopy done on Monday and my cervix looked fine, but the OBGYN did an endometrial biopsy because of the AGC.  I do not yet have those results back.  I have had normal paps the last 5 years, but did have one other abnormal pap with ASCUS about 6 years ago.  A colposcopy was done then that showed everything normal as well but my test came back hpv positive.  Since then, I've had no abnormal results until this last one.

Is it possible that whatever is causing my hcg level not to drop to 0 is what caused the AGC on the pap, rather than precancerous cells?  If so, would this show up very differently on the biopsy results just as products of conception or something like that?  What type of followup would be recommended if this shows up as retained tissue since I will be taking care of that most likely with a D&C next week.  

I have read quite a bit about how serious AGC can be and want to make sure I followup appropriately.  At the same time, the ectopic pregnancy was the result of an IVF cycle and we are hoping to start our next cycle in April and due to my age (39), I don't want to delay it if it isn't necessary.  

Any information you can provide would be greatly appreciated.  Thank you so much!

[Annekathryn Goodman, M.D.]

HI There
I completely agree!
Until you get this ectopic sorted out, doing pap smears will be inaccurate.
your glandular tissue is going to look strange in the setting of pregnancy stimulation and then methotrexate

I would suggest just repeating everything in three months

I know this must be a really stressful time for you. I hope it all goes smoothly
take care

[jfly]

Hi Dr. Goodman,

Thank you for such a quick response.  I received the results of my biopsy today and the OBGYN said everything came back normal and they want me to just follow up with a repeat pap in 6 months.  She said they had no problem with me starting a new IVF cycle prior to this as long as my RE was aware of the abnormal pap and colpo/biopsy.

In your opinion, is it okay to start the new IVF cycle in late March/April prior to my next pap which would be in late August.  I could potentially be 4 months pregnant at that time.

Thanks again for your advice!

[Annekathryn Goodman, M.D.]

Hi There
I think that sounds fine.
you have some competent doctors taking good care of you
take care