# TTC after Methotrexate



## ShariCA (May 25, 2005)

I had a tubal pregnancy. It was very early (numbers topped out at 567). I think perhaps it was just a regular miscarriage, but tissue tests didn't see any placental cells in the uterus, so ectopic was diagnosed. I was treated with methotrexate.

I am anxious for this to be over, and would like to TTC again soon, but what I've read seems to say we should wait three months. My doctor didn't say anything at all about waiting. Maybe he's waiting to discuss those things when my numbers drop to 0, but I don't know. I'll ask him the next time I see him.

But I had a few questions about waiting for anyone who knows. One site I read says to wait because of potential birth defects to a new baby if it's too soon. But I have read that the mtx is out of your system within a couple of weeks even in high doses. So how would that work?

I thought the waiting may be to make sure the body absorbed all the tissue left in the tube so there wouldn't be any obstuction for a potential new embryo to travel down and get stuck on, but it didn't say that.

Does anyone have any experience with this? Any opinions? Are there increased risks of birth defects? Or is it to make sure the tube is completely clear so as to avoid another ectopic?

Thanks for any info.


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## ShariCA (May 25, 2005)

I did a little research and found a study. I'm going to go ahead and post it in this thread in case someone does a search through the forums to find similar info.

http://qjmed.oxfordjournals.org/cgi/...full/92/10/551

I could be wrong, but from my reading in this article it seems that the birth defects occur primarily from depletion of folic acid due to the MTX. Most birth defect occur when the medicine is given while the the pregnancy is in progress, not preconception.

The fact that the medicine does stay in the liver tissues up to four months is the reason for caution about future pregnancies and the admonition to wait at least three months.

The birth defects are pretty serious, so although they say the chances of the birth defects are only "theoretical" if MTX is taken before conception, it would be safer to wait.

What they do say is that folic acid levels do need to be brought back up again, but that folic acid and MTX counteract each other. So I'm assuming that while a person is waiting for the MTX to do it's job, then you should avoid folic acid supplements.

I hope this helps anyone else with the same questions.


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## naturegirl (Apr 16, 2002)

You have it all right. That is the information I have come across also. It is also advised to wait 6 months if you have had 2 shots. It takes awhile to get your folic acid levels up to normal after the shots and since you can't start the folic acid supplementation until the bhcg levels reach 0, you sometimes have to wait a few extra weeks to get started on building them back up.

I am waiting for my levels to get down to 0 in the next week or two to start the supplementation. I have had 2 shots recently and plan on waiting until the new year to ttc. I think it is better safe than sorry and even though all the information I have seen is that the MTX is mainly shown to cause birth defects if you take it during pregnancy and in the first few weeks.

My doctor also didn't have any concerns about trying earlier. In fact he told me after the first shot that all I had to wait was until I had my first af to ttc more so they could get accurate dates and make sure my body was on track as far as cycles.

It is, fortunately, better for us to wait a few months anyway since we are currently building a new house and it would be nice to be close to completion of that project before adding a new one to the family. I am sad that my ds is getting older though too. He will probably be at least 4 1/2 or 5 before he gets a sibling...if ever. But I try not to think about the latter too much.


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## naturegirl (Apr 16, 2002)

Just checking in to see how you are doing?


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## vanessao (Aug 31, 2007)

I had to get a metho shot in Oct 2005 and was told that after my levels were down to 0 then we could TTC again, after waiting 3 months!! I was not happy about that but willing to wait. My levels got pretty high (2000 level) so it took until mid January for the number to hit 0. So we waited and then decided to not TTC for even longer. Then much to my surprise I got pregnant in July 2006 and now have a very healthy 5 month old (22lbs healthy)! I hope that gives you hope, good luck!


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## naturegirl (Apr 16, 2002)

Wow it sure took a long time for those #'s to come down!

Thank you for the inspiration. Some days I definitely need it more than others and today was one of those days.









And congratulations!


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## naturegirl (Apr 16, 2002)

Oops double post!


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## Judes Mama (Apr 9, 2006)

I currently am carrying an ectopic pregnancy. My hCG toppped out at 11,500at 6.5 weeks. I then had the first round of mtx shots and my numbers went to 5,500 in one week. Because they decreased by 50%, I didn't need a second round. My doctor expects that my numbers will be at zero by 2-3 weeks time. It seems that the numbers go down much more quickly with an ectopic than with a uterine miscarriage. My doc did say that my numbers would not be falling like this if there was anything going on in my uterus.

He told me that once my numbers get to zero that my period will come back within 1-2 months. Then, he wants us to wait at least one full cycle before getting pregnant again to give my uterus a chance to build back up.

He also mentioned that once I started bleeding and actually miscarrying the baby, then I should go ahead and restart the prenatals/folic acid. Hope this helps.


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## naturegirl (Apr 16, 2002)

So sorry you are going through this and thank you for sharing your story.

I wanted to give you my experience. My levels dropped from 990 to 110 in 2 weeks and then took another 4 weeks to get to 0.







Normally levels drop to 0 in 2-4 weeks however. This pregnancy (ectopic) seems to be taking longer to reach 0 than my 2 previous miscarriages.









It is not recommended to start taking folic acid supplements until your hcg levels reach 0-5 as it can interrupt the "process". My cycle returned when my levels were still over 30 so just having a menstrual cycle does not mean that your hcg levels have reached 0. And also you can ovulate and cycle with levels lower than 40.

A site with some good information is www.ectopic.org.uk They are generally very medically minded but good info on what to expect, side-effects of MTX, etc.

I hope you heal quickly and your hcg levels fall to 0 in the near future. I feel for you in these early days. It was a very sad time for me and my family and I wanted to share my condolences.


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## naturegirl (Apr 16, 2002)

Well I have started to ttc again! Wish me luck! (5 Months since ectopic)

*Judes Mama* How are you doing? It has been awhile since anyone posted on this thread but I have been thinking about you.


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## shrimpers77 (Nov 27, 2007)

I had a m/c recently, not an ectopic. But, I have rheumatoid arthritis & take low dose methotrexate as treatment for that. I had to be off the MTX for 3 months prior to conceiving because of the risk of birth defects from the folic acid depletion. When I take the MTX, I have to take 1mg of folic acid daily with it, but in my case it is being used differently. When I was on it, I was on the pill & used condoms EVERY time my husband & I had sex because I didn't want to accidently conceive & put my baby at risk. MTX is also used as a chemotherapy drug in high doses. Hope this info helps a little. Best wishes to you...
Jamie


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