Ectopic pregnancy - wait and see?

[Irelanda]

Hi there,

4 weeks ago I assumed I was miscarrying at approx 5.5 weeks pregnant. Initially heavy bleeding settled into light/moderate which persisted and had ectopic confirmed 8 days ago. (So I’m technically nearly 10 weeks)

My hcg levels have been relatively low, started from first blood test 8days ago at 280, but have crept up over the week to mid 400s, although last draw was tiny increase. The mass is also small 2.5cm (I think) and no free fluid identified.

I’m back for blood test tomorrow, if it remains the same or declines would you be happy to continue to wait and see?

I feel overall quite calm but the thought of having long drawn out wait and see and slow decline of hcg doesn’t sound that appealing, particularly as I understand you can still rupture with low levels.

I know mtx requires 12 weeks wait before ttc (which I’m keen to do asap, obviously safely to that time frame). But this has already felt quite a drawn out process.

Would you be happy to continue to wait and see to avoid the injection if my levels start to decline? I guess trying to figure out what the right balance is.

Appreciate they could go up tomorrow and injection may be unavoidable!

Hi OP, didn’t want to read and run. My ectopic was originally diagnosed as a PUL, so we were in and out for repeated scans. The HCG also kept rising. In the end, my mental health couldn’t take the wait and see option anymore- it had gone on for weeks by this point so we opted for treatment. I’m not sure if that really answers your question, but that was my experience. Started bleeding at 4 weeks but was 8 and a bit weeks when it was treated.

I do wish you all the best, it was a really stressful and sad time and I was also just desperate to get back to TTC. Best wishes and hope everything goes ok 💐

Thanks so much for your reply, reassuring to hear your experience and I’m just glad to hear that the mental load from the ins and outs and uncertainty factored into decision making around your treatment. Because my hcg levels are relatively low I don’t want to knee jerk into taking treatment if I don’t need it, but similarly the last week has felt so long I find it hard to think of continuing at this pace if I’m on a very slow decline, still with the thought of a possible rupture.

anyway thanks so much for your response, I really appreciate it,

@IrelandaSorry you are going through this. Ultimately the decision has to be yours based on the advice from your medical team. My first ectopic was treated with methotrexate. I had been monitored every other day for two weeks and I couldn’t take the uncertainty and worry anymore. After I had the injection I just felt an enormous sense of relief and my numbers decreased rapidly after that. It was definitely the right decision for me

@Irelanda Sorry to hear you are going through this; I've also been through an ectopic and know it's such a tough experience.
Mine was different in that when mine was discovered I didn't know I was pregnant, and ended up in emergency surgery with the loss of a fallopian tube.
But I came out the other side and got through it.
The main thing is you are being closely monitored and I hope you reach the treatment decision that feels the most comfortable for you 💐

I also had a similar experience in April / May this year. I believed i was miscarrying around 5.5 weeks but home pregnancy tests were still positive a few weeks later so I went in to be seen by EPAU. Initially I was diagnosed with a PUL and my HCG was low (lower than 200) but fluctuating. I had a d&c to rule out retained products but when that didn't affect my HCG they decided it must be ectopic but it was never seen on a scan. I spent weeks going in for blood tests to see my HCG go up and down and up again. Eventually I decided to have the mtx when my HCG was as low as 95 because it had barely come down at all since the previous test and I couldn't deal with the uncertainty and state of limbo any longer. I don't regret that decision at all - the mtx brought my hcg to 0 quickly and. The 3 month wait went quickly, my periods came back in that time, and it was really nice to be able to focus on life again without worrying about ttc (we had been trying for 10 months when i fell pregnant).

Hi
My experience was similar to yours in that my numbers were very low. I think the maximum they went was about 400-600 but my medical providers took thr view that it should be treated rather than prolonging things. Im not sure why now in hindsight because other than brown spotting I did not have any other symptoms like shoulder pain etc and my ectopic was never 100 percent visualised on scan. Despite this I took the drastic view of wanting the salpingectomy as opposed to methotrexate as I couldn't bear the thought of waiting 3 months to try again as it was a desperately wanted pregnancy and I did not have age on my side. Now I put it in perspective it was a strange decision I took but thankfully fell pregnant 6 weeks later with a continuing pregnancy. I hope you manage to come to a good decision for you. It's a horrible situation and so hard to think clearly when you are in it. Hopefully your levels reduce down soon or you manage to make peace with a decision xxx

Thanks so much all for sharing your experiences. I’m waiting for the results of today’s blood tests and either way scheduled to see doctor later this week where I think decision will be made on whether mtx feels right choice. Nice to hear others understand that there is relief in choosing to go down this road rather than more waiting and uncertainty . I appreciate all of you taking the time to tell me your experiences, I’ve found it a bit hard to know if anyone understands. I’m also balancing how much to tell anyone and whether to take some time off, I happened to be on leave last week but may well take a few days even if my levels are going down as I’m finding the balance of concentrating at work and worrying about results and what’s next difficult, even though I don’t feel particularly panicked, it’s more just handling logistics of it all!

I found out I was pregnant but didn't know how long far gone so had hcg levels done 3 times, after the 3rd time they messaged to say to book appointment for the Monday, thus was Friday evening. Unfortunately I got the pain early Sunday morning and rushed to A&E, told was just implantation and to rest. I asked for 2nd opinion and doctor said my hcg levels were indicating possible ectopic but they didn't scan on a Sunday so theyd admit me. On the way down to get scan in Monday morning I was in agony, then I remembered waking up in recovery as tube had burst. I was in hospital for 10 days as I had a bladder prolapse and so many infections. After ectopic I decided I could never risk it again. I did already have 4 dc. Worst part was my ward was next to the normal maternity and all I could hear were the babies

I felt similar to how you describe @Irelanda. I wasn't so worried about my health as there was nothing to indicate rupture was likely. At the same time, I was so preoccupied with the hassle of it all and the non-stop tests and uncertainty that I didn't really process what I was going through. People I told were very sympathetic but didn't really understand and their concern frustrated me. I took a few weeks off in the end and I'm glad I did. The whole thing was emotionally draining and even though I felt physically fine, I really needed that time as I was barely able to focus at work anyway. Please don't be afraid to take time off now and don't feel guilty about resting. I wish I'd been a bit easier on myself - I have quite a stressful job and it was just a lot to manage all at once!

Mine ruptured and it was life threatening and needed immediate emergency surgery, I didn't realise I was pregnant so no tests, about 10 weeks I think. Sounds like you are in good hands but things go downhill really fast when they do...

Thank you so much, nice to hear of your experience and especially that you get the whole faff of work. People have been so nice, but agree it’s not something easily understood, I admit I wouldn’t have prior to this. And yes work can feel demanding on a normal day, but trying to keep on top of everything knowing I will be in and out feels harder than maybe taking a bit of time.

Thanks so much everyone. Hcg has gone up again a bit today, but still overall low level. Meeting consultant tomorrow so imagine will have a clearer idea of next steps then.

Sounds like a very similar situation to mine in Jan 2025 @Irelanda, I had very slow rising HCG and a very small mass was seen on my left ovary which did not seem to be getting bigger with each scan. I ended up having the MTX injection and like others I was really upset about having to wait the 3 months to ttc again - however, looking back on it I actually benefited from the 3 month break as by the time the ordeal was over, I was pretty mentally drained and needed to have a break from obsessing over getting pregnant, the 3 months went extremely quickly and I used the time to take care of myself and really get on top of all my supplements etc.

I was also worried about the effects of the MTX injection as had read some horror stories, however I’m pleased to say I really did not get any nasty effects from it and it successfully resolved the ectopic with one dose.

Im pleased to say that in January this year I got pregnant and now have my 4 week old newborn sleeping on my chest ☺️ it all seems so all consuming when you’re going through it (understandably!) x