Eptopic & Expacant management

[Bizz35]

Hello,

After having a PUL for for a few weeks they discovered a small eptopic on Friday. Everything happened very quickly and i felt i was given barely any information. They have suggested expectant management. My HCG is around 900 at the moment and i haven’t had ant pain or bleeding. i had a small rise in my last draw and due another test Monday. I asked about the injection but kept cutting me off and i felt like they just wanted to get me out the door.

I am going to go back to the EPU on Monday and ask to speak to a doctor.

Has anybody had a experience of expectant management? How did it work out for you?

i am so scared and emotional and can’t seem to get it together.

i have 2 children 7 and 5 and so worried i won’t be able to convieve again.

Hiya, I'm sorry you are going through this, it's so difficult, and also that you feel dismissed by the EPU, they should have talked you through your treatment options at least and agreed to a plan you were comfortable with.

I had an ectopic in January last year, I was recommended surgery as I was in pain and bleeding but I decided on expectant management as I didn't want to reduce my chances of conceiving again. Unfortunately for me my HCG wasn't going down quick enough to guarantee the pregnancy wasn't going to rupture so I agreed to the injection in the end which fortunately worked. I will say the methotrexate was pretty unpleasant in it's side effects and also pretty painful - more so then the ectopic itself, but then it does usually revolve an ectopic a lot quicker then expectant management so what is best for you depends on your circumstances and priorities. Hopefully they will explain more at your appointment on Monday.

You can't TTC again for 3 months after the injection (which is why I was trying to go expectant management as my first choice, I was desperate to conceive again as I had no children and had been trying a long time). I had the injection in January and was lucky enough to then conceive a healthy baby boy in May.

Wishing you all the best whatever you decide to do xx

Sorry your going through this and haven't been given enough information or options, I had an ectopic when my DD was 3, had surgery where they took away the pregnancy and fallopian tube so I was concerned that I would have trouble conceiving again, but I went on to have two other children and am currently 14 weeks pregnant with number 4 so although i understand the worry please don't think it will be the end of having other children. Sending hugs x

Sorry you're going through an ectopic OP 💐

I also had surgery for mine (it ruptured so no choice not to have the surgery) and I have conceived twice since, first time on the second cycle and second time on the 3rd cycle. I know (and also know of) lots of women who have had children following the loss of a tube.

In my case the rupture happened the day after my diagnosis - so before I had my repeat 48 hour bloods to see if my HCG had fallen and before expectant management could properly begin.

I asked about the injection at diagnosis and my EPU said they prefer expectant management as an initial approach where possible due to the side effects of methotrexate, especially at the dose needed for an ectopic. Yours may be similar but do raise it with the doctor again tomorrow - they should be talking it all through with you.

Did they give you any information to take home? If not, the Ectopic Pregnancy Trust have good information and I also found some useful leaflets on the miscarriage association website.

Thank you all for replying. It’s making me feel a little less alone. And i am so sorry for your losses ❤️

Those that has the injection how long did it take you to get back down to 0 on your HCG?

i keep reading conflicting information on future fertility with the operation.

i am a person who doesn’t deal with uncertainty very well. x

If it helps, I had my 28 week midwife appointment today, less than 18 months after losing one of my tubes. It doesn't seem to have harmed my fertility and I conceived on my 3rd cycle, despite being in my mid 30s.

My SIL had my niece following an ectopic, one of my colleagues had a child following an ectopic. One of the nurses who cared for me had two ectopics but went on to have two DC. The EPU doctor I saw for my current pregnancy was one of two children born to his mother after her ectopic and loss of a tube. The doctor said to me that you only really need one fallopian tube to have a child, much like you only need one testicle if male. The second tube and second testicle are just a bonus.

The surgeon I had for my ectopic said she'd performed caesaereans on women she'd previously removed tubes from.

It's natural to worry (I certainly worried lots about my fertility 18 months ago) but try and just focus on recovery for now. One step at a time.

So sorry you’re going through this. I had an ectopic 9/10 months ago and it’s awful. I’m sorry you’re not getting much info or support either. I’d definitely speak to a dr. I used the ectopic pregnancy trust forum too, it was so helpful.

I presented in the EPAU at 5w4 with side pain (couldn’t lie down) back pain, light bleeding and what felt like severe trapped gas - my HCG was only 150 odd.
I had a scan at 6 weeks and it was a PUL.
3 days later I was bleeding heavily and miscarrying. My hcg lowered to 40 odd but continued to rise slowly.
After weeks of blood tests and more scans they found ectopic on right side, they suspected it but couldn’t see it. My hcg was 142.

I had methotrexate. My hcg didnt decrease to the desired % so I started considering another jab or surgery. ( it rose to 221 but only dropped to 151)

I took a day or so to decide and thankfully it dropped considerably and it continued to fall.
My PUL scan was 21st July, MTX was 7 aug, I was discharged on 29th aug and got my negative pregnancy test on 7th sept.

I hope those timelines help. I was gutted we couldn’t TTC for months but I’ve literally last week just got my first positive test since and I’m 4 weeks today.

reach out to others for support online, I can’t tell you how helpful it was.

take good care of yourself.

I can't remember how long it took after the jab for HCG to return to zero, but it was pretty rapid, two weeks perhaps?

My bloods came back as 1100 from 850 so
still going up. they are saying they will no longer give me the injection or they hesitant too. So my options are to wait and see or go for the surgery sooner rather than later.

Worried about getting pregnant again and what the chances would be. They said still positive but you never know.

i would really like this to be over as mentally it has really started to take its toll 😩

Any rationale for not offering the injection? Many people with much higher hcg are still offered it? I’d speak to PALS and challenge if needed.
the ectopic pregnancy trust have info re fertility rates following, general consensus is it doesn’t affect fertility either without a tube or after MTX. Even with one tube the tube will serve both ovaries!

There are so many sucsess
stories after ectopic, don’t loose hope.

They mentioned that the latest research is pointing to it being as effective as expectant management but then i have seen some positive outcomes. I wish the decision was out if my hands as both options really suck. i think they would if i really pushed.

i am going to see what my bloods are saying tomorrow and then if risen have the surgery.

Thanks for your patience postive stories and congratulations 🥳

MTX worked for me but I was really struggling with it dragging on for weeks and weeks and the constant panic. Everyone is of course different so I hope you can take some time and support to come to the best decision for you. look after yourself, you’re not alone 🧡

Hi everyone, i ended up with the surgery i just couldn’t take it anymore. I am not really in pain anymore and taking it slow. Thanks for all your comments. Looking forward to getting back to normal and being able to TTC again soon x

So sorry you had to go through surgery but I hope you are recovering ok and being well taken care of x