Thanks for all of the comments and questions. As the weeks and months go by I will get to as much as I can. I would like to finish up a few more about ectopics. I realize this topic only applies to a few of you, but everyone having fertility treatment should know more about ectopics.
What are the Treatments for Ectopic Pregnancy? It’s surgery (almost always laparoscopy) , Methotrexate or observation. Observation is ok if the levels are falling and you feel well and you are highly supervised. Before we started using Methotrexate (about 20 years ago), everyone had surgery.
If I have surgery, does my tube need to be removed? Not always. Sometimes, if there is no rupture, the tube can be opened and the pregnancy removed. If however, the tube is removed, it’s usually for a few good reasons. Studies have shown that the natural fertility is the same after a tube is either fixed or removed for ectopic. The reasons for this may be that the tube was damaged anyway (leading to the ectopic), therefore its usefulness was low. It’s also possible that the ectopic occurred in a normal tube, but the ectopic damaged the tube. Also, having an ectopic increase the chances of another, so removing the tube will prevent that. Also, many patients who have ectopics are undergoing IVF, so if IVF is happening, removing the tube is less of a concern. Problems associated with leaving the tube in are an increased risk of re-operation bleeding from that tube. Another is that the hCG levels sometimes do not completely fall after leaving the tube in. If this is the case, methotrexate or additional surgery may be necessary.
What is Methotrexate? Methotrexate (MTX) is a medication that can treat most ectopics. It interferes with folic acid metabolism. DNA, RNA and proteins cannot be made or maintained without folic acid, therefore MTX causes cell death. The reason the other cells of the body are not harmed is because the pregnancy cells are dividing much more rapidly and need more folic acid. If the dose was higher, and the treatment longer, the other cells would have trouble surviving. MTX was developed and is still used as chemotherapy for certain cancers (other rapidly dividing cells). The dose of MTX for ectopic pregnancies is lower than for cancer chemotherapy, so the side effects are minimal. The package insert says MTX can cause hair loss, nausea and vomiting, low blood counts and other complications. The reality is that because the dose is relatively low, these side effects are very rare. I have never seen them, maybe some of you have. The dose is calculated based on a person’s height and weight.
One dose of MTX successfully treats an ectopic pregnancy 80-90% of the time. Sometimes a second injection is necessary if the first is not effective. We measure the effectiveness buy the level of the hCG. If the hCG numbers don’t fall after 1 week, a second injection may be necessary. And rarely, even after methotrexate, tubal bleeding can occur making surgery necessary.
That will do for now. Haven’t decided on the next topic yet. Please read disclaimer 5/17/06. Dr. Licciardi
As someone goign through infertility treatment for close to a year now, I enjoy reading your column. I have had 5 unsuccessful IUIs, and my first IVF was a chemical. I am starting to think it may be immune issues, but my doctor said that there is no evidence that immune issues cause impantation failure or early losses. Could you touch on immune issues sometime in the future?
ReplyDeleteAgain, thanks for doing this blog.
My understanding is that ectopic pregnancies can occur anywhere in and around the reproductive tract. If someone has had any type (including non-tubal) of ectopic, is the risk just as great?
ReplyDeleteThanks!
I had an HSG done (very painful). My doctor, a reproductive endocrinologist, has told me that I have "partial distal occlusion of the right fallopian tube with trace spillage." He has said that a lap is not necessary. However, it sounds like it's a hydrosalpinx. Can you touch on whether having either of these problems can interfere with conception either naturally or via IVF? I have read something about this type of tube causing fluid to leak into your uterus making implantation impossible. My dr says that since it's not completely blocked I don't have that problem.
ReplyDeleteIf you're open to suggeston about the next topic, how about something general about how you counsel Mr and Mrs Infertile on when they should move on from each type of treatment and escalate towards IVF. How long of what counts as a fair trial?
ReplyDeleteI mean, the other options are much cheaper, but also work less often, no?
I enjoy reading your blog. I'm VERY glad that you are doing this. I was wondering if you could (when you get the chance...) talk about prolactin levels and low and immobile sperm. I would really appreciate it!
ReplyDeleteThank you for so much information.. As an IVF veteran and an ectopic survivor as well, you answered a lot of questions.
ReplyDeleteMy first beta was 33 and 3 days later was at 335. They doubled fine after that up to my last beta which was in the 4000 range..
I was wondering if you had any information on Lupus. I think there are more people that have that then they think. I was just diagnosed after 6 years.
I also know there are 2 different types.. will the one that cause the skin issues cause miscarriages?
Congratulations on being in New York as one of the best RE's in NY.
ReplyDeleteI am so happy to have found your blog, it has helped me so much.
Christine
Atlanta GA
Can you talk about the new AMH test for ovarian reserve?
ReplyDeleteGreat blog by the way!
This is a fantastic blog, i wish i found it sooner. Please keep at it.
ReplyDeleteI have fibromyaglia and will be embarking on IVF next week and wonder if it's possible for you to share whether having FM makes IVF a bit more difficult?
btw FM was only diagnosed last year after a traumatic ectopic pregnancy. could ectopic pregnancy trigger off FM?
Dear dr Liccardi,
ReplyDeleteI was really happy to find your blogg. It has heped me alot to understand more about infertility and IVF. My husband and I have done 4 unsucessful IVF procedures. It seems like our embryos are too slow. (3-cells on day 2 and 6 cells on day 3). Our doctors have no explanation to this. We have tried different types of protocols, and we are starting to lose hope. Is there anything at all one can do to change the embryo quality?
We live in Sweden and we have asked our doctors here if there is any treatment option that is not offered here that we could have somewhere else but the answer to this was no. They say that there are not much difference in how IVF is done in different countries or clinics. Is this really true?
Dear Dr. Liccardi,
ReplyDeleteI am an ectopic pregnancy survivor who has a few concerns that I DESPERATELY need answers to. I was hoping that you could possibly help.
Three years ago, I had a copperwire IUD as my method of birth control, however, I ended up pregnant. We soon found out that it was an eptopic, and I was given the drug Methotrexate to abort the pregnancy. Apparently, I was very close to severe complications with my tubes, and if the Methotrexate hadn't worked right away, I was going to need surgery to remove my right tube.
Three years later, I am married, and trying to get pregnant. Needless to say, it's not working, and we've been trying for 8 months now. (I have always been OVERLY fertile, and my two children were conceived while I was using several forms of contraceptives...)
I have had NO luck becomming pregnant after being given two Methotrexate injections, and am concerned. At only 26 years old and being married, it is a VERY large concern!
Could the Methotrexate have caused fertility complications? Will I ever be able to conceive again?
That sounds awful, anyway I'm just a nurse but I saw many cases of mothers that lost their babies and it's terrible to saw a mother in this situation, I'm stuying to be a doctor and help.
ReplyDelete