Methotrexate Treatment for Ectopic Pregnancy – Full Text View Brief Summary: Ectopic pregnancy is an important cause of maternal morbidity and occasionally mortality. Deaths associated with ectopic pregnancy have declined, though approximately 75% of deaths in the first trimester and 9-13% of all pregnancy-related deaths are associated ectopic pregnancy.
The main stays of management for ectopic pregnancy were surgery and medical treatment. Medical management with systemic methotrexate administration avoids the inherent morbidity of anesthesia and surgery is cost-effective, and also offers success rates comparable to surgical management, with no loss in future potential fertility.
However, although medical management using methotrexate is used commonly, there is no solid consensus regarding dose protocol. Currently, there are three methotrexate protocols for the treatment of an ectopic pregnancy, “multi-dose”, “single-dose”, or “two-dose”.
- Among them, the multi-dose protocol includes the administration of 4 methotrexate doses alternating with leucovorin (rescue regimen).
- As a result of the multiple dosing of methotrexate, side effects are more common.
- In contrast, the advantages of the single-dose protocol include elimination of a rescue regimen, lower incidence of adverse effects, and better compliance.
However, the single-dose protocol was found to be associated with a considerably lower success rate as compared with the multi-dose protocol (88% versus 93%) in a recent meta-analysis. The two-dose protocol, which it balances efficacy and safety/convenience, was described as a cross between the multi-dose and single-dose protocols.
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Contents
- 1 How many times can you take methotrexate for ectopic pregnancy?
- 2 Can you have a baby after methotrexate?
- 3 Does methotrexate affect egg quality?
- 4 What happens if you take methotrexate twice?
How many times can you take methotrexate for ectopic pregnancy?
Methotrexate is a type of medicine that stops cells from dividing. It can be used as a way (other than surgery) to treat a pregnancy that’s implanted outside the uterus (ectopic pregnancy). It’s given by injection, and usually just 1 dose is given.
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How long do you take methotrexate for ectopic pregnancy?
Conclusion – The median time to resolution for ectopic pregnancies treated with methotrexate was 22 days, with the majority resolved within 5 weeks. Baseline hCG and early trends are predictive of time to resolution, with a rise above 1000 IU/L by day 4 associated with the longest time to resolution.
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How often does methotrexate not work for ectopic pregnancy?
Methotrexate treatment for ectopic pregnancy has a very good success rate ( over 95 per cent ) and, in small doses, is safe to use with few side effects. It also avoids the use of a general anaesthetic and the need for surgery.
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Can you have a baby after methotrexate?
What are the risks of using methotrexate in pregnancy? – Methotrexate used in early pregnancy can cause miscarriage and/or serious birth defects in the baby, and can affect the baby’s growth in the womb. The risk of poor pregnancy outcomes is greater with high doses of methotrexate.
However, lower dose methotrexate (used for autoimmune disease) has also been linked to miscarriage, and it is not clear whether it may sometimes cause birth defects. For this reason, methotrexate is not recommended during pregnancy. After stopping methotrexate, it can stay in the body for some time. The manufacturers of methotrexate recommend that women avoid getting pregnant for six months after finishing treatment with methotrexate.
Women who are taking methotrexate and planning a pregnancy should speak to their doctor to discuss switching to a different medicine before stopping contraception.
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Can ectopic pregnancy grow after methotrexate?
Abstract – BACKGROUND: The aim of the present study was to evaluate the effect of methotrexate (MTX) treatment on the ultrasonographic appearance of extrauterine pregnancy (EUP) and, particularly, to test the hypothesis that the ultrasonographic appearance is not predictive of treatment success.
- METHODS: A prospective cohort study.
- The study group included 56 women with tubal EUP who received a single-dose protocol of MTX.
- EUP was diagnosed whenever an intrauterine gestational sac was not identified by transvaginal ultrasonography (TVUS), accompanied by an abnormal rise or plateau in hCG concentration.
Serial TVUS was performed weekly until hCG normalization or the size of the ectopic mass declined to 1 cm 2, RESULTS: Ectopic tubal mass was identified on TVUS in 45 (80%) women with a mean size of 4 ± 0.5 cm 2, Following the first week of MTX injection, the mean size of the ectopic mass significantly increased to 6 ± 0.8 cm 2 ( P = 0.02).
- The initial size of the ectopic mass was not related to the success of the treatment nor to serum hCG levels.
- Ultrasonographic resolution of the ectopic mass was documented in 27 women following a mean of 42 ± 2.4 days (range 7–63 days).
- CONCLUSIONS: The initial size of a tubal pregnancy is not related to the success of MTX treatment.
MTX treatment in tubal pregnancy is followed by an initial increase in the size of the ectopic mass. Accordingly, such enlargement of the ectopic mass should not be considered as a higher risk for failure of treatment.
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Can a fetus survive methotrexate?
Taking methotrexate in pregnancy may lead to birth abnormalities that affect a child’s physical and mental development. In some cases, methotrexate can result in fetal death.
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What is the next step if methotrexate doesn’t work?
11. Will I ever need to take biologics? – Doctors may start you on methotrexate alone, which is known as methotrexate monotherapy, or combine methotrexate with other non-biologic DMARDs or with biologic DMARDs. “For patients who have a more aggressive disease or what we call moderate to severe activity, methotrexate alone might not be adequate,” Dr.
- Feldman says.
- If you aren’t responding to methotrexate after a two-month period, your rheumatologist may try some kind of combination therapy, such as adding sulfasalazine and hydroxychloroquine (called triple therapy) or adding a biologic drug such as etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade).
It would be unlikely that you would skip methotrexate altogether and go straight to a biologic. Also, many insurance companies will not even allow you to start a biologic until you’ve “failed” with methotrexate. Many patients, “if you catch their RA early,” do well on just methotrexate, Dr.
- Feldman says.
- Here’s a final word about methotrexate from Dr.
- Feldman: “We have a lot of experience using this medication for the last 35 years.
- There are nuisance side effects for 10 to 15 percent of patients.
- But we are monitoring you very closely, and if we look at the control studies, it appears to be very effective for a significant portion of RA patients.
It may be all you need. In my personal experience, it’s very safe. And it’s the right place to start for most patients. The sooner you get on it, the sooner you’ll know if it works.”
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Can fallopian tube rupture after methotrexate?
Abstract – To determine the predictors for tubal rupture among women treated with methotrexate (MTX) for ectopic pregnancy. We performed a retrospective cohort analysis in a tertiary university-affiliated medical center. Medical records of 401 women who were diagnosed with ectopic pregnancy and were treated with MTX between January 2001 and June 2017 were reviewed. Forty-one women were diagnosed with ruptured ectopic pregnancy (study group) and 360 women with non-ruptured ectopic pregnancy (control group). Descriptive data and predictive variables for rupture ectopic pregnancy following MTX treatment were reviewed. Out of 122 women who failed MTX treatment, forty-one women had tubal rupture (33.6%). The median time interval from MTX treatment to tubal rupture was 6 days (1-25). β-hCG percentage change in the 48 h preceding MTX treatment and β-hCG level at day 0 were independent predictors for tubal rupture (odds ratio = 1.08, 95% confidence interval = 1.04-1.12, p 69% in the 48 h preceding methotrexate the probability for tubal rupture was 85%. Risk assessment for tubal rupture should be made before methotrexate treatment according to β-hCG dynamics and level. The absolute risk for tubal rupture in women with β-hCG increment<20% is low. Keywords: Beta human chorionic gonadotropin; Ectopic pregnancy; Methotrexate. © 2022. Society for Reproductive Investigation. View complete answer
At what week would an ectopic pregnancy rupture?
Topic Resources Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes.
In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy ruptures, women often have abdominal pain and vaginal bleeding, which, if not treated, can be fatal. Doctors base the diagnosis on results of blood tests and ultrasonography, done mainly to determine the location of the fetus. Usually, surgery is done to remove the fetus and placenta, but sometimes one or more doses of methotrexate can be used to end the ectopic pregnancy.
Pregnancy complications, such as ectopic pregnancy, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. Most pregnancy complications can be effectively treated.
In ectopic pregnancy, the fetus cannot survive, and if not diagnosed and treated promptly, ectopic pregnancy can cause life-threatening bleeding in the woman. Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus. However, if the tube is narrowed or blocked, the fertilized egg may never reach the uterus.
Sometimes the fertilized egg then implants in tissues outside of the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually develop in one of the fallopian tubes (as a tubal pregnancy) but may develop in other locations. A fetus in an ectopic pregnancy sometimes survives for several weeks.
- However, because tissues outside the uterus cannot provide the necessary blood supply and support, ultimately the fetus does not survive.
- The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is able to live on its own.
- When an ectopic pregnancy ruptures, bleeding may be severe and even threaten the life of the woman.
The later the structure ruptures, the worse the blood loss, and the higher the risk of death. However, if an ectopic pregnancy is treated before it ruptures, the woman rarely dies. About two of 100 pregnancies are an ectopic pregnancy. Risk factors (conditions that increase the risk of a disorder) that particularly increase the risk for an ectopic pregnancy include
A previous ectopic pregnancy Fallopian tube abnormalities
Pregnancy is less likely to occur after tubal ligation is done or when an IUD is in place (fewer than 1.5% of women become pregnant). However, if pregnancy does occur, about 5% of them are ectopic. Other risk factors for ectopic pregnancy include
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What should you avoid while taking methotrexate?
Precautions – It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects. Blood and urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby.
The medicine may also cause birth defects if it is used by the father when his sexual partner becomes pregnant. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant. Female patients should use an effective form of birth control during treatment and for at least 3 months after the last dose.
Male patients who have female partners should use an effective form of birth control during treatment and for at least 3 months after the last dose. Tell your doctor right away if pregnancy occurs while you are using this medicine. This medicine may cause serious allergic reactions, including anaphylaxis, which may be life-threatening and require immediate medical attention.
Check with your doctor right away if you have a rash, itching, dizziness, fainting, fast heartbeat, trouble breathing or swallowing, or chest tightness while you are using this medicine. Talk with your doctor before using this medicine if you plan to have children. Some men and women who use this medicine have become infertile (unable to have children).
Limit alcohol use with this medicine. Alcohol may increase the risk for liver problems. Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin.
- If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
- Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
- Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
- Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
- Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
- Avoid contact sports or other situations where bruising or injury could occur.
This medicine may cause stomach and bowel problems. Check with your doctor right away if you have stomach pain, black, tarry stools, constipation, diarrhea, loss of appetite, nausea, pain in the back of the throat or chest when swallowing, or vomiting blood or material that looks like coffee grounds.
Check with your doctor right away if you have cough, fever, or trouble breathing. These could be symptoms of a serious lung or breathing problems (eg, acute or chronic interstitial pneumonitis). While you are being treated with methotrexate, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor’s approval.
Methotrexate may lower your body’s resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you.
Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. Serious skin reactions (eg, toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, or erythema multiforme) can occur with this medicine.
Check with your doctor right away if you have blistering, peeling, or loosening of the skin, blue-green to black skin discoloration, cough, cracks in the skin, diarrhea, itching, joint or muscle pain, loss of heat from the body, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, fever or chills, or unusual tiredness or weakness while you are using this medicine.
This medicine may make your skin more sensitive to sunlight. Wear sunscreen, eye protection, and a hat. Do not use sunlamps or tanning beds. Tell your doctor right away if you have a change in how much or how often you urinate, rapid weight gain, swelling in the legs, ankles, or feet, or trouble breathing.
These could be symptoms of a serious kidney problem. This medicine may cause serious nerve problems. Check with your doctor right away if you have seizures, confusion, tingling or numbness in your hands, feet, or lips, trouble seeing, or headache. This medicine may increase your risk for other cancers, including blood or skin cancer.
- The risk for skin cancer may be increased if you take cyclosporine after receiving treatment with methotrexate for psoriasis.
- This medicine may cause a serious reaction called tumor lysis syndrome.
- Your doctor may give you a medicine to help prevent this.
- Tell your doctor right away if you have a change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter ) medicines and herbal or vitamin supplements.
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How long after ectopic pregnancy can you try again?
Trying for another baby – You may want to try for another baby when you and your partner feel physically and emotionally ready. You’ll probably be advised to wait until you’ve had at least 2 periods after treatment before trying again to allow yourself to recover.
- If you were treated with methotrexate, it’s usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.
- Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they’ve had a fallopian tube removed.
Occasionally, it may be necessary to use fertility treatment such as IVF, The chances of having another ectopic pregnancy are higher if you’ve had one before, but the risk is still small. If you do become pregnant again, it’s a good idea to let your GP know as soon as possible so early scans can be carried out to check everything is OK.
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How can I get pregnant fast after ectopic pregnancy?
IVF after ectopic pregnancy – In vitro fertilization, IVF will be the best option for having a successful pregnancy for many women with a history of tubal damage and one or more ectopic pregnancies. Our IVF success rates
Pregnancy success rates with IVF are excellent in (young) women with tubal problems Tubal pregnancy results from in vitro in only about 3% of cases
Does methotrexate affect egg quality?
Result(s) – The cumulative intrauterine pregnancy rate achieved with controlled ovarian stimulation at 2 years after methotrexate exposure was 43%, with a mean time to conceive of 181 days. Thirty-five patients with similar fertility treatments pre- and post-methotrexate were identified.
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Can ectopic pregnancy grow after methotrexate?
Abstract – BACKGROUND: The aim of the present study was to evaluate the effect of methotrexate (MTX) treatment on the ultrasonographic appearance of extrauterine pregnancy (EUP) and, particularly, to test the hypothesis that the ultrasonographic appearance is not predictive of treatment success.
- METHODS: A prospective cohort study.
- The study group included 56 women with tubal EUP who received a single-dose protocol of MTX.
- EUP was diagnosed whenever an intrauterine gestational sac was not identified by transvaginal ultrasonography (TVUS), accompanied by an abnormal rise or plateau in hCG concentration.
Serial TVUS was performed weekly until hCG normalization or the size of the ectopic mass declined to 1 cm 2, RESULTS: Ectopic tubal mass was identified on TVUS in 45 (80%) women with a mean size of 4 ± 0.5 cm 2, Following the first week of MTX injection, the mean size of the ectopic mass significantly increased to 6 ± 0.8 cm 2 ( P = 0.02).
The initial size of the ectopic mass was not related to the success of the treatment nor to serum hCG levels. Ultrasonographic resolution of the ectopic mass was documented in 27 women following a mean of 42 ± 2.4 days (range 7–63 days). CONCLUSIONS: The initial size of a tubal pregnancy is not related to the success of MTX treatment.
MTX treatment in tubal pregnancy is followed by an initial increase in the size of the ectopic mass. Accordingly, such enlargement of the ectopic mass should not be considered as a higher risk for failure of treatment.
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What happens if you take methotrexate twice?
Methotrexate is a common prescription medication for rheumatoid arthritis, other inflammatory types of arthritis and autoimmune disease, several types of cancer, and more. Methotrexate dosage is different from that of other medications in that you only take it once a week.
- That can be confusing, especially if your healthcare provider or pharmacist haven’t explained it.
- It’s not uncommon for someone to overdose on methotrexate because they take it every day.
- Too much methotrexate can cause severe toxic effects, especially liver toxicity.
- Never take more than is prescribed or change the dosing schedule on your own.
This article goes through the uses of methotrexate and the doses for them, plus the side effects and warnings you need to be aware of with this drug.
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What is the next treatment after methotrexate?
11. Will I ever need to take biologics? – Doctors may start you on methotrexate alone, which is known as methotrexate monotherapy, or combine methotrexate with other non-biologic DMARDs or with biologic DMARDs. “For patients who have a more aggressive disease or what we call moderate to severe activity, methotrexate alone might not be adequate,” Dr.
Feldman says. If you aren’t responding to methotrexate after a two-month period, your rheumatologist may try some kind of combination therapy, such as adding sulfasalazine and hydroxychloroquine (called triple therapy) or adding a biologic drug such as etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade).
It would be unlikely that you would skip methotrexate altogether and go straight to a biologic. Also, many insurance companies will not even allow you to start a biologic until you’ve “failed” with methotrexate. Many patients, “if you catch their RA early,” do well on just methotrexate, Dr.
- Feldman says.
- Here’s a final word about methotrexate from Dr.
- Feldman: “We have a lot of experience using this medication for the last 35 years.
- There are nuisance side effects for 10 to 15 percent of patients.
- But we are monitoring you very closely, and if we look at the control studies, it appears to be very effective for a significant portion of RA patients.
It may be all you need. In my personal experience, it’s very safe. And it’s the right place to start for most patients. The sooner you get on it, the sooner you’ll know if it works.”
View complete answer
Why do you have to wait 3 months after methotrexate to get pregnant?
Why must I wait for three months before trying to conceive? – While there is no clear, researched evidence on how long a couple should wait to try to conceive after having treatment for ectopic pregnancy, we and other medical professionals advise that it may be best to wait for at least three months or two full menstrual cycles (periods) before trying to conceive for both physical and emotional reasons.
The bleed that occurs in the first week or so of treatment for an ectopic pregnancy is not your first period. It is the bleed that occurs in response to falling hormones associated with the lost pregnancy. Physically, this timeframe is to allow your cycle to return to normal and for there to be a clear period to date a new pregnancy from.
The date of the first day of the period is what is used to decide when to scan a new pregnancy; information that is invaluable in ensuring you are not suffering from another ectopic pregnancy. The first proper period you have after an ectopic pregnancy may be heavier than usual and the second more like your usual period.
A normal period would suggest you are hormonally ready to be able to try to conceive. Having two periods can also give an idea of menstrual cycle length, which may be different for a few months after your ectopic before settling back into its usual rhythm. This wait allows the internal inflammation and bruising from the ectopic and any associated treatment to heal.
In addition to the physical aspects of ectopic pregnancy, many people also feel an intense emotional impact. Taking time before trying to conceive again enables the necessary process of grief to surface and be worked through. The emotional recovery that is often needed can be significant and many underestimate this aspect.
If you have had either one or two injections of methotrexate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood or urinary tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the drug may have reduced the level of folate in your body which is needed to ensure a baby develops healthily.
The methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs, and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered.
A shortage of folate could result in a greater chance of a baby having a neural tube defect such as cleft lip and palate, or even spina bifida or other neural tube defects. If you have had medical management followed by surgery, you can start taking a folic acid supplement again once your doctors have confirmed that all of the pregnancy has resolved.
This is particularly important if you have been having blood tests to check hCG levels after your surgery. You can start to try to conceive again 12 weeks after the date that the methotrexate was administered. The NHS website has more information on vitamins, supplements, and nutrition during pregnancy.
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