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Methotrexate - worth it or just have a D&C?
15 replies to this topic
Posted 28 November 2011 - 09:12 AM
Hi all, a quick history - I had a m/c about 5 weeks ago, thought it had completed naturally but found out about 2 weeks ago there's some tissue left. Decided to wait for my period rather than methotrexate or D&C but I'm going back to my OB this afternoon to get something else sorted as my periods still haven't come and won't because hcg still up. About 2 weeks ago still up at 809.
So my OB mentioned methotrexate or D&C as other options and I know he'll offer the same today but I'm not sure about having the MT??
What are your experiences with it? Did you have to have a D&C anyway or did it work? And does it affect your ability or time to start trying again?
I know I'll go through this with my OB but would love to hear from women who have actually gone through it.
Posted 28 November 2011 - 09:15 AM
I had a d+c. I figured if the methotrexate didn't work, I would need a d+c anyway and I just wanted it all over. Methotrexate is not a nice drug either. D+C''s are not without risks of course.
It's really a personal decision.
Posted 28 November 2011 - 10:55 AM
I had mtx but because it was a choice between that or surgery for management of an ectopic. I'm trying for my first and am 36 so was keen to try and hold on to both my fallopian tubes for as long as possible. The specialists thought I was a good candidate for both so it ended up being a personal decision.
I ended up needing 2 doses of mtx. I've also had a D&C for a second pregnancy.
Issues to consider:
- LONG follow up going the drug route as you need to keep testing for blood hcg levels until they are zero, took me 2 mtx shots and 3 months.....
- months of ongoing bleeding, never that heavy for me, but there for weeks.
- there are SE to mtx as PP mentioned. I got off pretty lightly but coupled with hormone changes, the shock of my first pregnancy being an ecoptic (little did I know things would only get worse)made it a pretty horrible time. I took a few days off work here and there mainly because of my emotions rather than drug SE.
- on the other hand, D&C was quick and I tolerated the GA well. Was physically okay the next day. Very little bleeding but this may vary in your situation
- I think you need to wait 3 cycles before TTC after mtx, I was told 1 cycle after D&C.
Posted 28 November 2011 - 12:00 PM
Thank you both so much for your replies. Wow mtx does sound pretty horrible and the follow up puts me off too. I've felt like a pin cushion for the last couple of months and the cost has been huge. So the idea of having continual blood tests just freaks me out.
I think I'll request the D&C then. It will give me certainty and no horrible aftermath to have to deal with. Hopefully my OB has no objections. It's my body at the end of the day so I need to do what feels right for me.
Posted 28 November 2011 - 12:15 PM
Hi OP. Sorry about your mc.
I had about 30 shots of methotrexate (over about 3-4 months) for a persistent molar pregnancy last year, and whilst the side effects can be unpleasant, they don't tend to be too bad for the first few shots. They really ramp up if you're on it for an ongoing period, although, they don't necessarily affect everyone.
The one thing that I would check with your OB is (if you're wanting to TTC) is if it will restrict you from doing so for a period of time. I wasn't allowed to TTC for 12 months after my last shot, due to the need to monitor my hcg levels over that time. But you might want to check whether it will affect your eggs in the short term.
Posted 29 November 2011 - 12:02 AM
dont use methotextrate I had it for a ectopic m/c was not told the full side effects from this drug fell pg 5 mths later my daughter was s/b at 21 weeks due to NTD anencepahly.. I fully beleive the use of methotextrate significantly dropped my folic acid levels causing my daughters NTD, after we had katy the hospital said I should have been on high dose folic acid and not TTC for a full 12 mths I was told 3 mths and no mention of folic acid
I sam not trying to scare you just want you to be aware of what can happen
Posted 29 November 2011 - 09:38 AM
How are you going?
Just to update on my current situation, it looks like I have retained products as well. US today showed no ectopic. I'm having repeat bloods tomorrow but as it is unlikely to be a viable pregnancy, I will be looking at a D&C tomorrow afternoon.
Posted 29 November 2011 - 02:28 PM
Hi aussierach, thank you for your advice and no you didn't scare me. I'm so sorry you had to go through that, especially when it could have been prevented so easily.
Hi porkchop's mama - I'm going well thanks. I'm so sorry to hear you are also going through this Saw my OB yesterday and now that I have a bit more information I'm not having a D&C. My ob told me that the tissue will shrink and come away, hence why he said I'd get my periods. Obviously he can't tell me a date when this will happen but he said it will happen. I also had another blood test to see what my hcg levels are and also testing for progestrone (sp?) to see if I'm mid cycle, and therefore periods on their way.
If the levels are still high and I'm not mid cycle I can choose to take a drug, but not mtx, instead one called misoprostol I think it's called. It's basically tablets taken over the course of 24 hrs which makes your uterus contract. I've done a bit of research on it and together with what my ob said yesterday, it's used to medically treat an incomplete miscarriage, rather than having surgical treatment. He pretty much implied that going to theatre for a bit of tissue so small is a little excessive considering my body will get rid of it naturally anyway. Obviously there's a small chance it won't come away in which case a D&C would be a last resort.
So now I'm tossing up between letting my body do what it will naturally anyway, or take some drugs to speed the process up??? I think it will all hinge on what my blood test results are. Hopefully I'll get them this afternoon or tomorrow morning at the latest.
Posted 29 November 2011 - 02:36 PM
In your situation I would go the D&C I have fallen pregnant twice now after a D&C (due to mc) and I think it does also freshen things up and give you a better chance of TTC and staying pregannt.
Ive heard that your super fertile after a D&C and for me I have been.
Edited by Mummy Duck, 29 November 2011 - 02:41 PM.
Posted 29 November 2011 - 02:39 PM
Hello, I recently had a miscarriage and when deciding what to do I was told the misoprostol is not very successful if you are not already bleeding. So I went with the D&C, but I realise that is not an option for you and the situation is different. Just some information I was given.
Good luck I hope it works... plus hope that the super fertile business is true...
Posted 30 November 2011 - 08:30 AM
Well I got my blood test results yesterday and hcg still high at 715, so haven't even dropped by 100 in 12 days or even halved in 4 1/2 weeks and progesterone only 7 so definitely not mid cycle.
Therefore I've decided to give the misoprostol a go. Worse case scenario if it doesn't work I can always have a D&C but my ob is pretty confident that given my circumstances it will be successful. I guess I may as well try this first, it's been going on so long now, another week or so won't really make much difference. I think I'll start the dose Thursday night, that way my DH will be home with me as Friday I'll be home with DS and would prefer the worst of it to be over before then. So my fingers are crossed that it won't be too bad, considering the tissue is soooo small there's not a lot to expel.
How are you going porkchop's mama? Are you having your D&C today?
Posted 30 November 2011 - 08:35 AM
I had misoprostol last december for a missed misscarriage. While there is a big list of side effects I found that it worked well for me, with pain no worse than stong period pain and manageable bleeding.
I was pregnant again within 2 cycles and had an uneventful pregnancy and now have a healthy baby boy.
Good luck with it.
Edited by Crombek, 30 November 2011 - 08:38 AM.
Posted 30 November 2011 - 01:14 PM
Thanks wallofdodo and crombek - picked up my prescription so will take the first dose tomorrow afternoon.
And crombek it was so nice to hear a positive story. When searching on the net etc all you ever seem to read are the negative stories so it was very comforting to hear you had a positive story and that it worked well for you Oh and were you told you didn't have to wait at all before trying again? Obviously you fell 2nd cycle after but were you told to wait the first cycle or not? And did you try that first cycle? My ob said there's no reason to wait after taking misoprostol so would be interested to hear what you were told.
Posted 01 December 2011 - 01:27 PM
andrea79 - no, I didn't end up needing one. Phew. hcg went down a little. I have a break from blood tests for a week and then hopefully only one more to go.
Hope all is well with you and hope that your treatment goes as well as it can.
Posted 01 December 2011 - 02:55 PM
Hi PCM, oh that's a relief for you and always nice to have a break from blood tests. They get a bit much sometimes. I've finally reached the Medicare safety net after all of my tests and scans so it's nice to know the next couple I pay for I'll get nearly everything back.
Well some exciting news from me, about and hour before going and getting my tablets, I started spotting!! I couldn't believe it so just letting it happen naturally and fingers crossed it's all smooth sailing from here.
Looks like a good ending after a rough time for both of us
Oh and PP's, yes you are very fertile after a m/c, not just a D&C, so that's one positive I guess to take away from an overly negative experience. From a study I read it's the first 2-3 months afterwards.
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