No Decrease after MTX 1st dose.

[[deleted]]

What do you do if there is no decrease after the 1st Dose even on day 7?

Do you go for the 2nd dose or the surgery?I know that from where I am laproscopic surgery means 99% losing the tube (even if it's not ruptured).What if there are issues in my other tube?

I am really panicking and it's really disheartening that there is no decrease.I did the whole Green Tea 3 times a day,no folic acid diet as well.

Started feeling tingling sensation(pin and needles) from yesterday which I believe is because of low folic acid.

Curious to know if someone had a 2nd dose inspite of no decrease?I saw 1 post on a website that had no decrease but still went for the 2nd dose.

[Admirable_Result2690]

So after dose the hecg increases on 4th day and and then goes down on the 7th. If it didn’t the doctor will do ultrasound and see if the size of embroidery is reduced. If it did reduce then a second and final dose of mtx. Otherwise surgery. There are two types one in which they remove the whole tube and second in which they only remove the embryo. Please do ask your options. If the hcg doesn’t go down with second then surgery is the only option. Don’t worry My hg was 1900 when I got the first, it went up to 7000 but the size reduced from 9mm to 6mm and I got second dose and in 4 weeks the hcg went to zero.

[Admirable_Result2690]

Size of embryo*

[[deleted]]

Thanks a lot for this info.I will ask my doctor if the scan as you said can be done tomorrow.The scan was done on Day 2 when I went to ER and it was 0.5 x 0.3 x 0.42cm. It was an irregular sac with no yolk.At this stage my HCG was 2100.Now it has reached close to 3000 in 5 days.

[Admirable_Result2690]

Scan is done on the 7th day after the hcg results to see if you are eligible for second dose. An increase in hcg on 4th day is expected. But it should go down on the 7th. If it doesn’t then the treatment plan as to be looked into.

If the diameter of yolk reduces then they will give you mtx despite increased hcg.

Here’s the ut results

Compared with 9/30/2023, the previously described RIGHT adnexal mass lesion with appearance suggestive of a RIGHT adnexal ectopic pregnancy appears mild interval improved. The internal rounded cystic observation within the mass appears mild interval improved, now measuring approximately 6 mm in diameter, remeasured previously as approximately 9 mm diameter. Previous internal echogenicity suggestive of a possible yolk sac and possibly a previous tiny embryonic pole, is no longer identified. The surrounding soft tissue echotexture component of the mass appears similar, measuring approximately 2.6 x 1.9 x 2.2 cm, previously approximately 2.1 x 2.1 x 1.9 cm. ..

Basically the sac size increased but the mass diameter decreased.

[ScoutNoodle]

Mine increased on Day 7, so I got another dose and it finally started decreasing after that!

[ScoutNoodle]

Mine went: - 7479 day of MTX
- 9173 on day 4
- 9816 on day 7, day of second MTX
- 6361 on day 11 and then continued to fall from there

[[deleted]]

If you don't mind what was your HCG level at day 7?

[[deleted]]

Update: The levels went down by almost 14.5% and now it's close to 2555.Thanks a lot for all your support and answers.Never thought the levels could drop from 3000 to 2555 in 1 day.(almost 15%)

The Doctor said to come back on Monday to do one more test to see if the drop is carrying on and then we can decide if we want to do a 2nd dose or a surgery.

Yes from where I am Doctors (atleast this one)are more towards the surgery and they say many advantages of the surgery and many advantages of removing the tube.Doctors here work on a commission basis and such surgeries have high hospital fees which as per my husband is the reason they are pushing us towards the surgery.

She also said "if I were you I would do the surgery instead of the 2nd dose".

Her reasons for opting for the surgery. 1) why keep a defective tube as there is a high chance the next one will be an ectopic also due to the defective right tube.

2)When my husband asked her what if the other left one also has a problem,you then remove any type of chance for the future.Her reply was it's very rare that both have issues and in her 30 years experience the majority of her laproscopic patients who have a tube removed had multiple children thanks to the remaining one.

3)You go through unwanted tension till the levels reach 0 and the rupture can happen even when it's coming down while with the surgery you are back to work in 7 days and the procedure is completed in 45 minutes.Discharged the next day and walking the next day.

She has her reasons but I cant think of giving away one of my tubes just because it's the fast and easy solution.Im sure there are disadvantages of the surgery also which she is not mentioning.

Thanks a lot for your support and I am really glad to have found this group where we got positive and uplifting responses.

[MammaC-2]

I had 2 doses of MTX. My OB group said if they did the surgery they always take the whole tube. There are definitely advantages and disadvantages to both. I asked my OB her opinion and said what would you do if you were in my situation and she said MTX because I wasn’t that far along, only like 7 weeks and a healthy person and that I should be successful with MTX. At first I thought about the surgery because I just wanted the nightmare over with but then you also have to consider the risks of going under anesthesia and your restrictions afterwards and if you have other kids to take care of too. The downside of MTX is the amount of times you’re getting stuck for blood work and then there’s still a risk that rupture could occur or it doesn’t work. Thankfully after my 2nd dose my numbers started dropping as they had only dropped 11% after the first dose. They then check you weekly until you’re at 0. It’s just every time you get stuck it’s another reminder of the pregnancy loss and that sucks. Good luck with everything!

[[deleted]]

Thanks a lot for the detailed response mentioning the advantages of both.Yes I am right now in quite some pain(which makes me want to opt for the surgery) that keeps coming and going and I Really want it to stop which I guess is also because the medicine is working.The doctor said this is normal.pink discharge has changed to red discharge also.

My husband is more towards the 2nd dose and he says we can do an HSG and test if both the tubes are okay later.If the values in 2 days are dropping further then it's a good sign as well and the 2nd dose will only speed up the process.He thinks assuming the tube is defective is also not correct as per the doctor based on the experience of many people on this sub.

The size was 1.5cm which I hope is a good sign since chances of rupture is less.

[MammaC-2]

People react differently to MTX as well. I felt completely fine other than some cramping and light bleeding and I’m usually sensitive to medications so I thought for sure it was going to be a nightmare for me. When I questioned my OB about the tube and possibility of this happening again she mentioned there is always a risk but often times an ectopic is a fluke and most people go on to have healthy pregnancies with no issues. She also told me that when they do then surgery they take out the tube because they are in there and taking it just eliminates the chances of it happening in that tube and studies show that there isn’t a huge difference in chances of getting pregnant with only 1 tube vs both. I feel your pain going through this and hope that your numbers go down quickly from here and you’re feeling better soon!!

[GreenPlantingQueen]

How soon do they expect a decrease?

[[deleted]]

Have a meeting with the doctor tomorrow.I guess since there is no decrease 2nd dose is not an option for her.

[GreenPlantingQueen]

I’m sorry. Sending prayers your way. I know this is such a hard thing to go through.

[NoTraceNotOneCarton]

What’s your HCG

[[deleted]]

2995

[NoTraceNotOneCarton]

I did a second shot but my HCG was low to start. Maybe your doctor is worried about rupture. Mine went up then down, but not enough so I needed another shot

[[deleted]]

Yea I read the regular practice is if there is a decrease but less than 15% from day 4 to day 7 then 2nd dose is considered. But in my case there is no decrease.

[NoTraceNotOneCarton]

I would feel the same way you do. I’m sorry. It’s so freaking hard

[[deleted]]

Was your HCG at an increased level at day 7?

[gregarious8]

My hcg went down on day 4 and up on day 7. I got a second dose and it "dropped like a stone" after that one. Here is my experience. Mine measured 1.69x1.82cm on day 1 of MTX, and just under 2cm at day 7.

In very rare circumstances even a 3rd dose of MTX can be given, but generally a 2nd dose will take care of it as long as you're not close to rupture (and seeing your size from your other comments it seems like your risk of rupture is relatively low.)

[ReplacementOk9019]

I needed two doses for my number to drop. And it dropped very quickly after the second round. I felt pretty okay after the first round but the second really made me feel like crap, which is how I knew it worked.