[bd711]

Hi. We're in ectopic limbo, and I think I'm going mad. I've been convinced that there's a problem for 3 weeks now, and I'm befuddled at why my doctor isn't more concerned. We knew that there might be a problem when we got a "low positive" Beta HCG (21) 3 weeks ago after an otherwise uneventful IVF round. While my HCG levels doubled nicely at first, I had lots of brown, strange discharge, and I've had 2 separate days of full-on bleeding. At the same time, my HCG levels went UP, then DOWN, then back UP, and they've plateau'd between 650 and 750 for over a week. Nothing is showing up on an ultrasound.

It seems from everything I've read from this site and others, it's mighty likely that I have an ectopic pregnancy. But my doctor is having me do a d&c tomorrow and then repeat the HCG in a couple of days. At the same time, she's telling me that if I have ANY symptoms of an ectopic to go straight to the ER.

Although I appreciate her not jumping straight to methotrexate, I'm also concerned that waiting raises my risk that any ectopic pregnancy will rupture. Have others done a d&c as part of the process of dealing with a possible ectopic? Has it been helpful for anyone catching an ectopic before it ruptured?

Thanks! B

[jencat215]

Hi B-

I too had started with a low beta back in May that doubled very nicely for almost 2 weeks. I had a u/s scheduled for about 6 and a half weeks, but the night before I was at a concert and started to feel sharp pains on my left side. They were brief, so I just thought it was ligament pain. Then when I got home I couldn't sleep and finally at 3am the pain was so intense that I had DH take me to the ER.
(an aside: my last beta had been 355. At the ER I was now over 3000 and should have been 2x that). Anyway, they did a u/s and the stupid tech thought she saw something in my uterus, then the ER Dr. sent me home telling me that I had constipation. He told me to go to my RE appointment (in 7 hours), but tell them not to do a u/s because I already had one. Well, my RE wasn't stupid and did one and all they found in my uterus was blood. No sac. So they gave me methotrexate. The next day, the worst of my life, I almost died when my ectopic ruptured. Luckily DH took the day off with me. I was rushed to the hospital for emergency surgery. I had to have a transfusion since I had lost so much blood. When the paramedics came to get me (DH called 911) they could barely get a pulse. I was fortunate in many ways that day...to have my DH home and have him with me, noticing when I passed out, to have quick acting 911 response, and to have a wonderful ob/gyn do my surgery.

Anyway, if an ectopic is suspected, there is no reason to wait. A D&C won't solve that problem since they don't clean out the tubes. And even if you do get the metho shot, make sure you go back in a couple of days to make sure your beta starts dropping. I had my shot on a Monday and they wanted me to come back for a beta on Friday. I didn't make it (rupture was on Tuesday).

Oh, I had NO bleeding. A little spotting on my first beta day (my progesterone was low...they gave me supplements and the spotting only lasted 2 days).

Another reference for you. I got my first beta on CD30. My ectopic ruptured CD49...2 and a half weeks later. I tell you all of this not to scare you, but to make you aware. I would never wish that hell on anyone.
I am sorry this is happening to you. I wish you the best. Keep us informed on what you decide to do.

[bd711]

Thanks so much for your reply and advice. I think I read your story on another post, and it's one of the stories that leaves me completely befuddled about my dr's lack of panic. One of my biggest frustrations with this is that I'm convinced that the only reason the drs offices (my ob/gyn and the fertility center) didn't do anything about this last week is that everyone was off enjoying Thanksgiving. Aargh.

The dr. knows that the d&c won't do anything about an ectopic, but she apparently thinks that this could be a strange-acting uterine pregnancy (non-viable, of course). It just seems SO unlikely. Let's hope she's right...

[Kay]

BD711,
I am so sorry you are going through this!! I can relate to your pain. I lost a baby at 6.5 weeks due to ectopic. I too had low first Beta, but then it doubled and we thought all was well. I also spotted, but was told not to worry that it was quite common in early pregnancy. I was scheduled for a rutine u/s when they found no pregnancy in the uterus. They were able to see the baby in my left tube. It was heartbreaking... we could clearly see the baby with a heartbeat. I had surgery that night to remove the baby and a portion on my tube. I had no pain prior to this finding. My doctor informed me I was about two days away from rupture. Please be aggressive with your doctor about this. See if an U/S shows the baby in the tube. If there isn't a pg in the uterus really insist they address the ectopic issue. This is nothing to ignore or dismiss. I think because this is a somewhat rare occurance dr aren't too concerned, but the more I look into this the more I see ectopic is a risk with IVF.
I hope all of this is resolved for you very quickly. Again, I am sorry you have to deal with this.
Kay

[jenedens6102]

My OB did not want to do the D&C. First of all he knew that we'd been struggling with infertility for quite some time and a D&C can cause some scar tissue damage, not always but sometimes. He didn't want to risk doing any damage that wasn't necessary. With no signs of pregnancy in my uterus he didn't want to risk a surgery that mgiht not end up being the end of our loss. He was afraid of not finding anything in the uterine tissue and still having to do the methotrexate injection. I'm really sorry to hear that you are having to deal with this and so sorry to hear of your loss. I hope that between you and your doctor you guys can make the best decision for your health.

[rhart]

I had a D&C to make sure that I didn't have an abnormally developing uterine pregnancy. When they didn't find anything there, they moved on to my tube. I had already gone through two rounds of methotrexate by that point and my betas were still creeping up. If you don't think your doctor is handeling you well, go to another doctor.

[Aries]

My beta levels too were going up and down and my RE immediately gave me 1 shot of metho.Ofcourse they didn't fall fast enough so he gave me another one.Even then the beta was still around 500 I went in for laproscopy and had my left tube removed.I'm not sure how D&C will work if it's stuck in the tube but I'm sure your RE knows.And I had no bleeding at all.
GL hon..

[bd711]

Thanks all for your input. The D&C went fine, but the repeat betas showed that whatever was growing was, in fact, not in my uterus. My doctor was not surprised, though she had still thought it was possible that there could have been a uterine pregnancy gone bad. Now we know that's not the case. Today I got a shot (well, two) of methotrexate. I'm sad and weary - but I guess there's some relief in just knowing for sure that it's ectopic and we're dealing with it. Again, thanks all for your thoughts.

[jenedens6102]

Sorry to hear that the D&C wasn't the answer. I only got one dose of methotrexate but was told that if the levels didn't drop appropriately within the first 72 hours that I'd need another one. I hope you don't have any major side effects from the injection. The only thing I experienced was some hair loss. I hope that you are able to heal up and prepare for your next cycle in a few months. I'm so sorry again for your loss.