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Understanding Tubal Pregnancy and Ectopic hCG Levels

I am a mother of two who has gone through the experience a tubal pregnancy.

Human Chorionic Gonadotropin in Pregnancy

Human chorionic gonadotropin (hCG) is produced by an embryo once implantation has occurred. In a healthy pregnancy, the embryo implants in the uterus and the developing placenta causes hCG levels to rise. One to two weeks after conception (3-4 weeks of pregnancy, as dated from the last menstrual period), the hCG levels will be high enough to trigger a positive result on a home pregnancy test. According to the American Pregnancy Association, hCG levels will double every 48-72 hours during early pregnancy. They will typically peak between week eight and 11.

hCG levels can be monitored through a blood test. Quantitative beta hCG levels are determined every 48 hours to monitor pregnancies that are considered high risk. If the levels do not increase at the expected rate, the pregnancy is considered threatened. Slow rising hCG levels may indicate a non-viable intrauterine pregnancy, or may indicate an ectopic pregnancy has occurred. You can read this article that examines more insight and research into non-doubling hCG levels.

Ectopic Pregnancies

What Is an Ectopic Pregnancy?

When an egg is fertilized and implants in any location other than the uterus, the pregnancy is considered ectopic. "An ectopic pregnancy accounts for 1-2% of all pregnancies," says Dr. Tami Prince, an OBGYN at the Women's Health and Wellness Center of Georgia in Greensboro, Georgia. "They represent 2.7% of all pregnancy-related deaths according to the CDC and ACOG. 90% of ectopic pregnancies occur in the Fallopian tubes." Other times, a pregnancy may implant in the abdomen, in an ovary, or on the cervix—these cases are much rarer than a tubal pregnancy.

Spotting, cramping, and abdominal pain are often noted by the pregnant mother. If the pregnancy is far enough along, the ectopic pregnancy may be seen via a transvaginal ultrasound.

Can a baby survive an ectopic pregnancy?

When a pregnancy implants in a location outside the womb, the placenta cannot form normally and the hCG levels will not rise appropriately. The fetus does not get the necessary support it needs to develop. The embryo will rupture long before the fetus is viable.

What Does an Ectopic Pregnancy Feel Like?

According to New Kids-Center, here are some symptoms that you may feel if you are experiencing an ectopic pregnancy.

  • A mild to severe pain on the side of your pelvis. This pain may appear suddenly or gradually.
  • Vaginal bleeding that may seem different in color to menstrual bleeding. It may be more watery as well.
  • Painful bowel movements or even diarrhea.
  • Pain in your shoulder that increases when you lay down. This could possibly be internal bleeding that is irritating your organs.
  • Fainting. This is related to internal bleeding.
  • Heavy sweating.
  • Shortness of breath and/or rapid heartbeat.

Tubal Pregnancy

When an embryo implants in the Fallopian tube, the pregnancy is not viable and threatens the life of the mother.

When an embryo implants in the Fallopian tube, the pregnancy is not viable and threatens the life of the mother.

hCG Calculator

Do you want to know how quickly your hCG levels are increasing? Try this hCG calculator.

This calculator will determine your doubling time and compare it to the average.

Slow Rising hCG Levels

In some healthy pregnancies, the beta hCG level does not double every 48 hours. However, this is not necessarily a cause for concern. Many women have had low hCG levels and have gone on to have healthy pregnancies. According to Dr. Amos Grunebaum, an OBGYN at Cornell Weill Medical College, you should not put too much stock in having hCG levels determine the viability of a pregnancy. With that said, there should still be some monitoring. A drop in hCG levels ranging around 36% and more could indicate a miscarriage or ectopic pregnancy.

In addition, once hCG levels reach 6,000, the rate of increase begins to slow in all pregnancies. Late in the first trimester, hormone levels begin to plateau—the hCG level may even decrease a bit in the early part of the second trimester to a new, stable level that will be maintained until the pregnancy is complete.

Can a blood test detect an ectopic pregnancy?

A blood test merely gives a reading on hCG levels. A single quantitative hormone level is not useful for the diagnosis of an ectopic pregnancy. Serial measurements must be taken over time to determine how likely a pregnancy is to proceed.

Quantitative beta hCG levels are not diagnostic for an ectopic pregnancy. These levels are simply part of a larger clinical picture – the diagnosis of an ectopic pregnancy includes the evaluation of hCG levels in addition to ultrasonography and a physical exam. If the pregnancy can be visualized in a Fallopian tube (or elsewhere), the ectopic is confirmed. If the pregnancy cannot be visualized at all, the pregnancy might be ectopic, depending on the hCG levels. If the hCG levels are above 1,800 and the embryo cannot be visualized in the womb, the suspicion for an ectopic pregnancy increases dramatically.

Normal vs. Slow Rising hCG

Starting with an hCG level of 160, this graph depicts a doubling beta hCG (blue line) vs. a hormone level rising by only 66% every 48 hours. Pregnancies with hCG levels rising slower than 66% typically fail, or are ectopic.

Starting with an hCG level of 160, this graph depicts a doubling beta hCG (blue line) vs. a hormone level rising by only 66% every 48 hours. Pregnancies with hCG levels rising slower than 66% typically fail, or are ectopic.

Ultrasound Diagnosis of Ectopic Pregnancy

Tubal Pregnancy Diagnosis

Many women suspect a problem early in pregnancy, as spotting and cramping or abdominal pain are often present. In some tubal pregnancies, there are no early warning signs, and the first sign of trouble may be a ruptured Fallopian tube.

If spotting and cramping are observed, a woman should call her physician immediately. A workup will generally be ordered, including beta hCG levels and ultrasound examinations to determine the location and viability of the pregnancy. If the hormone levels are rising less than 66% over a 48 hour period, an ectopic pregnancy will be suspected.

If the hCG levels are low (less than 1,800), the pregnancy may not be visible on the ultrasound machine. In this case, a woman is often presented with a choice to wait and monitor the pregnancy until it can be observed, or to have a procedure called a Dilation and Curettage (D&C) to determine if there is any pregnancy tissue is in the womb. If there is no tissue in the womb, the pregnancy is determined to be ectopic. This method of determining the location of the failing pregnancy is not preferred, as there is a chance that there is an intrauterine pregnancy, and a D&C will end the pregnancy. If this method is used, and a pregnancy is not found in the womb, the ectopic pregnancy may be treated with methotrexate. Methotrexate is injected and is often successful at ending an ectopic pregnancy without surgery.

If the hormone levels are over 1,800 and the pregnancy can be visualized in a Fallopian tube, the diagnosis is certain and treatment will be scheduled immediately (by methotrexate injection if the pregnancy is in a very early stage, or by removal of the pregnancy and Fallopian tube).

How Long Does It Take for an Ectopic Pregnancy to Rupture?

According to Dr. Antonette Dulay, a perinatologist at Main Line Health in Philadelphia, Pennsylvania, an ectopic pregnancy can rupture anytime between six and 16 weeks. The bleeding after the rupture can be very severe and life-threatening. The longer it takes for a rupture to occur, the more at risk the mother is of a life-threatening occurrance.

Symptoms of an Ectopic Pregnancy

Treatment with Methotrexate

If a tubal pregnancy is an early stage, it may be treated medically (as opposed to surgically). Methotrexate is successful at treating tubal pregnancies when:

  • beta hCG levels of 5,000 or less.
  • No cardiac activity of the embryo is observed.
  • The Fallopian tube is not ruptured or torn.

According to the University of Michigan, methotrexate works by preventing cell division and growth. The embryo breaks down and is passed from the Fallopian tube. If methotrexate is the chosen treatment option, hCG levels will be monitored on a regular basis until they have returned to 0.

"Methotrexate can be given as a single-dose regimen, two-dose regimen, and fixed multiple-dose regimen," says Dr. Prince. "The choice of regimen is guided by the initial hCG levels and discussions with the patient about the risks and benefits of the medication. There are similar success rates for both the single-dose and multiple-dose regimens. The latter is associated with an increased risk for adverse effects." According to Dr. Prince, these side effects include diarrhea, nausea, vomiting, dizziness, and stomatitis. "These side effects are directly related to the fact that methotrexate stops rapidly dividing cells in the body. This includes the linings of the stomach, bowel, and mouth."

According to Dr. Prince, here are some things that should be avoided during treatment.

  • Exercise.
  • Alcohol.
  • Sexual intercourse.
  • Medications, foods, or vitamins that contain folic acid. Prenatal vitamins and folic acid supplements should be discontinued during treatment.
  • Exposure to sunlight.
  • Non-steroidal anti-inflammatory (NSAIDS) medications such as Ibuprofen, Aleve, or Advil as they may interfere with methotrexate.
  • Medications and gas-producing foods that may either mask pain or be confused with worsening symptoms.

If the hormone levels begin to drop after the treatment is started, blood tests will be performed weekly until the hCG cannot be detected. This may take anywhere from 1-3 months to occur. "Two rounds of methotrexate are generally given before surgical intervention," says Dr. Prince.

Surgical Treatment for Ectopic Pregnancies

If medical treatment for an ectopic pregnancy fails, or if the tube ruptures or tears, surgical treatment will be required.

According to research from Dr. Vanitha Sivalingam, ectopic pregnancies are the leading cause of first trimester deaths in pregnant women. Between 1980 and 2007, there were 876 maternal deaths in the U.S. related to the condition. A ruptured ectopic pregnancy is a medical emergency and must be treated immediately to save the mother's life. An ultrasound examination will generally show a significant amount of "free fluid" in the abdomen, indicating internal bleeding due to the ruptured Fallopian tube. A salpingectomy (removal of the Fallopian tube) is generally performed to remove the pregnancy and to stop internal bleeding. In some cases, the pregnancy is removed without the removal of the entire Fallopian tube - this procedure is called a salpingostomy.

Both types of surgery may be performed through tiny incisions (laparascopic surgery), though they may sometimes require a larger incision (laparotomy).

hCG levels may be monitored by a physician until the hormone level falls to undetectable levels.

Fertility After Ectopic Pregnancy

If a Fallopian tube is removed via salpingectomy and the other tube is healthy, many women will be able to conceive again. According to the American Pregnancy Association, there is roughly a 60% chance of a successful pregnancy if the Fallopian tube has been left in place.

If, however, the other tube is also affected by scar tissue or other abnormalities, fertility will be significantly impacted. Fertility treatments such as in-vitro fertilization (IVF) may be required to conceive in this scenario.

After a woman has experienced a tubal pregnancy, however, she is at an increased risk for having another ectopic pregnancy. Approximately 10-15% of women with a prior ectopic pregnancy will experience another. For this reason, all future pregnancies must be monitored with beta hCG levels and early utlrasound examinations may be performed to verify the location of the embryo. You can read this personal account of a successful pregnancy following an ectopic pregnancy.

The Author's Experience with a Tubal Pregnancy

I was approximately 5 weeks pregnant and had frequent spotting, so beta hCG levels were ordered by my obstetrician. My first result showed a level of 1,411. Two days later, a repeat blood draw indicated the level had only risen to 1,629. Three days later (over a weekend), the levels rose to 2,100. While the levels were increasing, they were rising so slowly that the pregnancy was considered a failure. I was offered a D&C, but refused since we couldn't visualize the pregnancy via ultrasound. A few days later, I woke to severe pain and rushed to the emergency room - the pregnancy was ectopic and had ruptured. I was bleeding internally and my blood pressure was dropping. I had emergency surgery to remove the Fallopian tube and pregnancy. The physical recovery took approximately one week, and I was told my other tube was not scarred, which improves our chances for conceiving again.

Sources

  • Dulay, A. T. Ectopic Pregnancy. From Merck Manual.
  • Ectopic Pregnancy: Symptoms, Causes, Risks and Treatment. From American Pregnancy Association.
  • Grunebaum, A. Normal hCG Levels In Early Pregnancy. From BabyMed.
  • Human Chorionic Gonadotropin (HCG): The Pregnancy Hormone. From American Pregnancy Association.
  • Methotrexate for Ectopic Pregnancy. From Michigan Medicine.
  • Sivalingam, V. N., Duncan, W. C., Kirk, E., Shephard, L. A., & Horne, A. W. (2011). Diagnosis and management of ectopic pregnancy. The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists, 37(4), 231–240.
  • What Does an Ectopic Pregnancy Feel Like? From New Kids-Center.

Tubal Pregnancy Treatment Poll

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: I had an ectopic pregnancy, but after having a single methotrexate shot, my hCG level dropped to normal. I am still having a little bit of pain in my right Fallopian tube, which had the pregnancy. Is this normal or is something wrong?

Answer: In general, pain is a signal that something is not well in your body. You should seek medical attention from your physician immediately to verify the ectopic pregnancy fully resolved and no other medical conditions exist.

Question: I did in-vitro fertilization with four embryos. The ultrasound was empty at six weeks, and the hCG level was 500. The hCG level then went up, then down to 90 and it's now at 500. Is this indicative of an ectopic pregnancy?

Answer: Your physician should order additional hCG tests and monitoring. There are several possibilities for your particular situation that could cause fluctuating hCG levels. With a lack of visualization of the pregnancy on an ultrasound, I would consult your physician immediately with any questions regarding the potential for a chemical pregnancy or ectopic implantation.

Question: I had ectopic pregnancy surgery 5 weeks ago and my hcg level today is 7. Does that mean my HCG hormone levels have taken a long time to drop?

Answer: An HCG level of 7 is extremely low, but is still "present" and should be monitored by your physician. I would request a follow-up appointment with your doctor to ensure you are monitored appropriately.

Question: After having an ectopic pregnancy, is it possible for your hCG levels to rise slowly in a subsequent pregnancy because of the methotrexate?

Answer: If the first pregnancy had fully resolved and a second pregnancy happens after the methotrexate therapy had been completed, it is unlikely that a slow rise in hCG levels is due to the methotrexate. Methotrexate has an elimination half-life of 3 to 10 hours. In less than three days (after stopping treatment), the methotrexate should be completely cleared from your system. If hCG levels are rising slowly for a subsequent pregnancy, you should see a physician immediately as a second ectopic pregnancy is possible.

Question: I went to the ER with sharp pains in my left pelvic side a week after getting the shot. The mass had slightly increased and there were small pockets of fluid (slightly more than the previous week). I was admitted. The next day my hemoglobin had started to increase, pain was better, no change in my ultrasound, and HCG had dropped to 98. I have been on bed rest with limited walking for the week. Is it possible for the mass to still be there even if my HCG levels drop back to 0?

Answer: The only way to verify the mass is no longer there is to make a follow-up appointment with your physician and to request an ultrasound. If your HCG levels are currently at 0, then the tubal pregnancy is not progressing. As always, you should continue to follow up with your doctor to ensure the treatment has been successful.

Question: I found out I was pregnant on 7/1. On 7/3 HCG level was 1,300, on 7/5 it was 1,900, and on 7/10 it was 2,005. My OB wants to do another HCG test on 7/12 and depending on the numbers, they want to give me methotrexate. They can't see a gestational sac, the baby, or heartbeat. My 7/5 ultrasound put me at five weeks, but today's ultrasound puts me at five weeks and two days. I'm terrified I'm going to bleed to death if it is tubal. Do I have cause for serious concern?

Answer: I am glad you are under the care of a physician. I had very similar HCG numbers in my first tubal pregnancy, and the OB/GYN could not visualize the sac or heartbeat. It was ectopic, and I had emergency surgery after a tubal rupture. You should definitely be closely monitored by your OB, and if you experience pain, you should head to an emergency room without delay. Since you are being monitored and treated appropriately, you are in good hands and should be on the road to recovery very soon.

Question: My wife currently has a tubal pregnancy. Her beta hcg level is 358. How can l solve it?

Answer: She will need to see a physician (OB/GYN) immediately, as an ectopic pregnancy is a life-threatening emergency.

Question: I had an ectopic pregnancy earlier this year, and I just found out I am pregnant again. My first hCG was 378, and two days later the second hCG was 1800. Could this be a sign of another ectopic pregnancy?

Answer: The increase in your hCG levels appears to be normal, so that is a promising sign. Women who have had a prior tubal pregnancy are more likely to experience one in the future, but most women can go on to have a healthy, intra-uterine pregnancy. It is good you are under the care of a physician who will monitor both your beta hCG levels and can (and should) order an early vaginal ultrasound to verify a gestational sac is visualized in the womb. Once the gestational sac is visualized in the uterus, an ectopic pregnancy can be ruled out.

Question: My hCG level was 843 on Wedsnesday morning. Two days later, it increased by only 1. On Sunday, it went up to 889. Since then, a few days have passed, and it is over 1500. I still have a pregnancy of unknown location, but wondering if I'm still at risk of an ectopic. They are doing more blood tests on Thursday. If it has doubled again, can it be an ectopic pregnancy?

Answer: The fact that your hCG doubled from the 23rd of September to the 25th of September is reassuring. It is interesting that your hCG did not double for a few days, but hopefully, your blood test will demonstrate an appropriate rise in level on Thursday. If your hCG continues to double, the chances of an ectopic pregnancy are greatly reduced, and your physician will continue to monitor until the pregnancy can be verified by ultrasound to be intra-uterine.

Question: I just had an ectopic pregnancy. My hCG level was 1100. I will get blood drawn on the 4th and 7th day after my shot. I plan on traveling in two weeks. Will I be safe to travel?

Answer: I would absolutely consult your physician to determine the safety of your travel plans. Since you are undergoing treatment for an ectopic pregnancy, it would be extremely unwise to travel without medical consent as an ectopic pregnancy is a medical emergency. Tubal pregnancies require monitoring until the hCG levels approach zero. As always with medical questions, asking your physician is the most prudent decision.

Question: Suspected heterotopic pregnancy. My HCG levels were: July 6 - 3300; July 11 - 5500; July 14 - 8900; and July 16 - 200. Can HCG drop that quickly?

Answer: That is a very rapid drop-off of HCG levels, and I would consult your physician with any questions about the blood test results. It is possible that the HCG level from an intra-uterine twin was causing the increase in HCG level, and may have become non-viable, causing a dramatic drop in HCG levels. That is a very large decrease in HCG to occur in 2 days, however, so I would ask your attending physician for the reason the level has dropped so dramatically. You may want to have the levels re-tested to rule out a laboratory error. Heterotopic pregnancies are extremely difficult and must be monitored very closely.

Question: My wife's period was supposed to have started yesterday. She took a pregnancy test, and it came out negative. Should she wait two weeks and then take a pregnancy test again? She has had an ectopic pregnancy before. Could you give any advice?

Answer: My advice would be for your wife to contact her physician and ask for a beta hCG blood test. This will show hCG levels down to very low levels, which might not be picked up by a commercially available urine-based pregnancy test. The blood test will let you know if there is a pregnancy. There are many reasons a woman's menstrual cycle may be late. Even if she is not pregnant, she should see her physician to rule out any other medical problems.

Question: Does pregnancy survive the methotrexate shot?

Answer: The methotrexate shot will end the pregnancy by interrupting the metabolism of folate. Ectopic pregnancies are generally confirmed by ultrasound and by monitoring the human chorionic gonadotropin levels prior to the administration of methotrexate, as the treatment is designed to terminate the pregnancy.

Question: I think I'm four weeks and three days pregnant, but my doctor says five weeks. My first hCG was 17; 48 hrs later it was 74; 96 hrs later it was 477. The doctor thinks ectopic; it’s doubling. I had an ultrasound and a visit yesterday. If it’s not at 1000 or higher he wants to give me the injection tomorrow, even without seeing if the baby is in the tube or not. My tubes were clear. I have a history of miscarriages, but I’ve never had an ectopic pregnancy. I’m 41 years old. What do you think?

Answer: Your hCG levels are doubling nicely. Since pregnancy dates are often off, I would be leery of ending a wanted pregnancy if they are not certain it is ectopic and cannot see anything in the tube. Does your doctor state why he thinks it is ectopic? With your hCG levels increasing nicely and nothing visualized in the tubes, I would be more inclined to watch (very carefully) and wait. I have had two ectopic pregnancies, and both had hCG levels that increased very slowly (never doubling). While the first one was never visualized, extra fluid could be seen in the ovarian area. I would, at the very least, seek a second opinion on the matter from a different physician. It is possible it is ectopic, and that is a life-threatening emergency, but since the hormone levels are doubling and there are no visual signs of an ectopic, a second opinion is warranted.

Question: My period is forty-five days late. I have had issues with hormonal imbalance before due to the FP jab, but I got treated and received my period on June 15/18. They later disappeared to date. I have done a home test, and I am not pregnant. I have some white discharge, what could be the issue?

Answer: In this case, I would consult your physician to have additional testing done to determine the cause of your late period and discharge. A medical professional will be able to determine the cause of your late cycle and may be able to suggest an appropriate treatment.

Question: My husband and I tried in-vitro fertilization. Ten days after my embryo transfer I had an HCG level of 45. I was tested again two days later, and my Hcg level was 79. Five days after that my HCG level was 250. Doctors are suggesting an ectopic pregnancy. What do you think? Is it time to terminate this pregnancy or give it more time?

Answer: I am glad you are being followed very carefully by a medical professional. The hCG rise is not rising as fast as would be expected, which is why your physician is concerned. As with all medical conditions, I would follow the advice of your doctor as he or she knows the specifics of your particular case and has access to the information required to make decisions about your healthcare needs. In addition to hCG levels, it might be possible to determine the location of the pregnancy using ultrasound (though the pregnancy must develop to a certain stage to be visualized).

Question: Can you carry a set of twins in your fallopian tubes for four months?

Answer: I cannot find a medical report of twins being carried bilaterally in Fallopian tubes for four months, but there are reports of babies who successfully gestate outside of the womb (usually in the abdomen, not in the Fallopian tubes, which rupture as the embryo grows). In this case, I would say it is highly unlikely for a pair of 20-week old fetuses to survive inside Fallopian tubes.

Question: I took a pregnancy test at home and it was positive. I went to get an abortion, and the testing showed a positive blood hCG pregnancy test, but no sac. I began feeling awful pain in my left side, with light vaginal bleeding. Today the bleeding became heavy, and I felt sleepy and lethargic. I went to the ER two days ago, and the doctors said it was a miscarriage. I feel much worse today. I am so thirsty and feel like I have heavy limbs. This is not right. What do I do?

Answer: You need to return to the emergency room immediately to be seen. They will be able to evaluate you for the possibility of an ectopic pregnancy or other condition that might be causing your symptoms. Once you have been seen and treated at the emergency room, it would be prudent to obtain a regular physician (OB/GYN) who can monitor your health over the long term. If you cannot afford a physician and are in the USA, Planned Parenthood provides free women's health care to those who cannot afford it.

Question: I found out I was pregnant on the 4th of July. My betas were rising properly than fell slightly than rose again. I feel like my doctor made a mistake. My highest HCG level was 56. I was given the methotrexate shot when the tech saw some free fluid around my right tube. I had no symptoms, and feel like they acted in haste. I feel like we should have waited to see what my betas were going to do. How often are viable pregnancies misdiagnosed?

Answer: One way to confirm an ectopic pregnancy is to perform a dilation and curettage (D&C) of the uterus. If fetal tissue is found in the uterus, then the pregnancy is known to be intra-uterine. Since this method would end the pregnancy anyway, it is rarely performed instead before administering methotrexate. Since a D&C is rarely performed after methotrexate is given, it is difficult to estimate the number of false positives from beta hCG tests and ultrasound. A failure of beta hCG to double appropriately generally indicates the pregnancy is not proceeding as expected. Poor hCG numbers in the presence of fluid in the adnexa are highly indicative of an ectopic pregnancy.

While it is stressful to wonder about the "what if" situation (and wonder if the pregnancy might have been typical), the likelihood is overwhelming that your pregnancy was, indeed, ectopic. Some women do choose to wait out the betas, but this is a very risky situation.

In my situation, I did wait out the beta hCG, and the pregnancy was ectopic - my right Fallopian tube ruptured, and I lost a significant amount of blood and required emergency surgery. This is not a recommended course of action as it is extremely dangerous to the mother and there is nothing that can be done to save the ectopic pregnancy.

Question: Can you fly (long haul flight) if hCG has gone from 4000 to 2 with two doses of MTX but the mass remains in the interstitial cornua?

Answer: This question should be asked of your personal physician, who will be able to advise your of your particular health risks with regard to any travel while still in treatment for an ectopic pregnancy. A long haul flight with a residual mass in your cornua is something that should definitely be discussed with a medical professional, even if your hCG level has declined substantially.

Question: My hCG levels are 15904.5. Will the Methotrexate injection help my levels?

Answer: Methotrexate is not typically used with hcg levels that high, but I would consult your physician to determine the best treatment plan for your specific situation. With a more advanced ectopic pregnancy, there is the risk of a tubal rupture due to the size of the growing embryo, and you should be under the care and constant monitoring of a physician. Often, surgery is the recommended treatment plan with high hCG levels or advanced ectopic pregnancies.

Question: What happens when after the first dose of methotrexate the hCG levels drop, but not enough. My doctor applied another injection, but after that, there was suddenly an increase in hCG level. Is this normal?

Answer: An increase in hCG concentraion is not expected after the use of methotrexate, particularly after two doses. There are some cases of ectopic pregnancy that require surgical intervention when methotrexate isn't effective. As with all medical cases, your particular case must be followed and treated by a medical professional who has the diagnostic tools and your personal medical information to make the best decisions for your healthcare. You will require very careful monitoring and intervention by your physician.

Question: My ectopic was cured by conservative management, as my hCG was dropping rapidly from 9000 in three weeks. My level is 6 today. Do I need to do a scan to see where the ectopic is at now?

Answer: Your hCG levels have dropped substantially and are now very low. Your physician will determine if you need a scan to verify the pregnancy has fully resolved, and may order continuing beta hCG evaluations until your level drops to <5 or to 0. As with all medical concerns, it is best to contact your consulting physician to determine the next course of action, as every person has a different medical profile and history, with a different treatment algorithm and monitoring requirements.

Question: I hope you will add information about ectopic pregnancies that attach to a cesarean scar. Does Methotrexate work as well on c-section scar ectopics as it does on tubal pregnancies?

Answer: Cesarean scar pregnancies (CSP's) are extremely rare and happen when the embryo implants into the scar in the uterus created by a prior cesarean section. This specific form of ectopic pregnancy is often misdiagnosed as a failed miscarriage or cervical pregnancy, which is dangerous for the mother as it must be treated appropriately. If methotrexate or a standard dilation and curettage (D&C), the treatment is often ineffective and the mother may experience extreme bleeding. The most effective treatment for a CSP is surgery, and often a uterine artery embolization is required to stop bleeding. In some women, a hysterectomy is required. Fortunately, the incidence of a CSP is extremely low, with only approximately 0.15% of women with a prior cesarean section experiencing one. Constant monitoring by a physician is necessary for all pregnancies, and especially so for pregnancies following a cesarean section to ensure the embryo has not implanted in the surgical wound scar. For more information on cesarean scar pregnancies, there is an excellent medical article on this specific topic (Timor-Tritsch, I, Monteagudo, A, & Agten, A (2015). Cesarean Scar Pregnancy Diagnosis and Management).

Question: I had an ectopic pregnancy. Can I get pregnant with one Fallopian tube?

Answer: It is absolutely possible to get pregnant again with only one Fallopian tube. It might take slightly longer to conceive, but many women are able to have a successful pregnancy after losing one tube to an ectopic. Women who have had one ectopic pregnancy are at a higher risk for subsequent ectopics, so it is important to remain under the care of your physician for close monitoring once you do conceive. If it takes longer than 12 months to conceive, consult your doctor for an infertility work-up and plan.

Question: I had an ectopic pregnancy in June, 2018. I took six pregnancy tests in the month of August, 2018. Is it possible that I could be pregnant again? Are my HCG levels just slowly rising due to the methotrexate taken in June?

Answer: Did your physician monitor your hCG levels after your methotrexate treatment to verify they reached zero after your first ectopic pregnancy? If so, you are likely pregnant again. If your current hCG levels are rising very slowly, it is possible you have another ectopic pregnancy. Please see your physician as soon as possible to determine if your initial ectopic pregnancy never fully resolved or to determine if a second pregnancy has occurred.

Question: I had an HSG in October. What are my chances of having another tubal? I just found out I'm pregnant.

Answer: What were the results of your hysterosalpingogram (HSG)? Did the evaluation show any blockages when it was done a month ago? If your tubes showed scarring or blockages, an ectopic pregnancy might be more likely. Some people have ectopic pregnancies without any evidence of tubal blockage, so there is no guarantee for an intra-uterine pregnancy even if the HSG was clear. Unfortunately, for those who have experienced one tubal pregnancy, there is a 15% chance for a recurrent ectopic. Approximately 60%-70% of women can have a healthy, uncomplicated intrauterine pregnancy after having an ectopic, and this is the reason for hope. It is very important to see your obstetrician very early in your pregnancy, as you should have beta hCG levels taken and monitored to ensure the hormone levels are doubling appropriately. An ultrasound can also be done at around 5-6 weeks of pregnancy to verify the location of the pregnancy and fetal heartbeat.

Question: I had an ectopic pregnancy and have been treated with methotrexate (95.5 mg). After 6 days, my HCG result is 12,500. Is this something good or bad?

Answer: If methotrexate has successfully treated the ectopic pregnancy, your hCG numbers should drop fairly quickly to an undetectable number. Since you still have a fairly high hCG level, I would contact your physician immediately to ensure the methotrexate was effective. In some cases, the medical therapy is not sufficient, and surgery will be required to prevent the rupture of the tube.

According to the Journal of Reproductive Medicine, 15% of patients in a study containing 58 participants experienced a failure of methotrexate therapy. An additional 15% required a second dose of methotrexate to successfully treat the tubal pregnancy. Patients with an hCG level greater than 3,000 mIU/mL were more likely to fail methotrexate treatment therapy and were more likely to require a surgical approach. Source: Dilbaz S1, Caliskan E, Dilbaz B, Degirmenci O, Haberal A, .J Reprod Med. 2006 Feb;51(2):87-93). Predictors of methotrexate treatment failure in ectopic pregnancy.

Question: I received my methotrexate (MTX) shot on six days ago and my HCG was at 2160. After the shot it went up to 3200, which is odd. I was told this was normal three days later. My HCG today (twelfth day after the shot) is at 2979 and has dropped very little since my last test. Is it fine? I was not told about avoiding food rich in folate and have been having oranges and avocados. Could foods rich in folate slow down the drop in beta HCG levels?

Answer: Unfortunately, folic acid can reduce the effectiveness of methotrexate. The medication works by interfering with folic acid, preventing embryonic cells from dividing and multiplying. If you consume a diet high in folates (including multi-vitamins), this may prevent the methotrexate from blocking enough activity to stop the ectopic embryo from growing. You need to return to your physician for a follow-up ultrasound and further testing to ensure the single dose was effective. You may need an additional dose of methotrexate or a different treatment to end the tubal pregnancy.

Question: I started bleeding on October 1st. I am still bleeding now. The bleeding does not occur everyday, but is present most days. When will the bleeding stop completely? (12/12/18)

Answer: Bleeding for two months warrants a trip to your OB/GYN physician to determine the cause and to verify your hCG levels are falling to zero. Some women will have sporadic bleeding and spotting for up to six weeks after their methotrexate injection. If the bleeding becomes heavy (you soak through a pad in an hour) or have pain, then the bleeding should be treated as an emergency and you should go to your closest emergency department. Your next normal menstrual cycle will arrive approximately four weeks after your hCG levels fall to zero.

Question: I had an ectopic pregnancy, and I had a shot of methotrexate on Dec. 28th, 2018. After 12 days I had a beta hCG titer, and the result was 37mIu/ml, which is still positive. I have not been able to go back to my doctor yet, but right now it seems like I'm having my period. Is this because I am free from ectopic pregnancy?

Answer: It is possible that the bleeding you are experiencing is a menstrual cycle, but it is important to visit your physician to verify your beta hCG levels have returned to 0, and the ectopic pregnancy is resolved. Routine monitoring is absolutely critical in this situation, mainly because your last hCG test still demonstrated a positive result.

Question: I had one tubal ligation 6 years ago. I missed my period this month and took a pregnancy test. It is positive. My hCG level is 5,000. Could this pregnancy be ectopic? I don't have any symptoms today and I am currently 6 weeks, 5 days pregnant.

Answer: Since you have a beta hCG level, it sounds like your physician is taking blood beta hCG measurements. A single measurement is not as useful as serial measurements taken every other day to verify your hCG levels are increasing at the appropriate rate. A transvaginal ultrasound could be performed at this stage to verify the location of the gestational sac, to determine if the pregnancy is in the proper location. Pregnancy symptoms are sometimes not apparent early on in the pregnancy. I would contact your physician to find out what your care plan is, and to ask the following questions:

1) Are my hCG levels rising appropriately?

2) Could I have an early ultrasound to make sure the pregnancy is in the right location?

Getting answers to these questions will determine the progress and location of your pregnancy, and will help to establish a good system of communication with your attending OB/GYN.

Question: I found out I'm pregnant yesterday and I have been spotting. My doctor performed blood work and an ultrasound. We didn't see a sac and my beta HCG level was around 250. My physician told me to come back in 2/3 days to repeat. What could be causing my spotting since my blood work looked fine, and the only issue is that we couldn't see the sac on the ultrasound?

Answer: I am glad you are receiving frequent care from a physician. Your hCG level is likely too low to observe a gestational sac. Since this level doubles approximately every 48 hours in early pregnancy, you should be able to observe the sac soon (at an hCG level of around 1000).

Question: My beta HCG level decreased from 3900 to 2800 as I'm having an ectopic pregnancy. How much time it will take to resolve this as I took 3 shots of methotrexate?

Answer: It is vital you remain under the guidance and care of a qualified medical professional who can evaluate and treat your particular case. In some cases, methotrexate is insufficient to resolve an ectopic pregnancy and surgery will be required. Please follow the advice of your physician.

Question: Hello, I had an ectopic pregnancy with removal of my left tube. It has been a week since the surgery and I took an ovulation test. It came back positive: is it possible that I am really ovulating?

Answer: It is possible that you are already ovulating one week after surgery. If you would like to avoid pregnancy, you should take precautions as it is possible to become pregnant. Many doctors advise waiting at least one cycle after an ectopic pregnancy before trying to become pregnant. I would consult your physician to determine when it would be safe for you to try to conceive again.

Question: I had my first round of Methotrexate on October 5th with an HCG of 4500. My second round was on Oct 9th- HCG- 9000. My HCG levels have been as follows: Oct 11- 10000, Oct 15- 7700, and Oct 17th- 7100. I was asked to come back on Oct 21st for blood work. I am not experiencing any pain and there was no sign of fluid or blood in the ultrasound, so my doctor is hoping it would resolve on its own and not lead to surgery. What are my chances of avoiding surgery despite my ectopic pregnancy?

Answer: I also hope your ectopic pregnancy resolves and does not require surgery. The only way to know if the ectopic pregnancy has resolved is to continue to follow-up with your physician and obtain serial beta hCG readings until they approach 0. The fact that your hCG level is reducing is a promising sign, though only your doctor will be able to properly determine whether the methotrexate has been effective in your particular case.

Question: My HCG levels have been going up great. The first draw had a level of 90, at 48 hours it was 202, then 6 days later it was at 3321. This is a good rate yet they can't see anything on the tummy or internal scan. My progesterone is 56 and the endometrial lining is 25?

Answer: I would continue to follow up with your doctor. It is possible that the pregnancy simply isn't visible to their ultrasonic equipment yet. The rate of increase in your HCG levels is encouraging and I would not worry unnecessarily. Follow up regularly with your physician to ensure everything is progressing as expected.

Question: I had an ectopic pregnancy which resulted in needing surgery. I recently just got pregnant again, but I had bleeding and cramps so they said most likely a miscarriage. Before the bleeding, I had a positive blood test and my HCG levels were 19. After the bleeding started I went to the ER and that blood test said my levels dropped to 5. Do my symptoms mean it was just a normal miscarriage or could it still be an ectopic? I’m still bleeding but no more pain anymore.

Answer: The only way to verify is to obtain a complete examination by your OB/GYN. Your physician will be able to draw serial beta HCG blood tests to verify that your HCG levels return to 0. I would schedule a follow-up examination with your doctor to ensure the miscarriage was complete and that there is no possibility of another ectopic.

Question: My HCG level at four weeks and five days is 23. I’ve had two ectopic pregnancies before, one ending in surgery and another that resolved itself. Is there a chance of rupture early on with levels of 23? I’ve had a scan, and nothing came up.

Answer: Hopefully, you are under the care of a physician who is monitoring your HCG levels and verifying they continue to decrease over time. A level of 23 is very low. If the HCG numbers are continually reducing, that is an indication the issue is resolving. I would not rely on the fact a technician saw nothing on the scan, as I have had two ectopic pregnancies and neither one was observed on the scan. In the first one, nothing could be seen at all, and I had a rupture. In the second one, fluid could be seen in the adnexal area, but no mass or pregnancy could be observed. Both were surgically resolved for me. Please ensure you are carefully followed by your doctor until the hCG level is no longer detectable.

Question: I just recently had surgery last Wednesday because I had an ectopic pregnancy. I was wondering when can I have sexual intercourse with a woman, because I’m a woman. I was also wondering when my bleeding is going to stop because it’s very irregular. When will I know that my hormone level is at a 0 without speaking with my physician?

Answer: There are several questions here! I will address them one at a time:

1) You should consult your physician prior to having any sexual intercourse following an ectopic pregnancy. Your orientation is not important, but you must be sure that your body is recovered from any surgical or medical procedures before resuming relations.

2) Bleeding can take some time to resolve, as your hormone levels drop. As with any medical concern, this should be closely monitored by a licensed physician to be sure the ectopic pregnancy has resolved and your bleeding is within the realm of typical expectations following treatment.

3) You will not be able to determine your hormone levels without consulting your doctor, as HCG levels are quantified using a blood test to determine beta HCG. You should consult your physician as soon as possible to address your questions regarding bleeding, hormone levels, and ability to resume sexual relations with your partner.

Comments

Leah Lefler (author) from Western New York on January 23, 2020:

Rose, your best chance of pregnancy will likely be via the use of in vitro fertilization. This process involves the collection of your eggs and fertilization outside of the body, and the presence of Fallopian tubes is not required. I wish you the best of luck in conceiving. IVF is often a successful way to achieve pregnancy after bilateral ectopic pregnancies.

Rose marie on January 23, 2020:

May first pregnancy ectopic pregnancy

(left) if i remember they removed may left fallopian tube(2015)

My 2nd pregnancy ectopic pregnancy

(dec.9.2019) rigth the doctor said in medical cert is "S/P EXLP O SALPINGJECTOMY

My question is if i have a chance have a baby by IVF Sory for my english i try my best im realy not good in english

Leah Lefler (author) from Western New York on July 03, 2019:

The hCG level rise is excellent for your stage of pregnancy. Any pain should be evaluated by your physician with an internal ultrasound. Visualizing the gestational sac will allow your physician to verify the location of your pregnancy. Please report back - I hope all is well with your pregnancy!

Theresa on June 27, 2019:

So I am curious. My last period was May 22. I took a pregnancy test 6 days before my period is due... between last period and pregnancy test I had a 5cm cyst rupture on my right ovary. I have pain from my shoulder to my hip (all on my right side). It was bad and then disappeared for awhile. Now today it returned and really hurts. My first HCG test was 211 on the 17th of June. By the 20th of June it was 998! I have a ton of pain on my right side and since my number skyrocketed I’m wondering if that is caused by an eco topic pregnancy as wel!

Leah Lefler (author) from Western New York on May 21, 2019:

Some people feel pain and some do not, Ana. The most vital thing to do is to follow the advice of your physician and to receive regular monitoring until the location of your pregnancy can be verified. I have had two ectopic pregnancies and I had odd spotting/bleeding, but no pain until the pregnancy ruptured. When it ruptured, there was excruciating pain, but I had no pain symptoms before that time.

Ana on May 19, 2019:

I had an IUD as a form of birth control. Missed my period on 5/15 took a pregnancy test and it was positive. My last period was 4/15. Ultrasound didn't show anything on my uterus and my hcg levels are 51. Doctor said that might have been the reason why she didn't see anything cause I'm too early. If it is ectopic, should I be experiencing pain right now? Or would it be too soon to feel anything yet?

Leah Lefler (author) from Western New York on April 07, 2019:

Jane, it would be wise to consult your doctor as soon as possible due to your late cycle and pain. A medical professional will be able to help diagnose the cause of your symptoms, whether that is pregnancy or another condition.

Jane on April 02, 2019:

Hi my periods are late by 12 days and I am having crampings in my abdomen but I didn’t had complete sex please help me in this situation

Leah Lefler (author) from Western New York on March 28, 2019:

If I were in your situation, Kristin, I think I would ask my doctor for another beta hCG evaluation to verify the number has dropped to 0. If the ectopic pregnancy has resolved, this will give you reassurance. If the number has increased, it will give your doctor the information needed for different/additional intervention.

In general, a beta hCG of less than 5 is considered negative for pregnancy, but a follow-up beta hCG and doctor's visit would be a good idea, particularly since you are still cramping and spotting.

Kristin Carson on March 26, 2019:

Thank you so much for this informative article. I was diagnosed with an ectopic pregnancy earlier this year, and it took two rounds of methotrexate and 6.5 weeks for my hcg levels to go down. My last and hcg bloodwork my levels were at 2. My doctor said this meant that the ectopic pregnancy was resolved, but my nervous brain is trying to convince me that the pregnancy could possibly continue to grow. Have you ever heard of hcg levels going back up after they are at 2?

Also, about 2 weeks after the levels were at 2, I have had some light cramping (like menstrual cramps) and very light spotting. I wonder if this could be a period? Has anyone else had something similar to this? Thank you!

Leah Lefler (author) from Western New York on February 26, 2019:

Hi Angie, I am uncertain of the meaning of your comment. Where do you see any information about 48 days?

Angie on February 23, 2019:

48 days?? Isn't it 48-72 hours??

Leah Lefler (author) from Western New York on January 15, 2019:

I am sorry to learn that you have had some hearing loss, Jennifer. Methotrexate is actually used to stabilize hearing and prevent hearing loss in autoimmune diseases and is not listed as an ototoxic medication. I am sorry this has happened to you.

Jennifer C on January 14, 2019:

They don’t tell you routinely but a possible side effect of Methotrexate is hearing loss and Due to two rounds of it to treat my ectopic ( it ruptured anyway ) I now am mostly deaf in my left ear Cam only hear 35% . This was traced to that medication. Take the surgery that medicine is not to be trusted.

Leah Lefler (author) from Western New York on December 11, 2018:

It is impossible to say at this early stage, though the fact that the pregnancy is in the womb is excellent news and this means that you do NOT have an ectopic pregnancy. My first pregnancy had a slow hCG rise that picked up and my son was born with no issues. I have also had one miscarriage and two ectopic pregnancies, which had very poor hCG rises that never increased to an appropriate rate. I wish you a very happy, healthy pregnancy and continued care by your doctor will let you know that everything is developing as expected.

Aala Said on December 11, 2018:

thank you dear for answering

i had an ultrasound yesterday and the Embryo was visualized inside the womb with expected age at 5 weeks so now am i still at the risk zone to lose it or it becomes a safe pregnancy?

Leah Lefler (author) from Western New York on December 10, 2018:

Hello, Aala, the only way to definitively tell if a pregnancy is ectopic is by visualization via ultrasound or surgery. While your hCG levels are increasing, they are not increasing at the level one would expect, but additional hCG levels are required. It is extremely important to receive regular monitoring and care from a physician in this case.

Aala Said on December 10, 2018:

HELLO DEAR

i gound out that im pregnant in December 4 and the bhcg was 68

after 84 hours it became 84 and after other 48 it became 264

am i still facing the risk of ectopic pregnency ?

Leah Lefler (author) from Western New York on November 24, 2018:

Sanya, I am so sorry you have lost the pregnancy. The lack of spotting and bleeding is a bit concerning, as typically when a miscarriage has occurred there will be bleeding. Was the sac visualized in the uterus or in your Fallopian tube? I would definitely seek a second opinion and have another beta hCG to ensure your levels have dropped to zero, as you should be monitored until there is absolutely no sign of pregnancy. With both of my ectopics, they never did visualize the sac in the tube at the OB/GYN's office. They did see adnexal fluid (fluid around the ovaries), but the ectopic pregnancy wasn't seen until I was admitted to the hospital after my tube ruptured. I think the ultrasound equipment at our local hospital was more sensitive than the one at the OB/GYN's office.

I would call and be seen as an emergency appointment by another obstetrician in your area as soon as possible.

Sanya on November 24, 2018:

Got pregnant last week then I went dbgyn to confirm my pregnancy she did an ultrasound and she told me that I’m 4 weeks pregnant she saw the sac after 1 week later I went as she told me to go she took another scan and she said she couldn’t find anything other than a blood clot .

She just asked me to back nd take one beta hcg so I got the result next day and it 84 by seeing the result she told me like your everything is gone there is nothing left

I didn’t even have a light spotting or bleeding neither

Actually I was tensioned so i forgot to ask her what might have happened

She just asked me to stop tablets

So it will go it’s you don’t need to take any further test or treatments

Maybe I should change my gyn

If anyone else had similar please help me with that

Leah Lefler (author) from Western New York on November 04, 2018:

It might be too early to visualize the pregnancy, Wexx, though it is good you are being monitored carefully. I have had two healthy pregnancies and three miscarriages (two of the miscarriages were ectopic pregnancies). I had spotting in all of my pregnancies in the first month after I received a positive pregnancy test. The ectopic pregnancies had very poor hCG increases (increasing by only about 100 over a 2-day period, never coming close to doubling). The gestational sac is typically visualized with an hCG level of >1,000 - so your ultrasound on September 30 might have been too early to see anything. I hope your physician will repeat a transvaginal ultrasound soon, as a gestational sac would likely be visible at this point.

Wexx on November 03, 2018:

Hello i am desperate for some sort of answer or help. Something, anything!

September 17 hcg was 28 (day of missed period),

September 20 hcg was 104

September 23 hcg was 348

September 30 hcg was 794

November 1 hcg was 1408

Light brown spotting on sept.24 red bleeding sept.25,26. Brown spotting 27,28 ending on 29th. No pain or cramping. Ultrasound on sept.30 found nothing in uterus or tubes. Was put on prometrium 200mg daily. I dont know what to think.

Leah Lefler (author) from Western New York on October 31, 2018:

Thank you, RTalloni. This was an extremely difficult time for our family, and the angst waiting the beta hCG levels every 48 hours was agonizing. While it was a very difficult time, it has allowed me to connect with many others who have gone through (or are going through) a similar circumstance.

RTalloni on October 31, 2018:

This informative post is helpful. Though I know ectopic pregnancies are dangerous conditions I did not know of the many variables involved. I am so thankful for the help you received, allowing you to be with your family and share your experience for the benefit of others.

Leah Lefler (author) from Western New York on October 30, 2018:

I am so sorry you are going through this, Bobby. An adnexal mass is a mass in the general ovarian area, so they are likely referring to the same visualization on the ultrasound. The level your hCG is increasing will give them additional information, as an ectopic pregnancy will not have a beta that doubles in the appropriate time frame. If they cannot visualize a sac in the uterus, observe a mass near the ovaries (adnexal), and the beta hCG increase is poor, then the signs point to an ectopic pregnancy. It is very good that you are seeing your doctor frequently and she will be able to advise you on the course of action based on the results of your beta hCG results and the ultrasound results.

Bobby on October 30, 2018:

Question-today I went to my doctor.its 9 days after from my missed period.at 1st she do TVS,in ultrasound room she says sac like structure seen in right ovary may be ectopic then she advice me to do beta hcg,result 640; but when I get ultrasound report then I see written adnexal mass and suggest do hcg after 48 hrs.now I’m confused what is right is it sac in right ovary or adnexal mass. It is ectopic or adnexal mass.please give me answer.

Leah Lefler (author) from Western New York on April 02, 2018:

Jo, my heart goes out to you. I have had two ectopic pregnancies and one full on rupture. I became very dizzy and the pain was staggering - like I had been shot in the side. I had difficulty standing up and had to be helped to the car. I have suffered from ovarian cysts my entire life and this pain surpassed a rupturing cyst. Persistent pain is not normal and I would insist on another follow up and/or a second opinion from another physician. I am so sorry you are going through this, as it is devastating.

Jo on April 02, 2018:

Hi I've been diagnosed with an ectopic two.weeks ago I've had methatrexate to avoid surgery. My hcg levels are falling nicely from 2400 to.505 however I'm still getting pain that radiates.down my leg and into my back. The mass as they described did initially get bigger however is now 10% smaller. I've been in hospital twice already but I'm so worried this isn't normal and I will rupture. Ive been told to go back to.hospital when the pain is constant and severe! Ive a high pain threshold! Any advice would be appreciated.

Leah Lefler (author) from Western New York on March 17, 2018:

I am glad the article was helpful to you, Babur. If you have any questions, please let me know!

Leah Lefler (author) from Western New York on March 11, 2018:

Marie, that is quite an ordeal. What does your physician say? I would certainly contact him/her to verify your bleeding is normal at this stage. I am so sorry you are going through this.

Marie on March 10, 2018:

I have a ectopic pregnancy and we got my hgc levels down to 28 but I’ve been bleed for almost three weeks now. Goes from light to heavy.

Leah Lefler (author) from Western New York on February 03, 2018:

TeeGee, the waiting game can be very frustrating. Your first menstrual cycle may be up to six weeks after your ectopic, and I would certainly place a call to your physician for guidance if it takes longer than six weeks. With PCOS, you may take longer, but verifying with your doctor is always the safest way to go. I also had taken a pregnancy test on a whim with my first ectopic pregnancy, and was extremely grateful it was found - though there was uncertainty in where my pregnancy was as they couldn't visualize it on their ultrasound machine. We waited until we could confirm and I did lose my right fallopian tube. I later lost my left with a subsequent ectopic pregnancy. I am very glad you caught your ectopic right away to spare the fallopian tube!

TeeGee on February 01, 2018:

I recently had an ectopic pregnancy which was terminated with the help of Methorexate. I was lucky that it did not rupture my fallopian tube. I had no signs of being pregnant and I am just thankful that I happened to take a pregnancy test on a whim and caught this soon and got immediate care. My question is, how long after the HGC comes back to normal, does one get a period? I have PCOS and dont ovulate at normal intervals; this waiting game is making me anxious.

Leah Lefler (author) from Western New York on December 05, 2017:

What, specifically, is the question about the video? With regard to hCG levels, they should double approximately every 48 hours in early pregnancy.

Crystal McConnell on December 05, 2017:

On the video ... 48days or 48hrs???! Lol

Leah Lefler (author) from Western New York on August 29, 2017:

I wish you much luck, Madhuri. HCG helps to trigger the release of eggs from the ovaries, and this can lead to an increase in the number of eggs released (and therefore fertilized). You may have a 20% chance of conceiving twins, and sometimes more are conceived. Hopefully your doctor can give you accurate statistics and is monitoring your condition carefully as you go through the treatments.

Leah Lefler (author) from Western New York on December 16, 2012:

Ectopic pregnancy is a frightening experience, teaches12345 - we were taken aback when my hCG levels weren't rising and my OB/Gyn thought it was ectopic. They couldn't find the pregnancy on the ultrasound, and that night I had terrible pain and the pregnancy ruptured. Fortunately we live close to the hospital and emergency surgery saved my life, but it is definitely a situation that must be monitored closely (and treated, once an ectopic is confirmed)!

Dianna Mendez on December 16, 2012:

Well done, Leah. I didn't have any problems during my pregnancy and thankful for it. I am sure your post is going to help many women (and men) to understand tubal pregnancy and to receive encouragement.

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