Andrea's Story

I spent 6 hours of my July 31st, 2001 birthday in the emergency room with my ectopic pregnancy. From what I've read from this website (thanks so much, Krista) and other sources, except for the birthday thing I was lucky--for someone with an ectopic pregnancy, that is. I didn't rupture and
they were able to treat me with Methotrexate, so I didn't have to have surgery. Funny, though, I don't feel too lucky.

Here's the story: up until about 5 days before my birthday (I turned 37) I'd had what I thought was a normal pregnancy. I did have a very small amount of bleeding at the time of my period, but it was really minimal. I also had some brown spotting the next week, which I have since been told is a sign of ectopic pregnancy, but at the time I had a nurse say it was a good sign of pregnancy, so I didn't suspect anything. Anyway, I was about 8 weeks along (from my last period) and feeling pretty good: I didn't have much nausea (maybe another bad sign in retrospect), but I was pretty tired.

I was excited and happy and my husband was happy, too and being really nice and solicitous. We hadn't been actively trying too long, in fact it was the first month I'd been taking my temperatures. I had, however, spent a couple of years trying to convince my husband (he thought he was too old, yeah right, like that gets better) but eventually it was our good friend Ch'aska who is now 2.5 years old that did the convincing.

Thursday the 26th of July I was completely exhausted after my 4 hours at work (I'm a half time librarian at that job, plus I sub other places; I've been keeping this flexibility for the hoped for baby) and I had some pain in my lower abdomen (in a half circle along the pelvic and hip bones, both sides at that point) but the pain wasn't too bad and more of an ache than crampy. In the car on the way home I checked the secretions in my vagina and they were pink, but just a very little. I was sort of scared, but mostly exhausted and really wanted to get home and lie down. My husband was out of town and wasn't going to be home until after midnight. So I went home and read about bleeding and pain and even though the books weren't completely clear, I decided I should call someone. I had only made my first appointment with the midwife that morning, and I wouldn't have had my first pregnancy appointment until 3 weeks after I took the Methotrexate.

So I call the after hours number and leave a message to be called by the midwife who had never heard of me (but she had delivered 2 kids for a friend of mine, one of them the above-mentioned Ch'aska). Margann (the midwife) called back and reassured me that everything was probably fine, but since there had been a mix-up in scheduling she was able to see me the next Monday (7/30). So, Friday and Saturday I had this dull ache in my gut, low on the right side, whenever I spent much time standing or walking around. No more bleeding, though. So I took it really easy and it seemed to get better. Monday afternoon was my appointment, and I went in feeling pretty good and we did all the normal things (talking about pregnancy and my habits, getting acquainted, answering questions) right up to the time Margann examined my uterus. She said it seemed kind of small. They have ultrasound in the office, so she suggested one (she had mentioned it already, so I still wasn't too worried).

She looked at it and then got one of the doctors (Margann said she wasn't officially trained in u/s, she'd learned by watching others so she wanted backup to be sure). Neither of them saw
anything in my uterus. Or anywhere else for that matter. The only thing they saw was a cyst on my left ovary, but they said that was normal in pregnancy. So, we sit down to talk about it and she says there are 3 possibilities: 1)I wasn't as far along as I thought (this seemed awfully unlikely), 2)I'd had a miscarriage (also unlikely, since I hadn't bled hardly at all), and 3)you guessed it. She said they would use some of the blood they had already taken for other tests for a quantative beta-HCG, and then I was to come back in Wednesday to get more blood drawn, and they would have the results Thursday. And depending what the numbers did we would go from
there. I asked what would happen if it turned out to be ectopic. And she mentioned Methotrexate, for which I am very grateful. So at this point I was kind of in shock, and also scared. I didn't know how I would make it to Thursday.

I went out to the parking lot and called my husband from the car in tears. I went home and my husband made me a "special meal" (crab and chanterelles) which of course prompted me to cry and say "I don't FEEL very special". Then I logged on to the internet and learned all I could about Ectopic Pregnancies and Methotrexate. Which was a lot, actually. Hey I'm a librarian. One thing I learned was the HCG level at which you can definitely see an embryo with transvaginal ultrasound. So the next day was my birthday, and I wasn't supposed to work until the evening. I called and talked to the midwife and asked some questions and also asked her to call me with the previous day's level. I went back on the internet and researched diagnosis of ectopic pregnancy and found out about color doppler ultrasound, which was useful later that day for explaining to the ultrasound tech at the hospital what we were looking for and why we were
doing color ultrasound (to see unusual blood flow due to a placenta, etc.). About the middle of the afternoon I had a strong pain which I thought was partly intestinal. So I went to the toilet and then got a really strong pain which caused me to stagger to the bed and curl into a little ball,
which helped. I managed to call my husband and tell him to come home.

Then I called the midwife and she asked how bad the pain was and could she check the HCG result and call me right back. I said okay, and when she called back she said the HCG was 10,000 (WAY too high for a uterine pregnancy not to be seen) and told me to come in to the office. Then my husband got home and took me in. By the time we got there she said she had talked it over with a different doctor and I should go across the street to the E/R. So I did, and they got me in pretty quickly and did blood tests and the color ultrasound. Then there was a really long wait. It ended up that they switched from the daytime on-call doctor from my midwife's practice to the overnight on-call OB from another practice. The nurses didn't tell me much of what was going
on, though, including that the second doctor was waiting for results of a second HCG, which the first doctor for some reason hadn't ordered. After I asked they told me my blood readings were stable, so I wasn't hemorrhaging or anything. So after about 5 hours the doctor finally came. We talked about the tests and she told me there they still didn't see an embryo anywhere, but there was extra blood flow from my right ovary so that was probably where the pregnancy was. I was really glad I had been able to do the research and so was able to decide fairly easily on Methotrexate.

I didn't want to be operated on (who does?) and since they didn't know for sure where the pregnancy was, it would have been hard to operate on anyway. So I got the shot and went home.  
There had been a dinner party planned with a number of friends the next night, partly to celebrate several of our birthdays. I decided we should go anyway, and everyone was very nice and supportive (okay, the 2 year-olds were really demanding and wanted to play with me NOW! <grin>, but that's 2 year-olds for you) and it was really good for me to go and be surrounded by my friends, even if I felt yucky and couldn't really appreciate the food that had been planned based on my suggestions. We had also been planning to leave on Friday morning to drive to Crested Butte, Colorado (from our home in Santa Cruz, California) to visit some friends for 10 days or so. I know a missed vacation kind of pales in comparison to an ectopic pregnancy, but to me it seemed important both to try keep at least SOME part of my life like before (okay, so maybe I was in the denial stage at that point) and also I didn't need ANOTHER disappointment at that point. Also my husband really wanted to go and I didn't want to disappoint him (okay, so deep denial). We knew we probably couldn't leave on Friday, but I hoped maybe early the next week. But we couldn't plan that either, because we had to see what the HCG levels did.

Friday 8/3 was day 4, and my HCG levels had risen from 10,000 to 12,000. This is very common, but still frustrating and worrying. We then were waiting to test again on Monday, looking for a drop of at least 15%. Monday I went to work, so I wouldn't just sit at home obsessing the whole
time. In retrospect, maybe I shouldn't have gone back yet, but everyone was really nice to me, so it made me feel some better. I asked my boss if I could have a couple more days off the following week, and she said yes, even though she really couldn't spare me. On Monday my HCG was down to 8,500-almost 25% drop. The doctor said based on that it should be okay for me to go to Colorado and to get the subsequent HCG 9 days later instead of 7. So we went online and booked a flight to Denver for Wednesday. Of course after having little pain (nothing acetominophen or no more than 2 ibuprofen would take care of) for the first week plus after Methotrexate, I got much worse pain on Wednesday-4 ibuprofen every 3-4 hours wasn't nearly enough, especially for sleeping.

Of course my doctors in California couldn't do anything, but since we were in a small town our friends had doctor friends who would give me a prescription for Tylenol 3, and that did the trick. Anyway, the trip to Colorado was good. The woman of the couple we were visiting had been on
Methotrexate for 6 months for breast cancer, so in comparison I felt lucky again. (I have since found out that one of my colleagues/friends was on it for 10 YEARS for psoriasis.) My friend and I talked about how there are some psychological similarities between ectopic pregnancies and breast cancer, in that there is something you really WANT (the baby, the breast), but at the exact same time you want it OUT OF THERE because it could kill you. Very hard to deal with this conflict--it makes you feel crazy!

We came back from Colorado and I went back to work. In retrospect again it was probably still too early-I was really raw emotionally and crying a lot, and not really ready to function if something went wrong-but fortunately nothing did. I got another HCG and in 9 days it had dropped from 8,500 to 139, which was reassuring. The next week, though, it only went down to 31, and week after that to 12. I'm now officially sick of this and just want it OVER, so I can get on with putting myself back together and deciding where to go from here.

The ovarian ectopic thing is really frustrating. Because it is so rare (no more than 1.5% of ectopics and 1/2500-1/4000 pregnancies) there is almost no information out there about it. Combine that with the fact that I was treated with Methotrexate (previous treatment had mostly been removing the ovary), and the chance of finding any kind of precedents for my risk of future fertility impairment or (worse) future ectopics becomes ravishingly small.  My biggest question, of course, is why this happened and what the chances are of its happening again. See, I'm a very emotional person, but also a very logical thinker. I really need facts so I can use my logical side to reassure the more emotional part (which is still freaking out right now).

Unfortunately there aren't many (any?) facts to be had on what might cause an embryo to go backwards out of the fallopian tube. And we don't even know if that is what happened; it may possibly have been fertilized before being released from the ovary. Actually we don't even know it was ovarian: because they didn't have to do surgery, all we have is increased blood flow around my right ovary as viewed on the color Doppler ultrasound to go by-that and the fact that they didn't see anything anywhere else. The more I look into it the more questions I have. For instance, a couple places mention that abnormal levels of progesterone may be a factor in problems of fallopian transport, but they don't know nearly enough about it to say what levels of progesterone might indicate a problem-much less to test for it. Neither my midwife (who had an ectopic herself, as well as PID, a healthy child through IVF, etc.) nor the doctor who is following the ectopic (because she treated me in the emergency room) say they would suggest an HSG test in my case because: 1)It's not really fun to have the test, 2)It costs a fair amount of money (which my insurance probably wouldn't cover), 3)they don't think my situation really calls for it because since it wasn't tubal and I have no known predispositions for ectopic pregnancy (other than having had this one) there isn't too much reason to think there is any tubal damage--basically they are calling this a fluke.

Still, though, I'm kind of scared and don't want to go through this again. I'm still confused about what happened. Everyone keeps telling me that my chances for having a normal pregnancy are really good. Well, excuse me, but they were an awful lot better this time and I still had one, so I'm not all that reassured. Part of me wants to try again right away and just put this behind me. And if it worked just fine right away then I suppose it would be very healing. But if I don't get pregnant soon, or if I have another ectopic, then I'll still be so fragile from this time that I'm
afraid I couldn't take it. If I'm not trying, then I can't fail. But then I won't have a baby that way either.

Is this your story?  I would love to hear how you are doing, but have misplaced your e-mail address...Krista