My own case study
Over 2 weeks ago I was warned to prepare for miscarriage, which ended up in tube removal from an ectopic pregnancy. This is me sharing my data and experiences, since I spent most of my time on Reddit while in my own in-between. I hope something somewhere in here helps someone one day.
Background: I’m a 38yo female and husband is a 39yo male. We have tried to make a baby on and off since getting married 10 years ago, and started fertility care a year and a half ago (he had two kidney transplants during the first 10 years of our marriage which impacted trying timelines but surprisingly had no impact on male fertility). His fertility is well above average, mine is above average “for my age group.” We’ve been pregnant 4 times now with 0 live births.
Testing went well however we had 4 failed medicated timed intercourse cycles, and my HSG test suggested Hydrosalpinx. This and endometriosis were ruled out with antibody testing and a diagnostic laparoscopy. We progressed to IUI, and had an ectopic pregnancy our first cycle.
Timeline:
Cycle day 13: after using Letrazole, follicles were still not ready.
Cycle day 15: Follicles were 16mm and 18mm, trigger shot provided.
Cycle day 16: (“2w2d”) IUI was done with great sperm quality. Started progesterone suppositories.
4w4d I got positives.
4w6d clinical hCG is 126, progesterone is 28.
5w1d hcg is 368.
5w2d I had brown spotting and lost the only pregnancy symptom I had - gas. Called my fertility clinic.
5w4d hCG is 394, and I’m told to plan for miscarriage. After saying I was having pain in my left hip, they started ectopic protocol (basically just increased monitoring and guidance on what to watch for).
6w hCG is 1069. Pain still in my left hip, uterus is empty.
6w2d hCG is 1568. Pain still is in my left hip but they see a small mass by my right ovary. Uterus is empty. Left hip pain ends up just being an old lady sore hip haha.
6w6d hCG is 3306. Uterus is still empty but mass near right ovary has grown. I’m sent to the ER.
ER: the ER cannot conclude it’s ectopic, saying the mass could be ectopic or a corpus luteum (a cyst that develops and feeds the embryo until the placenta is formed, if I remember right). They say I may be wrong on my dates (I wasn’t!), congratulate me on my pregnancy, and tell me to follow up with my OB. My fertility clinic calls my OB directly who gets me in to see her (I was a new patient with my first scan scheduled weeks later).
7w2d at my OB hCG is 5700. Uterus is empty, there is a mass by my right ovary which is inconclusive but assumed to be ectopic. For personal-emotional and personal-logical reasons, my husband and I choose surgery over methotrexate. Surgery was scheduled for the next day.
Surgery: the plan was diagnostic laparoscopy, and tube removal if ectopic was confirmed. During surgery ectopic was confirmed, and I was already bleeding internally - the leaking of blood likely delayed rupture. My right tube was removed.
Recovery: physical recovery has been so easy! I was prescribed Oxycodone 5mg in addition to prescription-strength ibuprofen and in 24 hours I’ve only taken one of each. Pain is hardly perceptible and it’s surprising I feel absolutely nothing where the tube was removed - discomfort is entirely isolated to the largest 1” surgical site.
Meds: I was prescribed Tesslon Pearls since this overlapped an awful cold and we were worried about coughing after an abdominal wound. I was prescribed Lovanox related to a DVT I developed after a leg injury 9 years ago (a precaution). I was prescribed Oxycodone 5mg, Ibuprofen 600mg, and Zofran as part of standard treatment.
What I wish I’d known:
- Unless medically unable to have flexibility, you can voice your opinion about methotrexate vs surgery. If time is on your side, research both to brainstorm questions to make informed decisions that make sense to you.
- The hospital may ask what you want done with your “product of conception.” This was a very emotional question which caught us off guard.
- The hospital may give you the option to have your embryo tested for genetic factors, and gender.
- Pain is all over the map! I felt none before and after surgery, and I know that’s not a universal guarantee. Emotional and physical pain heal on different timelines but for the physical part, my bandages and medical records are the only signs anything happened at all.
- Listen to your body. This absolutely would have ruptured if early and adamant efforts hadn’t happened. I’m also aware that my life-threatening emergency was prevented due to quick and easy medical access, and there are too many who don’t have that available. I’m always open to feedback on what I can do to better support all women (and people) having access to efficient healthcare.
- A single fallopian tube can drift across to snag an egg from the opposite ovary!
Next steps: We’ll monitor hCG until it returns to pre-pregnancy levels, then will return to IUI treatment - as hard as it is to say “let’s do this again!” I’m in a US state which voted against mandated IVF coverage, though my employer-sponsored plan covers IUI at nearly 100%. We will continue IUI, and have more talking to do before my husband and I decide our opinions about the $31,000+ uncertain investment IVF is.
Anyway this is my objective journey. My numbers and timelines. While emotions exist, I’m still working to feel them through the medical crisis the last few weeks have been. It was helpful for me to type this out and I hope one day someone connects with any of this in a way which is helpful or makes them feel less alone in their own journey.