Ectopic Pregnancies Suck!

On May 21, 2009, a doctor told me I was suffering from an ectopic pregnancy, that it was not a viable pregnancy, that I was at serious risk of having my fallopian tube rupture and of then of potentially bleeding to death, and that I needed to have it terminated immediately.

May 21, 2009 will not go down as the best day of my life.

A. Ectopic-Pregnancy-Wa?

The ectopic pregnancy was the worst thing that ever happened to me.  If you’re going through this right now, I’m so very sorry. 

For those of you who don't know what an ectopic pregnancy is--it's a pregnancy that's growing outside of the uterus.  In most cases (including mine) that means the fallopian tubes.  Fallopian tubes do not have the resources and are not big enough to support a pregnancy.  Some will resolve (end) on their own.  Others will continue to grow and will, most likely, cause your fallopian to rupture, causing massive internal bleeding and possibly death.  Ectopic pregnancies are not viable pregnancies.  They are also extremely dangerous to the mother's life. 

I've read that ectopic pregnancies are the leading cause of pregnancy-related death in the first trimester of pregnancy.

You do not want to mess around with an ectopic pregnancy.

B. Treatment Options--How to do the Most Damage for the Least Damage

I was given two options, and I needed to decide pretty much immediately: (1) have the pregnancy surgically removed from my fallopian tube or (2) take a shot of methotrexate--a form of chemotherapy that stops new cells from growing. 

The upside to the surgical option is that when it's done, it's done.  The ectopic pregnancy is removed immediately.  The downside was that I would actually have to have surgery (I think laproscopic), increasing risk of infection etc.  Also, surgery worsens the scarring that’s probably already in the tube, making future ectopic pregnancies more likely.

The upside to methotrexate is that it’s just a shot.  No surgery and no risk of further damaging the tube.  Of course, methotrxate is chemotherapy.  There are all kinds of unlikely but serious risks (hair falls out, etc.).  And, there's still a risk of the tube rupturing because the pregnancy is not gone--it's just going to stop developing and eventually shrink / absorb.  For this reason, not all ectopic pregnancies are even eligible for methotrexate.  If the ectopic is too far along or seems like it might burst at any second, methotrexate is not a good option.  Also, the methotrexate stays the body for a while, so my doctor said no trying to make babies for at least three months after the shot.

Considering how early along I was in the pregnancy (about 35 days past ovulation) and that my tube did not appear to be in immediate danger of rupturing, the doctor recommended the shot.  (She all but said we would be idiots to do the surgery when methotrexate was a viable option.)  My husband (who was actually out of town for work) and I did some super quick research (me from the hospital on my phone, him at work) and decided the risk-reward of methotrexate made it a better option, especially because we wanted to avoid any further tube damage.

So I went with door number 2--the shot in the ass.

Fortunately, my husband arrived back (barely) before I had the shot.  It was administered by a chemo nurse and, no lie, was fluorescent green.  (Or at least, that's how I remember it.)  It was a big honkin' needle, too. 

C. Methotrexate No-Nos

After the shot, I wasn't allowed to be alone or drive for several days because of the continued risk of tubal rupture.  (Think Moby Dick--"thar she blows!")  Also, I had to have my blood monitored every week to make sure my HCG levels were falling--demonstrating that the pregnancy was actually terminating properly.  There were also some other things I couldn't do while recovering:

1.         Take prenatal vitamins.

Folic acid—which helps new cells grow—is the enemy of methotrexate—which is trying to stop the cells from growing.  So those vitamins you've been so carefully taking to make sure you have a strong little fetus?  Dump 'em.

2.         Wear tampons

This might not seem like much of a sacrifice, but it really sucked.  A lot.  I hadn’t worn pads since I first got my period as a teenager.  I guess I hadn't really given a lot of thought to how much blood I would lose in the process, but it was epic.  Seriously.  The amount of blood in this process required those big industrial pads, the ones that would shift around and make me feel like I was smuggling a banana around in my underwear.  And it was swimsuit season during my no-tampons time, which was unfortunate.

3.         Drink

I read another blog where the blogger said, “just when you need a drink the most, you can’t have it.”  That is the truth!  Again, the methotrexate shot is out there killing your cells—including liver cells.  You aren’t allowed to drink because it's not the best for your poor beaten upon body.  But I agree, there were definitely times I really, really wanted to have a drink during that time.

4.         Have sex

Considering sex was what got me into the whole mess, and considering the copious amounts of blood pouring from my body for months, this was not as big of a sacrifice as you might think.  My husband was not very happy, though.

D. The Second Shooter

The day my ectopic pregnancy was diagnosed, my HCG level was 682--not a good number for a pregnancy that far along, demonstrating that it was already unhealthy.  My doctor said if it did not fall by enough (I think she wanted 30%), I'd have to have another shot, but most people only needed one shot.  If I had another shot, my doctor said no trying to make babies for six months instead of three.

A second shot was unthinkable.

A week later, my HCG was 546--it had not fallen enough and I needed another shot.  That was the first time I really broke down and sobbed.  Up until that point, I was in survival mode, I think.  Hearing I needed a second shot was even more devastating than the original diagnosis.

Strange, right?

[Although I will say this--to this day my husband and I proudly joke that our first pregnancy was a tough little guy and he was not coming out without a fight.]

The doctor's warning about no trying to make babies for six months after two shots ended up not being as much of a sacrifice as I thought it was going to be.... because that's almost how long it took for me to recover.

E. Recovery--The Fall of HCG

It took a little over two months (of dreaded weekly blood draws--the bruises on my arms made me look like a junkie) for my HCG to fall to "not pregnant" levels (and the weeks where it barely fell were truly irritating).  One of the things I found most frustrating about the recovery from the ectopic pregnancy was not knowing how long it would take for my numbers to fall, so here are my numbers (to give you a sense of one person's experience): 

05/21/2009      682

05/28/2009      546

06/04/2009      240

06/06/2009      180

06/07/2009      180

06/12/2009      135

06/19/2009      65

06/26/2009      65

07/06/2009      35

07/13/2009      29

07/20/2009      13

07/27/2009      5

I was pretty stoked when my levels finally fell to 5, aka no longer pregnant.  Please pass the Merlot.  No honey, I'm still not in the mood for sex.  Maybe tomorrow.

F. Recovery -- The Crimson Tide

The hardest part of the recovery was the blood loss.  I did not expect it.  And I bled A LOT.  I had period-like bleeding for one hundred and nine days.  ONE HUNDRED AND NINE DAYS.  And this is with the banana pads.  Boooooo.

Not only was I bleeding outside, but I also had internal bleeding.  To the best of my understanding, the internal bleeding was caused at least in part by my body trying to flush the embryo out of my tube.  It really sucked.  First, my abdomen was distended.  I looked perpetually bloated, which I guess I was.  Second, and this is something I’m a little embarrassed writing even now, going to the bathroom (number two) was agonizing!  I would, literally, sit on the toilet and dig my nails into my thighs when I was going to the bathroom.  My doctor told me that all of the blood sitting around my organs caused them to be irritated, and “straining” to go to the bathroom caused the pain.  (I am NOT a "strainer"!)  All I know is that at work one time I almost screamed out in the bathroom.  That would’ve been awkward.  

The combination of the internal and external bleeding had the expected consequences.  I bruised more easily.  I was weak.  I was dizzy.  The experience reminded me—blood is good.

The doctors measured my hemoglobin during that time and confirmed that I lost a lot of blood. 

Tomorrow I'm going to tell the story about how I almost died, too.  Fun times!