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Trying for baby. Took Siphene and inj HUMOG. Got Methotrexate injection after a positive pregnancy. Use of the medicine?

Mar 2016
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Hello doctor,
We have been trying for baby for last 1.5 years. After consulting with doctors, took Siphene 50 and inj HUMOG 150 iu for about 6 cycles in last one year.
Cycle which started on 25-Jan-2013, i didn't take any medicine and on 4-Mar urine test confirmed pregnancy. After that doctor asked to go for Beta HCG test, which came 1435. On 6-Mar HCG level was 3430.
On 9-Mar I went for scanning and scanner told that it's a tubal pregnancy and we should consult with doctor immediately. HCG level on 9-Mar was 5830.
On 9-Mar itself inj Methotrexate was given and i was told to go for Beta HCG test on 13-Mar.
Today (13-Mar) HCG level is 9935, which has increased further but after injection we were expecting it to come down.
Please advise what happens normally is such cases. Can it be treated with medicine or i might need to be operated?

Posted Mon, 1 Apr 2013 in Women's Health
Answered by Dr. S Patra 1 hour later

Thanks for writing to us. I am trying to solve your problem.

Tubal pregnancy is a serious medical condition and may be life-threatening if it remains untreated. Abnormal rise of of beta-HCG is predominant feature of ectopic pregnancy.

Tubal pregnancy can be treated either medically or surgically. These are as follows:

MEDICAL TREATMENT- It can be effectively treated with methotrexate (first line drug of choice) in following condition only:
1) Blood beta-HCG level less than 5000 mIU/ ml. 2) Embryo with no cardiac activity 3) Ectopic mass size less than 3.5 cm.

SURGICAL TREATMENT- It is the ideal choice whether beta-HCG level does not come down after medical treatment or you are presenting with severe abdominal pain / vaginal bleeding. Tubal pregnancy can be removed by laparoscopic surgery or by laparotomy procedure.

Generally two types of surgery is done- 1) Salpingostomy- here one slit is made on fallopian tube to remove the ectopic mass. Here, fallopian tube is preserved.
2) Salpingectomy- removing of a section of fallopian tube including ectopic mass.

You may need to take methotrexate injection following surgery in resistance case of ectopic pregnancy. In such case, beta-HCG level is also to be estimated.

In conclusion, your blood beta-HCG level on 13th March is 9935 mIU/ml and it is quite high enough. Therefore, medical treatment is not preferable in your case as there is gradual rising of beta-HCG in spite of use methotrexate injection. Surgical treatment is ideal in this case.

So, please consult with your gynecologist at the earliest to assess current status of your condition by complete physical/ pelvic examination and to make decision whether urgent surgery is needed or not.

But, you must be aware of some alarming symptoms like vaginal bleeding or severe lower abdominal pain/ vomiting, high pulse rate etc. In such case, immediate hospitalization is mandatory to perform the surgery to save your life.

Hope I have answered your query. If you have any further questions I will be happy to help.

Wish your good health & take care yourself.

Dr Soumen
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