I’m (at the moment) experiencing a PUL as too early/hcg too low to pick up on ultrasound. Dr advised that I “wait to see what happens” … I go back tomorrow for another US (though they still aren’t confident they’ll see anything as hcg hardly risen)
She then talked about non intervention management for ectopic pregnancy, which quite frankly fills me with terror!
The idea of just waiting for an ectopic to pass in the hope that it doesn’t rupture.?! I know I’ll be closely monitored, but that isn’t enough to ease to fears at the moment.
Reaching out to see if there is anyone that has been through this and can offer any guidance on outcome. How long did you wait? At what stage did ectopic clear, or did you end up needing methotrexate or surgery? And how the hell did you stay sane through it all?!
I am so sorry you are going through this, it’s just awful. I had a PUL in 2017 which turned out to be an ectopic and ruptured but I was quite far along - 9/10 weeks. What is your HCG level just now and how many weeks are you? I was told after my ectopic that the protocol should be to keep someone in until a PUL is located. I can’t remember the exact HCG level which they say should be enough to show a pregnancy on an ultrasound- 1500/2000 rings a bell. My HCG level was high enough that if the pregnancy was healthy, should have shown on the ultrasound but it didn’t and at that point I should have been admitted but I was sent home. I hope you have lots of support around you right now. Go with your gut and shout loudly at the hospital if something doesn’t feel right - I was far too polite! 💞
thanks Lou9… I’m only 5+4 and hcg only 250 (was only 105 at first test). That’s why I’m freaking out so much, I don’t want to wait 2/3 weeks for levels to reach a stage where they can see and then risk a rupture.
I’ll speak to them tomorrow and see what else can be done and whether I can just push for the methotrexate now (not that I’m particularly keen on having that either).
Thanks so much for replying and I’m sorry you had to experience that. It must’ve been so traumatic for you x
Hi, I'm so sorry you're going through this, I know how utterly heartbreaking, scary and confusing it can be. I went through this last year, went for a viability scan at 7 weeks and they couldn't see anything there. My clinic didn't do hcg tests but sent me to the epu and said to stop the meds. At the EPU They poked and prodded me a bit to see if I had pain which would have suggested ectopic but I didn't have that much pain but my cervix was still closed so they couldn't entirely rule it out as they couldn't see evidence of it on the scan but couldn't locate it. They did HCG tests but I can't recall now what the level was. I had already started spotting a couple of days before so they said to just wait another week and come back for a repeat test to make sure the levels had fallen enough. Luckily for me I guess I started bleeding within a day or so and when I went back for the repeat HCG they were comfortable that it had fallen enough. I remember just being completely dumfounded as to how I could be pregnant but they couldn't locate it, I can only assume that it maybe was ectopic but resolved itself quite quickly without any intervention.I hope you don't end up needing any intervention either, thinking of you x
thank you so muchfor replying, that’s reassuring to read. I’m so hoping it passes on its own, but it’s a pretty anxious time just hoping they catch it before it ruptures.
hello lovely. So sorry to hear you are going through this. They really are scary times! I had multiple ectopics when we were trying naturally and the reason I ended up at EPU was spotting yet a positive urine pregnancy test. Both times probably was only between 4-5 weeks pregnant so way to early for a scan to show anything. So indeed classed as a PUL but the bloods they did with low HCG and progesteron, made them suspect ectopic which they warned me for. But without confirmation on a scan they wouldn’t intervene. So I ended up back at the EPU every 2-3 days for repeat HCG bloodtests and occasional scan (every 5-7 days). Which meant they kept an eye on the HCG levels not becoming too high but also at a certain level they would expect to see something on a scan. Sadly they did confirm ectopic but first one solved itself after 2-3 weeks of monitoring with bloods and scans. HCG came slowly down on its own and they kept monitoring this until below 5 with bloodtests. 2nd confirmed ectopic on a scan (started off similar as above) they saw a continues rise in HCG but too slow for normal pregnancy and once US confirmed it was in my other tube we discussed options once HCG got too high. We decided surgery to remove the tube as due to liver bloodtests of me injection wasn’t an option. I had the surgery and showed a small rupture and bleed when they removed the tube. But recovered relatively well after this. No experience on the injection but know that many women need 2 injections if one is not doing enough and they say not to become pregnancy for 6 months after you had 2 injections as can harm new pregnancy/embryo. So pro’s and con’s for each intervention so do speak to them about that. I assume they will keep monitoring you closely which will give them enough time to respond if HCG levels rise to quickly.
Really anxious times and I kept hoping it might just be a miracle and all was well but sadly they were right from the start. Not perhaps the miracle story you hope to hear but I do hope it gives you re assurance it can solve it self. In my case I had 2 further early miscarriages and they wonder if they were also ectopic but solved them self early on.
Also if they do remove the tube, you should still be able to get pregnant normally (unless this was IVF?). My first ectopic was right tube but I ovulated left ovary and the 2nd was vice versa so it doesn’t mean if 1 tube is gone you can’t get pregnant from that sides ovary.
Good luck my love! Scary and sad times and take time to rest and grief and take it easy!
thank you so much for telling me your experiences. I’m really hoping it passes on its own, and I just need to trust that they’ll closely monitor me enough before it gets to being a problem. 4 rounds of failed ivf and I get my first implant and it’s growing in the wrong sodding place. Unbelievable, but I’ll hopefully get through it soon enough x
ooh hun, so sorry to hear about this being the first positive test after few IVF attempts and then this happens. That is just heartbreaking for you. I hope you will get confirmation soon so at least you are not in limbo and can work on a plan and like I said take your time, grief, be angry, sad, whatever you feel like and be kind to yourself! ❤️
I’m so sorry to hear you’re going through this, I know how frightening it is. I had a PUL back in July, it was picked up because my HCG wasn’t rising enough. At the first scan they saw nothing so diagnosed as PUL and at the 2nd scan a few days later there was a gestational sack in my womb but they said it could be a pseudo sac which sometimes happens with ectopics. Either way I was really early on…
They offered me the injection but I decided to manage it without. We’d been ttc for 2 years and didn’t want to prolong things by having to wait a least 3 months after to try again. So I went back every week for a blood test to check that my HCG was dropping and it did, fairly rapidly - within 3 weeks it was back to zero so they actually think now that it was an early miscarriage, not an ectopic.
I had read so many awful stories about rupturing even early on but still decided against the injection, based on our situation. They have to be cautious I think because ectopics can be so dangerous.
I hope you’re okay and get some answers soon, there are Facebook groups you can join for advice as well xx
thanks so much for commenting. I’m a fairly rationale person, with a “just get on with it” attitude, but this really has turned me into a mess. My Dr wants to carry on and see for another week, monitoring my bloods and then we’ll see what happens next week.
It’s helping me hear of others that have experienced this (not that I’d wish it on anyone), but it does provide comfort knowing others experiences x
I am currently going through a similar situation. I actually thought it was a chemical pregnancy because my period started 2 days after I got my first faint but obvious positive. I wanted to proceed with trying again the following cycle, so I called my fertility clinic to let them know I'd like to get an HSG just to make sure my tubes were clear. They told me that it would be fine but also noted that the pregnancy test must be negative the day of the HSG. My clinic is 2 1/2 hours away, so I decided to continue to test to ensure I didn't drive 2 1/2 hours there just to be turned around. But in this case, my tests were even darker. So I immediately thought ectopic.
Betas have been taken and they are rising, but rising slowly and taking about 3.5 days to double. Progesterone levels were extremely low as well.
I have another appointment tomorrow and will get an ultrasound then. At this point, I believe my HCG levels are high enough to at least see it on the US so that I can rid myself of the same worry you currently have. I was supposed to get a beta today, but when i went to the lab, they told me there was no order put in (very frustrating).
Nothing has been confirmed as of yet. I also have the same fear as you. When my HCG was less than 200, the ER doctor told me he felt the risk of rupture was extremely low based on that.
I'll update you after the appointment. Keep me updated as well.
oh I’m so sorry you’re in a similar position. It’s just such a lengthy process. Best of luck going through this, I’m finding it very helpful to speak to others that have/are experiencing the same (not that I’d wish it on anyone!) x
October 25 (cycle day 28): darker but still didn’t positive
October 26-30: heavy bleeding (period flow).
October 28: beta 42
October 31: beta 77
November 1: beta 139
November 4: beta 162
November 7: beta 457
November 10: beta 818
November 15: beta 134
Doctor said he believes my body is absorbing the pregnancy on its own. Follow up bloodwork next Monday and every Monday until it goes back to being negative. Although, I do wish this pregnancy would have progressed properly, I am happy to know, it seems to be resolving on its own without the need for the shot or surgery. I’ll update next week.
thank you for the update. I’m hoping I might be doing the same, very light bleeding started today (but that could also just be coming of progesterone). I think absorbing on own is the best outcome of a really shitty situation. I hope you get through it quickly and without any pain x
I'm so sorry you are going through this. Yes I have been through this. I have had 2 ectopics. My first one was first diagnosed as a PUL and I had expectant management for about 3 weeks before they were 100% sure it was in my tube and that it wasn't going anywhere, then I had methotrexate. I went in for blood tests every 2 days and had multiple scans with 4 different consultants. Then after the methotrexate it took another 4 weeks to come down. Unfortunately ectopics can be difficult to diagnose. I understand your fear, I had this too. And having the process drawn out is very difficult too. My second was a lot quicker as I went straight in for surgery, and in one respect was easier as it was over very quickly. They should keep a close eye on you. But do go to A&E if you are in a lot of pain. The Ectopic Pregnancy Trust has an excellent website with lots of information.
thanks so much, it is helping to know this drawn out approach seems to be the norm. Have started to calm down and trust that they won’t leave it too late to rupture. What a crappy ordeal. Hoping it will pass on its own. Thanks for replying and helping to ease my worries x
just updating (I found when I was scrolling the internet I could never see many final outcomes so wanted to add for anyone who may be at the start of experiencing the same).
Yesterday (after 2 weeks of hcg abnormally rising, but still nothing on US), my hcg finally started to fall at 7 weeks.
I’m so relieved this has passed without methotrexate or surgery, the best of a really crappy situation.
We have 2 eggs on ice so we will be trying again as soon as able. I’m hoping we only need to wait for one full cycle before we can try again. Best of luck to anyone going through the same. It is so so upsetting, especially after years of ivf and never seeing a positive to have it fail, but I’m not ready to give up hope yet x
Thank you for updating. I’m so so sorry you’re going through this - it’s sounds like such a dragged out failed cycle and I’m sending you so much strength. I’m glad it sounds like you’re not going to need any surgery. Really sending all the positive vibes for you to heal from this and manage to try again as soon as you’re ready x
So sorry you are experiencing this .. I had a PUL in 2021.. my HCG was rising but not doubling .. first beta was 300, second 1000.. went for a scan at 7 weeks at which point they couldn't find anything but saw a bulge in one of my tubes was sent straight to hospital and kept in... but then hcg started doubling again they wanted to give me methotrexate however I refused this as they were so uncertain. So I opted for surgery went to a really good doctor who had previously removed endometriosis for me ... after surgery he advised it wasn't ectopic and that the bulge in my tube was a cyst which can happen in pregnancy ... at this stage my hcg was doubling again although I was now hitting 9 weeks... I had more follows up in the EPU an at 10 weeks they now saw the sac in my uterus but no fetal pole eyc again HCG was rising but not doubling again ...they wanted to continue scanning me for another number of weeks however at this stage I was just devasted and exhausted by the journey so I asked for medical management which hospital then refused .. had to go to my fertility consultant to prescribe me something to help me miscarry which thankfully happened at home.
My only concern with methotrexate is that it is a folate receptor blocker .. so anyone that takes this needs to wait a number of months before trying again as there can be risks to development of baby on future pregnancy if you get pregnant to soon after the use of this tablet.
Wishing you a speedy recovery .. for the moment I would stay the course with the hospital in the hope it might resolve itself xx
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