February 13, 2004
"Ectopic or Non-Viable Intrauterine Pregnancy"
Thursday's (Feb. 12th) bloodwork showed that my hcg level had climbed to 221 from 177, which was not a good sign. Since my Tuesday exam had showed a clear uterus, it became more likely that I have an ectopic pregnancy. The nurse informed me that they were going to do some more tests on the blood from Tuesday, and they'd call me Friday to let me know what the next steps would be.
This morning, the nurse called to say that all my (additional) bloodwork looked fine, so Dr. Vaughn wanted me to go ahead and receive a dose of Methotrexate. Methotrexate is a chemotherapy drug most often used to treat cancer. In some ectopic/inviable pregnancy cases, an extremely low dose of it (1/10th of a chemotherapy dose) is administered as an alternative to surgery. Dr. Vaughn said the dose I would be getting is so low that very few side effects of any sort are ever reported.
At 1 pm, Dale and I went to the pharmacy, picked up the medicine, and went to the clinic for the injection. While we were waiting, the nurse popped in and informed us that following the injection, there would be a lot of bloodwork and monitoring and there was a mandatory $500 fee that would have to be paid up front. This took us by surprise. We didn't have that much loose change on us, nor were we carrying credit cards, so I ended up spending 15 minutes trying to get through to an insurance rep to find out if they'd cover the monitoring. While I was on the phone, the nurse came back and tried to get us to go back to the waiting room, but Dale refused, so they just shuffled us to a smaller exam room while they waited on our decision.
When I finally got to speak to a live person, she said it sounded like something they'd cover and we should only have a copay, but I'm not sure she knew what she was talking about. Dr. Vaughn came in and explained that we would NOT need to produce $500 in order for me to get the injection and do the monitoring. He said they'd file with the insurance and it would all most likely be covered, so we'd just have the copay. So Dale and I agreed to the injection.
The Methotrexate was administered in two injections in each hip. The injections themselves didn't hurt, but immediately afterwards I had a terrible ache in each hip that made me walk stiffly to the waiting room, then sit gingerly in a chair. We had to wait 20-25 minutes, then the nurse took my vitals again and we were cleared to leave. We left with a stack of lab slips and instructions on all the stuff I have to avoid until the Methotrexate is out of my system (through my next full cycle). Oh, and the ache was gone, so that's a plus.
Women who have had one ectopic pregnancy are more likely to have another, which is now a huge concern for me and Dale. Before the shot, while talking to Dr. Vaughn, we asked him what he thought about In Vitro Fertilization. He said that in a woman with normal tubes, it still has a higher success rate than other methods (regular intercourse and IUI). In a woman with abnormal tubes or a history of ectopic pregnancies, the chances of a good pregnancy through other means drops while the success rate of IVF is just as high. So we asked what his opinion was of us trying with IVF next, instead of doing more IUIs. He said, "I think everyone should do IVF from the start! It's just got the best success rate."
I called our insurance provider after we got home and confirmed that they'll cover IVF. (It actually falls under the same grouping as the IUI method we'd just tried.) So, Dale and I decided that when we're able to try again, we're going to go ahead and do IVF.