My first pregnancy turned out to be ectopic and was taken care of by two methotrexate injections. Does this drug pose any risks for my future attempts? Because I did have an ectopic pregnancy, what are the odds that I will have another the next time I get pregnant?

Irene

Methotrexate is a medication that is most often used in various forms of cancer chemotherapy. It was commonly used to treat a rare condition called gestational trophoblastic (placental) disease, a precancerous or cancerous condition of the placenta. Eventually doctors discovered that methotrexate's potent antiplacental effect would allow it to effectively kill the placenta from an ectopic (tubal) pregnancy. Once the placental tissue of the ectopic pregnancy dies, the ectopic pregnancy tissue is slowly reabsorbed by the body.

Methotrexate is rapidly cleared from the body and has no lasting effects, and no effect on future pregnancies. Although an ectopic pregnancy does pose some risk to fertility because it can damage the fallopian tube, in most cases of methotrexate treatment, the fallopian tube that contained the ectopic pregnancy is found to be undamaged and open when a hysterosalpingogram (an X- ray test of the tube) is done about three to four months later.

Up to 65-85 percent of women who have had a tubal pregnancy will have a normal pregnancy next time. However, many women who have tubal pregnancies have a past history of tubal adhesions, fertility surgery or infection, which increase the risk of another tubal pregnancy. The odds of developing another tubal pregnancy are high, with risk of recurrence approaching 25 percent after a first tubal pregnancy. When you conceive again, you should receive frequent tests of the level of hCG in your blood to track the progress of the pregnancy; when the value approaches 2,000miu/ml, a transvaginal ultrasound should be scheduled to determine the location of the pregnancy.