Based on your clinical data and the current testing we have done so far, your most probable diagnosis is and ectopic pregnancy. This is a condition when the pregnancy is located outside the uterus, usually in the fallopian tube, which can rupture and cause internal hemorrhage. In the past, this condition has always required immediate surgery. For more than five years, a medical treatment has been used to manage ectopic pregnancy. It consists of giving an injection of medication called Methotrexate (MTX). This medication works by destroying the placental cells. Although some side effects are possible, we find very few problems with using this drug. Methotrexate has been used for many years as an anticancer drug. The dosages we use to treat ecoptic pregnancy are much smaller than those used to treat cancer.

In order for a good outcome with this treatment, you must agree to the following:

1. Stop Prenatal Vitamins containing Folic Acid now. Avoid all sources of Folic Acid – Vitamins, fortified breakfast cereals. Decrease your intake of green leafy vegetables, liver, kidney, raw fruit, raw cereals.

2. Avoid alcohol for two weeks after receiving the MTX. Alcohol can increase the risk of liver damage.

3. Avoid prolonged exposure to direct sunlight or sunlamp for two weeks after receiving MTX, as your skin may be extremely sensitive.

4. The following side effects are most commonly seen (5-10%)
* Mouth sores – brush your teeth frequently with a soft brush, use a mild mouthwash and avoid hard or spicy foods which could irritate your mouth.
* Dry or burning eyes – use artificial tears, NOT Visine

5. Rare side effects include (<1%)
* Low platelet count, bruising or bleeding
* Nausea, vomiting or diarrhea
* Reversible hair loss
* Chemical hepatitis

6. Avoid intercourse until after your doctor says it is safe. Avoid becoming pregnant again for the next two months.

7. Most importantly, you must immediately call the office or go to an emergency room if you experience any significant episodes of abdominal pain or bleeding. Up to 10% of MTX-treated patients will still need surgery because of a tubal rupture and internal bleeding. This can occur several weeks after their initial diagnosis and treatment, even if the pregnancy test numbers are falling sufficiently.

You will need to be followed closely and have blood Beta hCG tests measured on a weekly basis. Therefore you will need to come back to see your doctor at least weekly for the next 4-8 weeks. This is to make sure that the medication is working. If you do not return for your appointment, you will be putting yourself in serious danger.

Some patients notice slight abdominal discomfort about 3-7 days after the medication is given as it begins to destroy the cells. Severe pain is NOT expected and you should come in immediately if this happens.