Ectopic Pregnancy · Methotrexate

Ectopic Pregnancy

Raw.  That’s how I felt after my diagnosis – as if someone had cracked me open, scooped out all of my insides, and sewed me back up haphazardly.  I had officially been broken.

The morning of my appointment, I was greeted with red, and clots.  I again felt the fear that this was all some sort of grandiose delusion and at any moment someone would tell me that none of this was real.  Was I currently losing our baby?

The ultrasound room felt strangely dark and ominous, not a place where I expected to hear a baby’s heartbeat.  Our technician assured us that she would let us know if she saw anything, and then proceeded to remain tight lipped throughout the procedure as she paused to draw lines or circles and print pictures.  My eyes were glued to the screen as I tried to make out what she was noticing that I so clearly could not pick up on, but I had seen enough ultrasound pictures to know what I didn’t see: a sac.  After shuffling around for about ten minutes, she ended the exam and broke her silence.  “There isn’t an embryo in your uterus, but you do have a lot of fluid which is odd; and there is something on your right ovary which makes me believe that this could be an ectopic pregnancy.”  And then she left.  

The resulting silence pierced my ears as I pulled on my bottoms and repeated to myself what would become my mantra for the day: Don’t cry.  Don’t cry.  Don’t cry.  I chewed on the inside of my cheek as a nurse led us into a room to wait for my doctor, double checking that I was sure I hadn’t been experiencing any pain for those eighteen days.  “No…nothing.”  I let the staff marvel at my body’s reaction, or lack thereof, while denial flared through my veins.  It could be a cyst, my mom has cysts, everyone has cysts!  It’s probably just a cyst.  …And a chemical pregnancy.  Once we were alone, I felt cracks beginning to form inside of me.  “I’m upset,” I explained to my husband, as hot tears began to roll down my face, “because this usually means you need surgery.”  Earlier in the week, post-diagnosis-hunting, I told my husband that I stumbled upon something saying that my symptoms could be from an ectopic pregnancy.  Once I explained what exactly that entailed, he responded with, “What?  That’s not a thing.” and now we were left facing that very real thing.  

I fell into a catatonic state while my husband played with the Mirena samples on the table and pointed out the most outrageous pamphlets on the wall (the one with a sperm meeting an egg at her front door with flowers was the winner).  My condition didn’t even earn a pamphlet – guess when you’re part of the 2% it’s not worth the paper.  For all my focus on pregnancy statistics, I was really beating the odds on this one.  I was walking a fine line between denial and devastation: How silly were we all going to feel once we realized this was one big misunderstanding?  Turns out, the only misunderstanding was between me and my body.  

Finally, my doctor breezed into the room with a handful of my ultrasound pictures, and asked to hear the story from my point of view.  It was me versus the ultrasound and my recollection of “not ovulating”, endless spotting, and lack of pain still brought her to the same conclusion: it was an ectopic pregnancy.  When I mentioned my cyst theory, she quickly dismissed it by saying that due to my positive pregnancy test and my empty (typical) uterus – there was no other feasible option.  She drew a picture to help us visualize what was happening, and then proceeded to explain what was going to happen.

IMG_4772

She provided two options and, considering I thought my only option was surgery, I felt a surge of hope for the first time that morning.

Option One: Methotrexate – a drug that they would inject via two shots to my butt which would then act as a sort of chemo and, she cringed as she said, “kill the cells”.  The shot came with its own set of conditions.

  • I’d have to stop taking my prenatal vitamins (doable)
  • Weekly blood tests would need to be performed until my hCG levels were below 5
  • We would not be able to try to conceive for another three months

Wasn’t I supposed to be laying down while she kicked me?  Three months sounds like a small price to pay in exchange for two viable tubes, but the hits wouldn’t stop coming.  She seemed optimistic and said that, though there may be scar tissue, we shouldn’t have any problem conceiving in the future and that this “didn’t take that long” to begin with (ignoring the fact that I wouldn’t call this a successful pregnancy in any way) .  

Option Two: Surgery – this one is more self explanatory, but there are still specific qualifications to require surgery (which she revealed would occur that very day if I was unable to receive the Methotrexate – talk about a change in plans).  

  • Unstable condition (I was stable physically at least)
  • Heartbeat – we did not have a heartbeat, and the next day we talked about how that was for the best as it would’ve made this entire process that much harder
  • Size – the larger the mass, the greater the odds of it bursting, the more likely that you’ll need immediate surgery.  Our little sac was measuring in at 3.4 cm, which was a mere 0.2 cm away from requiring surgery
  • HCG levels – high levels may not respond as well to Option 1

All in all, I was a stellar candidate for the medication and just needed the results of my blood test to further confirm the next step.  After examining my abdomen to triple-check my nonexistent pain (eventually I would recall that I felt the ectopic-related pain once: it seared through my abdomen while I laid in bed, leaving me incapable of doing something as simple as rolling over – my own internal straight jacket – and then swiftly released it’s hold on me), she said, “I cannot emphasize to you enough that this is no way your fault.  There’s nothing you could’ve done to prevent this.”  One giant glitch in my system.  This was all some sort of cruel joke where I finally got the pregnancy I’ve been hoping for – just not in the right place.  Like being granted a wish from a Genie, I wasn’t quite specific enough about what I wanted.  “I wish I was pregnant.” “Aha!  But you did not say where you wanted the pregnancy to be!”  Fool me once.

Her parting words were to avoid any food or drink in anticipation of potentially needing surgery.  Being a creature of habit, and not knowing what else to do with myself, I headed off to work.  This continued my ever-changing mantra:

Don’t cry on the street.

Don’t cry on the bus.

Don’t cry in the elevator.

Don’t cry at work.

Seriously, don’t cry on the bus.

My results were “positive” in the sense that I was eligible for the shots (hCG was at 480 and progesterone was lingering at a low 1).  For reasons I don’t deem worthy of investigating, they had to send the prescription to the pharmacy where I would then pick it up, bring it back to their office, and get injected with a drug that had the power to kill off my cells.  Cheery.  I felt irrevocably broken, emotionally exhausted, and just plain hungry as I waited at the pharmacy.  This gave me time to revert back to my misunderstanding theory and ponder if I even needed something so horrible injected into my body.  Wasn’t I working this out on my own?  How were my low hormone levels and spotting not indicative of my body flushing everything out?  I sent my husband a series of texts while waiting.

Me: I don’t need to do this!!! Come on – it’s healing on its own!

Now I’m reading all these things saying that I don’t need it!

Husband: But you are bleeding in your abdomen…she said you were

Me: NO no I was not!

She said in my uterus!

You’re allowed to have blood there

Husband: nooo she for sure said there was a little on the outside but mainly in your uterus

Me: Barely. She said barely.

I don’t want to to put myself through some treatment I don’t need! I don’t want to wait for three months when it could’ve worked out on its own!

Husband: Babe I don’t think this is something you can really just ride out….or should

This is the first time I’ve looked back at those texts – it’s like reading something sent by a stranger.  I was so driven by my emotions, I completely ignored all the facts – and facts are usually all I hold onto.

Right before I received the prescription, the pharmacist said that they needed to conduct an “interview” with me to confirm that I’m not pregnant.  With a deadpan manner I replied, “Well.  I am pregnant, that’s technically the problem.”  And I hated everything in that moment.  

The final visit to my doctor’s office was a numbing experience.  I was a dam waiting to burst and absolutely everything nearly set me off.  I was outraged when the receptionist greeted me with a huge smile and enthusiastic, “You’re back!” as if we were old friends and she was thrilled to see me again so soon.  I was furious when, post shots, I noticed that the nurses had gotten the liquid on what I had decided that morning was my new favorite sweater.  And I nearly lost my mind when, after applying two ridiculous-looking bandaids to my bum, one of the nurses said, “And no alcohol for two weeks.”

Wound: meet salt.

No alcohol, no intercourse, no sun, no working out – no coping mechanisms.  Everything had officially been taken from me.  Once the entire ordeal was over (and after the receptionist sent me away with a peppy, “Have a great weekend!”) I had to check my list to see if coffee was allowed, and I wandered into a Starbucks.  Yes, I want an extra shot.  Yes, I want whip cream.  …Was that woman in line flaunting her baby in front of me?  I was fueled only by caffeine and misery; my pre-breakdown time was running short.  The final bus ride on the way home was excruciatingly long.  Small hiccups of sobs escaped as I reminded myself that crying wasn’t allowed on the bus.  Why didn’t I just splurge on the damn Uber home?  

Finally, after a cruel seven hours, I was back in the safety of my own apartment.  I barely closed the door before the sobs wracked my body.  The events of the entire day slammed into me all at once and left me heaving – trying to grab quick bursts of air.  Suddenly, both my hands went numb and I dropped down to all fours while gasping,, “I can’t…I can’t…”.  If that was a bizarre side effect of the Methotrexate, I did not have the emotional capacity to address it.  I just couldn’t.  


We had the best of the worst situation.  Though I generally try to avoid playing the “it could’ve been worse” (surgery) game, because it’s equally as simple to play the “it could’ve been better” (normal pregnancy) game.  It’s a matter of trying to accept what happened and move forward as best as I can.  There have been days when I’m consumed by anger, that I feel completely betrayed by my own body, but then I try to remind myself that in a way, my body saved me.  Whether it’s true or not, I like to believe that my body was breaking down the cells well before their discovery and that’s what caused me to have minimal pain and also, for it to not rupture at 7 weeks and 2 days.  I have completely succumbed to this process – never again will I make assumptions about my cycle or ignore symptoms that are out of the ordinary.  Now, I can spend the next three months perfecting my Pregnancy Wish for our next TTC cycle. 

I wish I was pregnant…and that it implants in my uterus…and that it’s a healthy baby…and while we’re at it might as well give them my eyes and my husband’s smile and…

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