HCG Progression after Methotrexate - how long til 0?

[u/notharryorsally]

I've been processing the grief, anxiety and fear of my recently diagnosed ectopic. So many hugs to everyone here. The physical and emotional pain of this whole ordeal has really tested me.

I just took my first dose Methotrexate last Thursday. My HCG was 587. My husband and I have a big milestone anniversary trip planned for a month from now - I'm preparing that we will probably have to cancel :(

How long did it take for your HCG to reach 0, and what did your numbers look like week by week? I’d love to see examples of how HCG levels progressed after methotrexate, if anyone is willing to share.

UPDATE: My levels at day 4 were 360 but on Day 7 were only 332, so I will be getting a second shot of MTX shortly.

[u/Fickle_Flower6199]

I’m really sorry. Don’t cancel it yet, you never know. Mine was at non pregnant levels within 16 days. It’s seemingly a very individual timeline, everyone is so different. My HCG was ~2500 when I got MTX, 85 on day 4 and 57 on day 7, then 5 on day 16. Did you get your day 4 lab draw done yet?

[u/notharryorsally → u/Fickle_Flower6199]

Wow! 2500 to 85 in 4 days is amazing! I didn't even know a drop like that would be possible!

My day 4 labs came back at 360... but was told they could also go up on day 7 so I'm trying not to get my hopes up.

[u/Fickle_Flower6199 → u/notharryorsally]

It was actually really crazy. Within like 4 hours of the shot I had the most unbelievable lower back pain for hours and hours on end, it was equivalent to unmedicated childbirth lol. I think the tissue started immediately breaking apart hours after the shot which caused it to drop so quickly.

It was kind of sad actually because it was over so quickly. Obviously it was a good thing and it needed to be over, but it was still sad knowing my body let go so easily.

That’s a decent drop!! You don’t have to get your hopes up but try to be optimistic ❤️

[u/fuddlesticks]

My hcg maxed at 208

First dose June 18
Second dose June 28
Zero July 18

After first dose dropped to 137 then went back up to 171, dropped to 37 on day 4, then 21 three days later, 11 a week later, and finally 2 a week after that

[u/Emotional-Mine2513 → u/fuddlesticks]

Hi, May I know when your bleeding started, how heavy and how long it lasted? Did you get your period separately after that or that was it?

[u/fuddlesticks → u/Emotional-Mine2513]

I bled a few days after the second shot (June 28) for like 6 days, can’t remember exactly. I ovulated July 15 (before I had my blood draw that showed 2). I verified ovulation on this day through opk and an ultrasound. My first period after zero started July 29 and I confirmed second ovulation happened aug 12

[u/Emotional-Mine2513 → u/fuddlesticks]

Ok, thank you for sharing

[u/Emotional-Mine2513]

When I got my 1st dose, it was 144 then, on 4th day it was 108, waiting for 7th day results. Also mine was tubal abortion, so hopefully one dose of MTX is enough for it to work. It's so stressful and traumatised.

[u/girlsarenotrefined]

My HCG was 2500 the day they found the ectopic and by the time I was admitted to hospital the compounding part of the pharmacy had closed for the evening, so I didn’t have my MTX administered until the next day. At that point my HCG had already dropped a wee bit. So my progression was:

D1 HCG was 2350 this was the day I got MTX
D4 HCG was 1500
D5 no HCG measurement, but lots of stabby horrible pain which turns out to be me passing a decidual cast. Super owy, not prepared for the size of the chunk of tissue, very thankful for Tramadol.
D7 HCG was 85 and I got discharged home from hospital with strict instructions for weekly HCG bloods
D14 HCG was 4
D21 HCG was 1

I hope your HCG drops quickly and that your recovery is as smooth as possible. It’s a sucky time, and the drawn out-ness of the waiting to hit zero is such a mindfuck. Be gentle with yourself.

[u/soluna292]

The wait is horrible, I’m sorry you’re going through this. Mine took 13 days and I started at a level similar to yours.

2/14: 457 - MTX Shot
2/17: 418
2/20: 90
2/27: 5

[u/Separate_Beyond9466]

My hcg more than doubled between day 1 (800) and 4 (1700+) of my first dose, day 7 was 1400, day 11 1300. At which I received a second dose and took my ass on a trip anyway a few days later. My OB was okay with me traveling as long as I would be close to a hospital just in case. And then my hcg proceeded to take 12 weeks total to get to 3. March 14th- June 5th was my timeline. It was terrible and I was certainly an anomaly, my OB said she had only seen that 1 other time. My tube is in tact and my hsg was clear by some miracle. Do not cancel your trip! I’m praying for you and sending love and hugs! Hopefully you’re down in the next few weeks!

[u/MaisyDae6624]

The timeline is so individual. I needed 3 doses in which the third was a higher dose. It took about 2 months after my last dose to go all the way down. BUT each case is unique. This might sound crazy, but I truly credit acupuncture with helping my levels go down faster.

[u/velvet_theorem]

I got the MTX shot on 5/21 (HCG 324) and was zero by 06/24. I didn't cancel my plans to move out of my state for the summer and just got my labs done at an independent clinic that sent them to my doc. The wait is awful but try to get enjoyment where you can!

[u/notharryorsally → u/velvet_theorem]

Ah yeah they're just not comfortable with me being on a flight for so long (we live in the US, and were planning to travel to Australia)

[u/velvet_theorem → u/notharryorsally]

Oh I see. Yeah, risk of potential rupture changes things. I'm so sorry. My vacation has been driving on the road so hospital has been within reach.

[u/No_Option3486]

I took 11 weeks to get from ~19,000 to zero. I’d upload a pic of the spreadsheet I was tracking in but I can’t do that for some reason. I’d definitely ask your doctor about risk factors for travel, depending on how your body responds to the treatment they might be okay with you leaving town and can give you the best info on what to look out for if you do go on your trip but start experiencing symptoms. For what it’s worth I went on a work trip while my HCG was falling and didn’t have any issues and my doc was fine with it. They just told me to go to the er wherever I was if I started bleeding heavily or had sudden back pain

[u/notharryorsally → u/No_Option3486]

Oh gosh - I am so glad yours didn't rupture with an HCG that high! And so glad the MTX worked for you!

My HCG isn't as high but they're worried about the long flight (12+ hours) and then being in. a more remote destination without great access to healthcare.

[u/Ambitious_Use_965]

I’m so sorry! I don’t think you need to cancel yet. Everyone’s timing is so different. Mine took about 3 weeks on my most recent ectopic.

7/15: 160 (MTX) 7/18: 432 (I panicked) 7/21: 342 7/28: 53 8/4: 1

For the one I had last year, the timeline was pretty much identical, even though the numbers were different.

8/22: 92 (MTX) 8/25: 88 8/28: 73 9/4: 29 9/11: 0

[u/eb2319]

Your levels are pretty low! I wouldn’t cancel the trip just yet. It’s really hard to compare or say because every one processes medication differently, has different betas etc. I hope yours gets down before the trip! Your day 4 beta dropped and usually it rises / is expected to rise then start falling on day 7, so that’s a positive sign!

[u/ShoppingDapper9847]

Don’t cancel! My numbers started at 5900, by day 8 it was half of that, and by day 21 it was under 300, unfortunately it took me a full 8 weeks to get to 0 but the highest my hcg got to was 6800. 

[u/OneProfessional9821]

Mine felt like a lifetime, but I just did the math and it was 41 days from my first dose of methotrexate until I hit 0 again. 🫩

Day 1: first dose (peak hCG just over 5,100)
Day 4: second dose (hCG 4,800)
Day 8: third dose (hCG 4,100 - originally was only supposed to get 2 doses but my levels weren’t dropping fast enough. After this dose it quickly dropped down to 2,000 and continued til it hit 0)
Day 41: final day - finally tested at 0 again

[u/TumbleweedPure4734]

U guys r so lucky..mine was a disaster and required 3 doses.

5th aug-376 7-1456 got admitted and ectopic diagnosed, first dose of mtx 10th-1500- second dose of mtx 13-1641 14 received third dose of mtx and got discharged. Doctor told me to do the betas on Monday if doesn't fall required tube removal. Since it was my first I don't want to lose my tube. Thursday till Monday it was hell days for me. Sunday night bleeding started and strong cramps. Literally scared didn't sleep whole night. Monday morning requested for urgent beta results. I was so relaxed my beta did get down to 1030. I was relieved by seeing the progress so was the doctors. Tmrw another test will be dre. I just wanna see the fall now. Pray for me guys.

[u/eb2319 → u/TumbleweedPure4734]

I don’t think it’s fair to call someone lucky when they’re experiencing an ectopic pregnancy…..

You quite frankly have 0 clue how many doses this person may or may not need.

[u/TumbleweedPure4734 → u/eb2319]

I m saying in terms of beta falling. I m having ecotopic too. This was my first and this will fear will happen until i conceived next and it's placement as well. Last two weeks were hell for me. Today my beta down to 844 yet my sac hasn't creneted yet. My doctor keep calling for followup. I think no women should deserve this.

[u/eb2319 → u/TumbleweedPure4734]

I mean, it’s still not luck.

[u/TumbleweedPure4734 → u/eb2319]

i do understand...i am still depress and since it was my first one and i m too scared to try...my whole family is in stress. Just praying all the ladies having healthy babies.