There was something (fluid filled cyst) in/on my cervix. That cyst was presumably the pregnancy, though he could not be 100% sure, he felt pretty certain given the position and size of the cyst that it was the pregnancy.
They could not tell whether it was passing through - a uterine pregnancy finally miscarrying, as my cramps and new spotting would suggest, or if it was a cervical ectopic pregnancy. The fact that they picked up Nabothian cysts (plural) at the last u/s and then this cyst where it is makes the OB think it was indeed an ectopic.
The options were d&c, which he didn't recommend and I immediately said no to; methotrexate; or wait and see if it passed or not. He also said there was a possibility that the fluid filled cyst was not the pregnancy, and they simply couldn't see it. He told me that if it were a cervical ectopic, then the risk for hemorrhage was much higher - either in a d&c (hence why he did not recommend it) or if the ectopic pregnancy were to try to miscarry. Which is why he recommended the methotrexate as the safest option. It would stop the growth on the cervix if it was an ectopic, and should it just be a cyst and a tubal pregnancy they couldn't see existed, it would also take care of that. So, that is what I did. One shot in each arm; I will be monitored until hcg is at 0 and I can start ttc after a full cycle.
That was all fine.
The raging, flaming, infuriating part came next. He indeed wanted to talk to me about my weight. In addition to telling me it was irresponsible to be trying to conceive at my weight and that I was extremely high-risk (which isn't true, as my blood pressure is normal and my glucose is normal and my thyroid is normal), and that I would die of heart attack or stroke in the next 20 years (my cholesterol is also normal), he told me I needed to put off ttc for a year and lose 100 pounds.
But oh, no, he's not done. And that part I expected, though not with such dramatic flair (I can't quite capture the disgust in his voice at the gall I show in ttc and just how high-risk I am, even though I'm basically healthy).
Additionally, I am currently consuming 3000-4000 calories a day just to maintain my current weight (no, I'm not) and that if I just eat like a normal person I will lose 2 pounds a week. Oh, and also - the best part - I need to eat smaller portions. This man, who knows nothing about my eating habits, having met me 20 minutes before and asked only if I eat junk food, sweets and consume sugary drinks, tells me the thing is my stomach is so stretched out from all the ginormous portions I eat that it will take awhile before I know I'm full. So I also need to slow down my eating, because it takes about 15 minutes for the stomach to signal that it's full, and I'm on my third or fourth cheeseburger by then, thinking I'm still hungry. I was gripping the table so hard my knuckles turned white, because otherwise I would have punched him. I start getting shaky and teary thinking about it. That is the rudest someone has ever been to me in my life and I'm furious about how he spoke to me.
So that's the update.I feel ok - crampy and bleedy, which sucks, but I'm ok. The one month off ttc sucks, but hey, maybe I can lose some of the weight that so disgusts this OB. I told the midwife about the appointment and relayed what he said, and she was pretty upset. I don't mean to start anything, but it was utterly inappropriate. It's one thing to nicely point out the risks of pregnany (and health) at my weight, it's actually his job. But to be a raging dick about it (in every paternalistic, chauvenistic sense of the word) was actually infuriating.
But I'm still glad to have (some) answer and for it to be drawing to a close.