Another HCG Levels Question

My LMP started May 29th.  I have been charting online with mymonthlycycles.com, which shows a history of having 32 day cycles.  We have been trying for our second child for 6 months.  I stopped using OPKs because I think they were detecting a surge around day 14 and I'd stop testing and I think what was happening is that I didn't ovulate as early as I thought I would, I'd stop testing and we'd miss the window.  So for the last cycle I intentionally didn't use the OPKs, avoided the possibility of getting pregnant with the 14 day theory  and just went with ovulation happening on day 18.  I got my BFP on Wednesday the 24th.  I had bought the tests at the store and was going to wait until Friday, thinking it was the first day I could get a positive.  I was surprised to get very strong blazing positives on two different brands of tests.  That would have been 8 DPO, if my math was right.  The next day I had my blood drawn, and I was told my HCG number was 226, and that was "low."  I was irritated by that since they never even asked if I knew how far along I would be.  They probably assumed I'd already missed my period, and maybe the numbers would be low if that were the case.  But 226 at 9 DPO seems rather high to me, with the reading I've done online since then.  I was told the progesterone numbers were fine, but wasn't given a specific number.

It seems weird to get 226 at 9 DPO.  Betasbase.info currently reports that highest level of HCG being reported at 10 DPO (the earliest they chart) is 245.  However, there was no way I could have gotten pregnant earlier than that because I was testing a theory so we avoided sex during the earlier window that would have supported ovulation closer to the 14 day point.  18 days is right on the mark, although I'm willing to concede it could have been on day 17, but earlier than that doesn't seem possible.

I'm having my blood drawn again on Monday the 29th, which according to my charting, is the day my period would be due.  I'll get those results probably on Tuesday and I'll ask for a specific number on the progesterone then as well.

My reading on high HCG numbers has pointed me in two different directions that concern me.  The bad result could be a molar pregnancy, the good result is the possibility of twins.  This is my 4th pregnancy.  My first was in 2004, resulted in a miscarriage at 8 weeks.  The second was my daughter, born in May 2008, the third was a chemical pregnancy back in February.  Because of all of this, I don't know which direction to take this.  There are no history of twins in the family, but it's my understanding that identical twins are something that just happen, and statistically it's more common with older couples.  I'm 36 and my husband is 45.  But the idea of a molar pregnancy is sitting in the back of my mind too.

Thoughts?

[AnnieBrooke]

The chart I have from the ultrasound technician at my perinatologist gives 40 - 6230 as the normal range for 14 dpo (which is when their charts start), so I wouldn't consider 226 at a possible 9 dpo either "low" or high enough to worry about a molar pregnancy.  (My guess would be that molar would be higher, given that all the way to 6230 is considered normal, and twins are not predictable by hCG numbers.)  I'm sorry, but all you can do is wait for your first ultrasound to know what you have.  

[Malenkaya]

Thank you.  I wish I would have known what the progesterone number was, she just said normal and I didn't think anything of it after she said my HCG numbers were low. Maybe she would have said those numbers were high if she'd had any clue when my LMP was.  Again, why would you say that to someone without having an idea the date on the pregnancy?

My main concern of course would be something being wrong, and molar pregnancy seems to be linked most commonly with high HCG.  The idea of twins would be exciting but isn't really expected.  It just seems like the out of the ordinary really happens to us, so the thought crossed my mind.  Our daughter, who is now 13 months, was born with Duarte Galactosemia, something we had never heard of before.  That's like a 1 in 60,000 likelihood, so I've learned never to rule anything out!

[AnnieBrooke]

The only reason I can think of for her to have told you that the number was low is if she had a date in her mine for your LMP that was further out there than it really was.  Nobody would give a relative word like low or high without a start point.  I would disregard it if you have a clear idea of when you conceived, which it sounds like you do.  

Remember, the range of normal in hCG readings is very, very wide.  Don't read much into a single reading except this -- you're pregnant!  You're going to be a mommy again!  And don't let not knowing a progesterone number bother you -- if it's normal, it's normal.

In fact, everything about your situation sounds normal to me.

[Malenkaya]

That's why I thought it was so weird.  I mean, at the time it took me aback, but then she said the progesterone numbers were good and the doctor is mainly concerned with seeing the numbers go up.  It wasn't until later that I thought to myself "what is she basing that number on?"  I had a chemical pregnancy in Feb and I had one set of betas drawn there that confirmed the miscarriage.  That was the last time anything should have been marked on my chart.  At no point did anyone ask me when my LMP was or how far along I suspected I was.  I will remember that nurse's name if/when I encounter her again.  Because I have a hard time believing the doctor would have wanted her to say that.

[AnnieBrooke]

Frankly, it sounds like she read the info from February and didn't think to ask if this was a new pregnancy.  It sounds hard to believe, since one would not draw betas in June if a pregnancy began in February, but it's also hard to understand what else she would be basing a comparison on.  She had to have a start point to even make that remark.  I would indeed tell the doc she said it.

[Malenkaya]

So I called the doctor's office this morning after getting back from the lab and having my blood drawn again.  I wanted to make sure they had on the chart when my LMP was so when they look at the numbers they really know what they're referencing.  I was told my progesterone from Thursday was 14.4 (totally normal, I guess between 9-47 is the norm for the entire first trimester) so nothing remarkable there.

It was a different nurse I spoke to and when I told her the last gal told me 226 was low, she immediately interrupted me and said "well, it is low" at which point I asked "based on what?"  Her response was "early pregnancy."  Wow, that's vague.  I had to tell her 3 times that no one ever asked me when my LMP was in order to be more specific on the numbers.  Finally she seemed to get it and asked me when it was.  When I said May 29th and I hadn't yet missed my period, I just caught the pregnancy early, she seemed to understand where I was coming from, but at that point was on the defensive and kind of rude.  She kept insisting 226 still *is* low, and the doctor is more interested in seeing the numbers rise than anything.  I get that, but way to be insensitive.

So now I'm waiting to see what this next set of numbers say.  I was hoping for results at the end of the day since I went in early, but due to the rudeness of the nurse I decided I didn't want to push it.

[peekawho]

Lots of doctors offices don't even employ RNs any longer.  They staff much less expensively now.
She might not even have been a nurse at all.  She sounds ignorant of some basics.

As Brooke says, just look for the appropriate rise.  Your numbers seem fine to me.  You cannot take a single HCG value and say anything accurate about it.

Best of luck,
Peek

[574alicia]

Hi,
If you have not even missed your period yet, your number of 226 is not low at all.  I just got my HCG levels tested and it says right on my lab sheet, 1 full week after conception 0-50 is considered normal.  2 full weeks, 20-500, 3 full weeks after conception, 500-5000.  I just had my blood drawn at 9dpo and it was 56.3, then at 16 dpo it was 1241...my doctor said that those numbers look really good.  And your 9 dpo was a lot higher than mine, I hope you get your results back soon, maybe you can go to the lab and pick them up yourself, that's what I always do.

[574alicia]

...and yes, the number does seem high, but what I have read molar pregnancies are rare they still can obviously happen but they are rare, try not to worry too much.

[Malenkaya]

I got my numbers back for today.  The nurse was much nicer this time (and it was the same girl from this morning).  My number today is 1054 at 28 days since LMP.  I'm 13 DPO and 1054 seems to continue to be off the charts I've seen.  I know the numbers vary quite widely (most say 3-426 for where I am) but even betabase.info is reporting 575 as their highest singleton at 13 DPO.

They did not repeat the progesterone because apparently the doctor was happy with the results the first time.  They will call in the morning to let me know what the doctor wants me to do next.

[peekawho]

Its too inaccurate to make any assumptions.  I'm glad they went up.  Keep us posted.

[AnnieBrooke]

The chart I have from the ultrasound technician at my perinatologist gives 40 - 6230 as the normal range for 14 dpo.  Don't know where they get their info, but only the best doctors and technicians work there.

[Malenkaya]

My doctor's office let me schedule my u/s at 7 1/2 weeks, which is 3 weeks from today.  I just found out from my mom this morning that twins run in the family through her mother, and the nurse said she thought it was definitely possible based on my numbers, from both the HCG and progesterone.  So I guess in 3 weeks we'll know.

[Malenkaya]

Just wanted to update and say that I had the u/s on 7/21 and they only saw one.  However, they dated the pregnancy at 6w2d instead of the 7w4d I think it should have been.  I go back again tomorrow to have another u/s to see about progress.

[AnnieBrooke]

Well, sorry about your hopes for twins, but how nice to have the one!  Congrats on the pregnancy!

[Malenkaya]

So my doctor's official word is that I got my BFP @ 4 DPO.  My HCG was then 225 @ 5 DPO and 1054 @ 9 DPO.  And she thinks that's perfectly normal.  I think she's possibly crazy.