HCG levels rise, drop, then rise again after IVF

Just wondering if anyone has experienced something similar to the following:

LMP 05/01/09
Egg retrieval 05/14/09
Transfer 3 days later
HCG level 12 days post retrieval 65
HCG level 15 days post retrieval 94
HCG level 18 days post retrieval 82
HCG level 20 days post retrieval 91
HCG level 22 days post retrieval 187
HCG level 25 days post retrieval 486

Two embryos were transferred.  My RE is not sure what is going on.  I am scheduled for an ultrasound on 06/11/09, which is one day short of 6 weeks since LMP.  After receiving the news that my levels had dropped from 94 to 82, my RE told me that I was miscarrying and to stop all meds.  Now, since my levels have started doubling they have put me back on my meds (estrogen and progesterone, which by the way, were at very high levels when I stopped taking them so I know my hormone levels are not causing a problem).  Everything I have read says that when hcg levels drop you are miscarrying but I have had no spotting and now my hcg levels are going up again.  I wondered if maybe both embryos implanted, one earlier than the other, and the first one did not survive, causing the drop in hcg levels.  That might explain why I still have increasing hcg levels now (the second embryo that implanted is now developing normally).  My doc also said we have to watch for an ectopic pregnancy.  I am just really confused right now and can't find any information on the internet about hcg levels that initially rose, then dropped, then rose again.  Any help would really be appreciated!

[peekawho]

It could be that both implanted first, and one stopped developing right away and the other is now growing.  

Hopefully, you will find out soon.  Keep us updated!

[AnnieBrooke]

The scenario peek sketched sounds most likely to me.  One embryo that is not growing at the normal rate can mask the successful growth of the other, and then when the first one fades and its influence is out of the picture, you can get a clear reading on the progress of the second one.  It's called "vanished twin," though when two embryos are simply put in by a doctor it's not like they were really ever twins.  I think (because your levels are now doubling as they should) that you are not at risk of ectopic on the one that is left.  Ectopic is marked by levels that don't double.  The one that is giving you the levels now looks like it is progressing normally.  Good luck, and keep us posted!

[kristi11871]

Hi guys,

Just got my blood levels back and hcg is dropping again, from 486 Monday to 443 today.  I am scheduled to go in tomorrow for ultrasound and discussion about whether to use a methotrexate injection or if a D&C is necessary.  I guess it will all depend on whether it was a uterine pregnancy or tubal and how much tissue developed.  Thanks for your responses.