high hcg

I had an early scan today because I had some light brown with a little red spotting over the past two days. It has now resolved. My LMP was 6/22 putting me at a calculated 8 wks. I have a very irregular cycle so date of conception i really uncertain and the OB today my uterus felt more like 6 weeks and the transvaginal sonogram looked like 5 to 5 1/2 wks. He saw an intrauterine gestational sac, maybe a hint of a yolk sac, but no fetal pole or heartbeat. My cervix is closed and he no longer saw bleeding or a hematoma on the ultrasound and basically told me things seemed fine and I should have another sono in one week. He ordered basic labs and a hcg quant which I had drawn later that day and the hcg came back at 10,000.  At this level, should we have been able to see more on the ultrasound? Why would it be higher than expected based on the ultrasound age. This range is normal for 8 wks but not 5 1/2, what does this mean? Can my pregnancy still be normal with this hcg level? Should I request a repeat hcg as my ob only ordered one? I am so worried and really want this baby, and more than anything I just want to know what could cause this discrepancy between the ultrasound and the hcg level. Do I still have a chance at a normal pregnancy?

[Elaine Brown, MD]

Hi!
HCG levels are very variable!  I have seen levels all over the place.  You definitely should see the sac at this value, and you have.  The measurement of the sac would be useful, if it was more than 15 mm and there is still no yolk sac, something is not right.  Rather than another HCG (or in addition to it) I would order a progesterone level.  If the value is greater than 15 that is good. If you do have another HCG done, it most likely won't double since the value is already so high.  It should continue to rise though.  If it declines, that is bad news.
I hope everything works out for you!  
Good luck!
Dr B