Fluctuating HCG

[ashbo]

I am under fertility treatment, with gonal injections. I tested Positive on day  9 or 10 after IUIs, with a HCG level of 575, and Progesterone of 95. I was told this was high and assumed mutiples. At day 11/12 my HCG dropped to 535 with Progesterone of 90 and was told they were concerned. Day 13/14 my HCG level was up at 700 with progesterone of 55. They waited to test again until day 16/17, the level dropped again to 600 I was not told my progesterone. They told me it was most likley etopic, no possibility of being a viable pregnacy, and they were waiting for me to miscarry. I am to get bloodwork again on 23/24.

My question is, Is there any possibility of a viable pregnacy? I have read online about heteropic but can not find any info on HCG level of heteropic Pregnancies. And if it is not a viable pregnacy why wait to end the pregnancy?

[ashbo]

I get blood work tomorrow, but as you stated they most likley can not see anything unless it comes back at 2000 or greater. I was hoping because the initial numbers were so high that it may mean I had one viable baby. I did call them with the questions you suggested, and they confirmed everything you stated. They do not beleive there is any hope. Thank you for you help.

Ashbo

[Elaine Brown, MD]

Hi!
You are obviously very knowledgeable on this subject!
I'm sorry that things didn't go better with the hcg levels, but at least it is a start.

With a heterotopic pregnancy (one in the tube and one in the uterus) you should still see a rising quantitative beta hcg.  The viable pregnancy would produce a level that should approximately double every 48 hours, and the non-viable pregnancy should add to that value. This of course doesn't rule out a non-viable heterotopic--if you follow me.

Have they offered you any ultrasounds? It can be difficult if not impossible to see anything with a quant less than 2000, but sometimes it is worth taking a peek.

I don't see any real advantage to waiting to end the pregnancy. Unless they still are holding out some slight hope. I can see some definite advantages to getting it over and done with--psychologically, as well as speeding up your next try.

One option would be to have a Dilation and curretage(d&c)--this would at least give you the answer as to whether the pregnancy is in the uterus or not--if so, they will see pregnancy tissue on the pathology analysis if not, they won't.

Have they discussed the possibility of methotrexate with you? That is a medical treatment to dissolve an ectopic pregnancy.  If the pregnancy is truly ectopic, there are many advantages to treating it medically as opposed to surgically.

I hope this helps you! I would give the clinic a ring and ask a few of these questions.  The one thing that you absolutely want to avoid without question is rupturing a tubal pregnancy while you are waiting for a miscarriage--so make sure they have a concrete plan of action for you SOON!

Good luck!

Dr B