Confusion around HCG levels

[adgal]

Hi Dr. Brown,

You were so helpful when I was suffering recurrent miscarriage in the past.  I now have a beautiful almost 2 year old, and have found myself pregnant again.  I am very confused about my RE's response to my HCG levels.  I am hoping you can provide some insight.

I am 42, and this is my 9th pregnancy.  I have one child.  All my pregnancies were naturally conceived.  I now see an RE who specializes in recurrent loss.  Unfortunately, there wasn't much they could do for me with the exception of donor eggs which is a very difficult thing to aquire in Canada.  It is illegal here to buy them.  So we tried again.  I am currently almost 5 weeks pregnant.  My first hcg test at 14dpo was 256.  Perfect.  At 16dpo they went to 597.  Again, things look great.  At 18dpo they only rose to 872.  My RE's office called to tell me, and initially said it was "good news".  I questioned the fact that they had not doubled in 48 hours.  Her response was "Dr. reviewed, and they are at an appropriate level for where you are at.  That's it, no other explanation.  I am so upset, and cannot reach them for clarification.  I am having them tested again next Tuesday...a very long 5 days away.  How can it be ok that they only rose approximately 50% in 48 hours when they are still below 1200?  I also told them that the intense nausea I had yesterday seemed almost gone today.  No response at all.  I am just a wreck about this, and for me, the worst thing is being in limbo like this.   I know you can't diagnose over the internet, but am wondering what your thoughts are on their response.

I should add.  I am on 200mg X 3 prometrium, baby asprin and fish oil (along with maternal vitamins).  I'm not having any bleeding, but am assuming that the prometrium would prevent that anyway.  My first ultrasound is scheduled for Dec. 5th. Thanks so much.

[Elaine Brown, MD]

Hi!
Your baby is soooo beautiful!
I'm sorry that your doctor's office was so abrupt on the phone.  In my experience that usually indicates that the person you are speaking to doesn't understand the information that they are relaying and therefore can't do any further interpretation.  It also is sometimes a new employee that just doesn't quite know what to say.
Give your history, I must admit that I am concerned.  The hcg value should rise by 60-100% in 48 hours.  You ALMOST squeaked that out, so I would most definitely NOT say that another miscarriage is in store.  I would tend to be cautious though, and always am anytime the hcg values are not rising exuberantly.  There is not anything that I would do differently. (other than perhaps test your values sooner).  You are at very low risk for an ectopic pregnancy, but unfortunately, at very high risk for another miscarriage.
Having said that though, there could be other reasons for the numbers to be low, such as statistics and lab technique.
I really hope that your next number is undisputably above the range at which you can have an ultrasound and get the answer AND further, that the anwer is another healthy pregnancy.
Good luck!
Dr B

[adgal]

Hi Dr. Brown.  I am not certain if you follow any of these threads, but just in case you do, I wanted to update you.  This is in fact an etopic pregnancy. I appreciate your response a great deal.  It was honest, and that is so important.  Thanks so much again, and I wish you well.

[Lou_x19]

I've had the implant in 3 years now was due out at the end of October and I was given the pill but I missed the last few of the packet. I havent had a period since June because of the inplant. My boyfriend and I have had intercourse 3 times from the 16th november where he has ejaculated in me, I've been feeling more tired and a lot more sick and I've been more moody than ever! Also when my nipples rub against my bra they are really sore and tingly and I get really bad headaches from time to time. I've took 3 hpt and all have came back negative! Is there still a chance I could be pregnant? If any of you's could help i'd really appreciate it, thanks!

[adgal]

Thank you so much!  Your explanation was exactly the kind of info I was looking for.  I did reach them again today, and they did in fact send me for an HCG test again this afternoon, results tomorrow.  They offered me an earlier ultrasound sound, but that seemed rather pointless given that having one earlier might just cause additional stress.  So I guess we shall see.  They told me that their lack of concern about my levels was because they are still going up, and they are falling in the normal range for where I am at (which made no sense to me as I had always thought it was about the increase, not the actual level).  Anyway, we shall see what happens.

Thanks again so much, and thanks for the compliment on my baby.  I think he is pretty fantastic as well.  And a miracle, 5 miscarriages and born just a week before I turned 41.  I am nothing if not stubborn..lol.  Happy Holidays to you and your family!