Fluctuating HCG and expectant management

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Hi there. I am roughly 4 + 5 weeks and the drs think I may have an ectopic, currently defined as a PUL but obviously very early so doubtful a scan would pick anything up. I had previous losses so they started HCG doubling last Friday, my levels over the last week have been 65,71, 65 and last one 79 which is when they scanned me (internal as well as abdominal). They said if levels continue to rise they will discuss with me methotrexate on Saturday . I have a few questions about this: it seems so drastic when levels are so low and nothing confirmed on scan. What scientific evidence points to a miscarriage in the womb not causing the same type of fluctuations? I can’t get my head around this at present?

Second,with such low HCG levels from what I’ve read expectant management is a reasonable option (as long as I remain pain free). Is this the case even if the levels continue to rise within small margins? I really would love to avoid medication as psychologically it will be extremely hard having to cope with waiting to try again as I’ve had previous losses and there’s nothing to say I want have one or more after this resolves itself,and I’m 36 in November.

Keen to hear your thoughts on this and whether anyone has had slightly rising low levels of HCG and continued to expectantly manage. Sorry to everyone that’s been through this :heart:

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Hi Queries123,

I am so sorry to hear that you are going through this worrying time. PUL leaves us with many questions and unknowns. During this time, its very important to look after yourself, and this includes ensuring that your medical team is answering all of your questions.

We do hear from women with spikes in hCG levels or levels that plateau for a while before settling with expectant and medical management with methotrexate. It is difficult to predict how quickly our levels will fall; for some, it can take up to 3 months. Unfortunately, I am not trained to advise on the management plan. I presume your doctors are looking at an overall trend, and I’d advise you to continue noting and asking your questions of them.

In regard to this period of time, it’s very important to care for yourself. We would advise not doing any heavy lifting or strenuous exercise whilst your levels are reducing. We have more information on expectant management on our website here - https://ectopic.org.uk/treating-an-ectopic-pregnancy

We are here for you throughout your journey and as long as needed.

With good wishes,

Michele

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811 (England & Wales) SC053187 (Scotland)

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Queries123:
Hi there. I am roughly 4 + 5 weeks and the drs think I may have an ectopic, currently defined as a PUL but obviously very early so doubtful a scan would pick anything up. I had previous losses so they started HCG doubling last Friday, my levels over the last week have been 65,71, 65 and last one 79 which is when they scanned me (internal as well as abdominal). They said if levels continue to rise they will discuss with me methotrexate on Saturday . I have a few questions about this: it seems so drastic when levels are so low and nothing confirmed on scan. What scientific evidence points to a miscarriage in the womb not causing the same type of fluctuations? I can’t get my head around this at present?

Second,with such low HCG levels from what I’ve read expectant management is a reasonable option (as long as I remain pain free). Is this the case even if the levels continue to rise within small margins? I really would love to avoid medication as psychologically it will be extremely hard having to cope with waiting to try again as I’ve had previous losses and there’s nothing to say I want have one or more after this resolves itself,and I’m 36 in November.

Keen to hear your thoughts on this and whether anyone has had slightly rising low levels of HCG and continued to expectantly manage. Sorry to everyone that’s been through this :heart:

Hi,

I’m sorry for what you’ve been through and I’m intrigued as to what your outcome was. I’m currently going through a similar situation and was also PUL last Tuesday. 48 hours after my hcg went from 870 to 328 and was sent home with expectant management. I had bloods done yesterday but I’m still waiting for the results. I’ve been bleeding since Saturday but they reassured me that is normal. I’d just like a definitive answer and for all this to be over with.

Regards

Gillian