Low and plateauing HCG - Anyone had simiilar experience?

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1

Hi there. I am a 30 year old woman with no known risk factors and currently 4 weeks and 6 days pregnant (ovulated sept 21). This is my first pregnancy and also my first ever cycle TTC. I went to my obgyn a few days after my positive pregnancy test to confirm with blood test but am being monitored after having my HCG levels checked. They were:

13DPO: 42

15DPO: 46

17DPO: 44

I assumed at the outset that this was a chemical pregnancy and I would start bleeding soon… But a week after my first blood test I have had no bleeding and no pain. I’ve had two transvaginal ultrasounds which were both clear.

My doctor said they would monitor and warned me to go to emergency if there was pain etc. I’m just confused as most ectopics seem to begin at higher levels. I’m just wondering if anyone has had a similar experience? Are plateauing levels with clear ultrasound definitely ectopic? If not what else could this be?

Thank you so much

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Dear confused1990,

I am so sorry to hear of the worrying time you are going through.

If scans are inconclusive, doctors would carry out a series of blood tests to check hCG levels to see if the numbers are rising as expected. However, in isolation, hCG tests only provide a part of the picture - declining levels indicate that a pregnancy has ended and will be miscarried. It can also possibly indicate an ectopic pregnancy that is “self-resolving”. Also hCG levels rising by less than 66% over 48 hours means it is likely (but not certain) that it is ectopic. If levels rise normally, they suggest the pregnancy is implanted in the uterus. You may see from this that hCG levels only indicate certain possibilities and are not in themselves a definitive guide.

Until a diagnosis is made, you pregnancy may be termed a Pregnancy of Unknown Location or PUL. This is not a diagnosis but a label until the final location can be identified with certainty. For every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; and not all of these will need treatment.

I’m sorry I cannot be more specific about what is happening and I understand how worrying it is when we are not sure what is going on with our bodies. Hopefully the your next tests will give you some clarification and as your Dr has mentioned, it is important to seek urgent medical advice with and abdominal pain, unusual bleeding, shoulder tip pain or you feel dizzy and unwell.

Sending much love,

Karen x

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3

Hi there,

I’m at the tail end of my ectopic journey for my first pregnancy (hopefully next Monday will be my final blood test) and I had similar levels to you. My starting numbers (before we realised it was ectopic) were roughly:

20DPO: 40 (Dr said that these levels were lower than expected for this stage of pregnancy)

22DPO: 38

At that point I was already miscarrying, so we left it 12 days before the next test. This is when we realised the levels were rising and I went to the hospital for further tests and scans, which is when it was found to be ectopic. The levels then were:

34DPO: 658

36DPO: 1236 (this was when I had an internal scan and they found a small mass in my tube, which turned out to be ectopic)

You might not be ectopic since everything is clear, but even with no pain there might be a risk so please keep an eye on any feelings you have. I thankfully did not have pain, just the odd very light cramp feeling, and it was only thanks to my GP having a followup blood test that it was caught early.

If you feel any shoulder-tip pain, which for me felt like I had slept funny on my left shoulder and it was slightly uncomfortable rather than painful, call the Dr right away.

I’ve my fingers crossed for you that it will all be ok. I don’t know if my ramblings were of any help, but I hope they were (even if just a little).

4

Thanks very much for your advice! My doctor is pretty sure its resolving as the latest level was 37 and I’ve now started bleeding but your story is a good reminder to keep an eye on it! Appreciate you sharing your experience.

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Just thought I’d add an update for anyone searching for similar experiences in the future. In my case my hcg went down to below 5 very quickly after I had started bleeding (37 on Monday to less than 5 by Friday). I still don’t know if it was an early failing ectopic or a uterine chemical pregnancy but my doctor seems happy for me to proceed as if it was a chemical. Very grateful for this forum for your support!