PUL, expectant management and fluctuating HCG

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Hi all, I’m 7 weeks and 4 days pregnant. Last week I started bleeding, they did my first HCG blood draw and it was determined that my pregnancy is non viable. At the time they suspected a miscarriage but told me to keep checking my HCG levels.

My HCG:
November 20: 123
November 22: 136
November 24: 71
November 26: 92
November 29: 202

I’ve already had 4 or 5 ultrasounds, no one can see anything, so for now the official diagnosis is still PUL.
My OBGYN today told me that because I don’t have any pains, nothing on the ultrasounds, and my HCG levels are still low, that we can still give it a few days and see if it starts dropping again. She said this recent rise is concerning but given my overall situation it doesn’t seem to warrant a surgery yet and we can wait until Tuesday to do another blood draw.
Does this really sound like an ok solution? Is it possible for HCG to fluctuate before resolving itself?
Obviously I will go to A&E if I feel any sudden pains or anything but I’m not sure if it’s really a good idea to wait until Tuesday.

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Hi modestmouse,

I am so sorry to hear that you are going through this concerning time. We do hear from women with an odd spike 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 why your levels fluctuate in such a manner. It is good that you are continuing to be monitored throughout this situation, and I encourage you to ask your medical team any questions that you have. There can be much we don’t understand, and we can advocate for ourselves to gain greater clarity.

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

As you mention, please keep an eye on any emerging symptoms and seek care if you are feeling increasingly unwell or suffer shoulder tip pain or intense bleeding.

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

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