Should we assume miscarriage with hcg levels going down

Alab-

Why were your HCG's done so far apart? Did you ever have a progesterone level checked? HCG does not continue doubling after it reaches about 3,000 & can even plateau at this point. Your number did not drop drastically, but I still don't think it is a great sign that it went down. It is very hard to tell what is going on at this point but I am VERY surprised that your doc did not order an US immediately. One of the major worries with abnormal HCG levels like yours is an ectopic pregnancy or a pregnancy that is outside of the uterus. This is a very serious condition & is not considered a viable pregnancy but can cause HCG levels to stay high & even continue to rise. I think that the chances of this being a viable pregnancy are extremely small. I would get in for an US tomorrow, at an HCG of 1500+ you can see a sac inside the uterus & if there is not a sac then this is VERY concerning for ectopic. Do you have any pain on one side of the abdomen or the other? If you do, then you should go to the ER immediately. I would demand an US tomorrow & don't take no for an answer. Waiting until next week is extremely dangerous as an ectopic pregnancy can be a life threatening condition if not treated right away. I am not meaning to scare you but, as an RN, this story makes me extremely nervous & I do not think it is smart to wait any longer. If you have any other questions please let me know but I really think this needs to be dealt with immediately. Good Luck, I am sorry I dont have better news for you.

Like Megan said, an Ultrasound is the best way of knowing now

*****BabyDust*****

Thank you Megan for leaving such an informative post. We did go to the ER and they found my pregnancy to be ectopic. We are both so devastated and lost. Neither one of us wants to go back to the Dr were have been seeing. Thank you again. They said I may still need surgery but gave me two shots of trex-something. I am so worried about our chances of ever getting pregnant again.

Alab-

I actually had an ectopic pregnancy 2 yrs ago, was treated with Methotrexate & am now pregnant with a viable pregnancy. Even if one of your tubes was damaged many many women get pregnant without issue with only one! I actually only have one functioning tube & obviously was still able to conceive. After your HCG goes down they should do an HSG to check to status of your tubes before TTC again. I know this is very difficult, but please know that it does get easier & there is light at the end of the tunnel. I am so glad that you went in, I was Sooo worried about you given the levels you reported. I understand you not wanting to go back to the doc that missed this, I would find a new OB ASAP. I think sometimes docs don't think about ectopic pregnancy if the patient is not having pain but it is better to treat an ectopic before the patient develops pain & then ruptures. When are you going back in for another HCG? I hope that you will be able to avoid surgery, methotrexate is a very effective treatment usually. Hang in there, things will get better.

Yes, I am so glad we did go in first thing this morning. My Ob/gyn wasn't going to do an US for another two weeks and I don't think I could've lived waiting and not knowing what was going on. Plus who knows what could've happened in the meantime... Let alone the risk it was causing... My Husband is so upset w/ the Dr, I am just trying to stay positive with the fact that I did ovulate, for the first time in a long time. Your post definitly prompted me to wake my Husband and head to the ER. We were at the ER less than an hour after I read your post. I really appreciate it. At the ER they could not believe my regular Dr hadn't checked things out.

What can I expect, honestly, from these injections? They kind of skimmed over the side effects and said I may have a month or so till this is behind me. My HCG today was about 7000..... I just don't understand why this had to happen. We are SO ready for a family, almost over ready, if that is possible!

Alab-

I am so happy that my advice was able to help you. I think you would have been in big trouble had you waited much longer than you had. At an HCG of 7,000 your tube was probably getting ready to rupture which is a huge emergency & this can be a life threatening situation. It is amazing that you didn't have severe pain yet.

As far as any side effects from the Methotrexate, most women don't really have any. I was actually on this medication as chemotherapy for a few years & if taken regularly this is when most side effects occur. I had quite a bit of nausea for 48 hrs after each injection, some fatigue & began to have some (not a ton) hair loss after being on it weekly for about 6 months. When I received the methotrexate to treat my ectopic, I really didn't notice any side effects. Most of the symptoms that I had were due to the ectopic itself (which I'll go over), not from the medication. The med is out of your system within 24-48 hrs, so if you have not had much nausea yet, you probably will not.

They will check your HCG levels weekly until they are less than 6, which is considered negative. Be prepared that this sometimes takes a very long time. I think it took mine almost 7 weeks to be negative & you won't get a real period until then although it is common to have quite a bit of bleeding throughout this whole process. Some doctors have you come in for an HCG 4 days after the methotrexate & at this point we expect that your level will have risen some (because of the injection itself) & then by the time you have the draw at 1 wk post injection it should be down from the day 4 level. Does that make sense? If the doc did not tell you to have the day 4 draw then just expect that your first level may be higher than it was prior to the injection & this is normal. This does NOT mean that the treatment did not work. The only reason that you would need surgery at this point is if you develop SEVERE pain on the side where your ectopic is or your levels continue rising dramatically by week 2. Occasionally another injection of methotrexate has to be given if the levels aren't falling adequately. As the medication starts to work you will develop some pain as the ectopic begins to shrink & move from your tube into your uterus so that it can pass. As long as the pain is not severe, this is considered normal. Things to watch for are shoulder pain &/or fainting spells, these symptoms can be from internal bleeding & if you develop them then you need to go immediately to the ER. Just remember that the symptoms that are worrisome are going to be SEVERE & you would not need to wonder whether or not that was what I was talking about. As the ectopic migrates down into you uterus you will probably start bleeding & this may be relatively heavy. You also may have some pretty strong cramping (in the middle) & for this you can take Advil. The symptoms are pretty much just like a regular miscarriage. Usually the cramping gets pretty bad, the bleeding becomes heavy, you may pass some tissue & then the cramping starts to ease off & then the bleeding decreases. Don't be alarmed if you don't get bleeding right away, it can often take a few weeks for this process to start. If at any point you are saturating more than an overnight maxi pad per hour for more than 3-4 hours in a row then you should call your doctor. There is usually less bleeding than a regular m/c because your lining is not as thick as it would have been if the pregnancy had been in your uterus.

I am sorry for such a long post, I just wanted to make sure that you had all of the information that I would normally give to one of my patients. Good Luck & let me know any time if you have any more questions or concerns, I am always happy to try my best to answer them! Take Care & remember that things will get better from here.

Hey Megan,

Thank you so much for all of the information. I was getting worried b/c I haven't had any bleeding yet, but thanks to your explanation it sounds like it may take some more time. I haven't had any terrible pain just a few 'nudges' on my right side once in awhile. I am going for bloodwork tomorrow to check the levels. Thank you for the heads up on not being worried if they have gone up a bit. My Husbad and I are trying to be positive and think at least I finally ovulated and hoping once we can start trying again, it will happen again and everything will work out as it should.

I so wish you were my DR! Or at least part of the team..... My question now is, where do I go from here? I don't really want to go back to the same ob/gyn and we had an appt to go w/ a very popular fertility clinic just before we got the positive, so I cancelled that appointment. Should I try to find a great ob/gyn? I am more comfortable w/ female Dr's but if has been challenge finding one. How do I know if they are good? Or should I try to get back into the fertility clinic? My issue w/ fertility was I was not ovulating. However, I never really felt like my ob was working toward a diagnosis. She just kept upping the clomid and checking my day 22 progesterone. I was never checked for cysts or anything, something I was told many ob/gyn's do when a patient is on clomid. After I had done a ton of research online I suggested we add metformin (possible PCOS). She did give me the perscription for metformin when I asked for it,and it was the cycle that we began w/ the met that we got a positive. I am not the type to feel so judgemental of a DR, and I certainly don't want to come off as rude, but I feel so disappointed in mine and the fact that I feel like I need to find a new one is so frustrating. Would you go back to the same Dr? Also, I read there may not be any diagnotic testing until a patiet has had 3 preg loses. This was very concerning b/c I certainly don't want to go through this again! I want to know if my tube(s) are blocked or have some other issue NOW, not 2 more more losses from here! I just need a plan of action.....

My Hubby's plan is we are finding a new, wonderful DR and then taking a vacation ;)

Thank you again for everything, you have been so amazing.

Alab-

I think it is completely reasonable to find a new doc at this point, I certainly would if I were in your position. while you do need to find an OB, I don't think it's a bad idea to also set up an appointment with an infertility clinic. Most OB's do not monitor with US when on Clomid but an RE definitely would & you probably need an entire work up for PCOS. It is encouraging that the metformin helped you to ovulate. Although I never tested positive for PCOS, my ovaries always had many little cysts & I had very irregular cycles. My RE went ahead & tried metformin & it worked like a charm, I started ovulating & my cycles became 28-30 days!

So, this is what I would do...call & make an appointment with the RE. They will definitely do an entire work up (although you don;t need the entire m/c work up done, just an HSG to check your tubes) & then decide if Clomid + Metformin are truely the best combination of meds for you. I have found the best way to find a good OB is to call your local hospital & ask for Labor & delivery. Ask to speak to one of the RN's there & ask for her recommendation on an OB. They know the docs best & will give you their honest opinion of who they think is the best. Whenever patients call me because they are moving out of the area & wonder how to find a new OB this is what I have them do & it seems to work out great. Just ask them which female doc they like best, believe me they work with them all the time & they see all sides of them! You may have to do your HCG's with your current doc but you shouldn't really have to see her unless something isn't going as planned. I would make those calls tomorrow though & call the OB office & at least set up a consult soon because we usually schedule out pretty far for new patients. When you call the RE's office, tell them that you did have an appointment scheduled but that you cancelled it because you got a + HPT & explain what has happened since. Tell them that you really do need to be seen as soon as they can get you in at least for a consult appt. As far as the RE goes, if they can get you in with a male provider sooner than a female, I would just go for it. It is not as if they will be seeing you long term anyways & I just think it is important that you get in! Good Luck, I am glad that you are recovering well & that I have been able to reassure you a little bit. Take Care & let me know if you need anything else!