Slow Betas and Likely MC or Ectopic. Advice?

manders85-2 · November 2017

Hi Ladies, I was on the first trimester board but am popping over here after some discouraging beta hcgs in the past few days.

I'm curious to hear any of your experiences on slow rising betas, ectopic or miscarriage so I can help to better prepare myself and my husband.

We got our first positive home pregnancy test last week. We have been TTC for 2 years. 3 failed IUIs and this time got pregnant naturally! That has me feeling better because for a while I had no hope we could even get pregnant.

Anyway, we went in for BETA hcg monitoring with our RE shortly after the positive test around 15 DPO and got a first hcg back at 32.

Beta 1 = 32
Beta 2 = 58 (48 hours later)
Beta 3 = 83 (48 hours later)
Beta 4 = 91 (48 hours later)

This 91 is obviously the most odd and my Dr's office gave me ectopic precautions given the rise and now super slow rise. Does any of this look similar to any one's situation? I'd really appreciate your advice or insights into what happened with you with these dismal HCGs.

dpjennifer · November 2017

manders85-2 Sorry for the stressful situation. Those are pretty low numbers, especially for how far along I'd assume you'd be; however, they are continuing to go up. I do know some ladies previously on the TTCAL board who had slow rising betas and went on to have successful pregnancies. But, I also know ladies with slow rising betas who ended up with a MC or ectopic.
I can't personally help through my situation because all my pregnancies ended in MC, BUT all of my hcg numbers ended up going down from the first to second beta.
I really hope you get some better news soon. When is your next beta?

manders85-2 · November 2017

Thanks @dpjennifer for your input. My next beta is tmw -- so another 48 hours later. I know it will be really helpful to see what's going on. I am on prometrium suppositories and wondering when they'll have me stop those... I imagine after my beta drops or my beta just plateaus?

manders85-2 · November 2017

Just an update, my fifth beta is showing a definite plateau and went from 91 to 95.6. They officially had me stop the prometrium and now we wait for it to go down. Now I'm Judy hopefully it's a MC versus ectopic!

kathrenne · November 2017

Generally that type of bhcg result is an earmark of an ectopic pregnancy, and I would also point out that even if you miscarry naturally, it is likely ectopic; it's not really an "either/or" type of thing, and most of my ectopic pregnancies miscarried without treatment. Two had to be terminated- even if that ends up being the route you have to take, with nothing seen on ultrasound and a bhcg that low, assuming you have no liver issues, it's "easily" (physically, not emotionally) treated with an injection of methatrexate without needing a D&C.

You mentioned three failed IUIs, have you had any testing done to see if there are blockages in your tubes? The combination of multiple failed IUIs and an ectopic pregnancy could definitely be caused by tubal scarring, and if that's true, you could start narrowing treatment options down to something like IVF.

dpjennifer · November 2017

manders85-2 Sorry you're going through this again.

I hope it ends up not being an ectopic.

acunamatada · November 2017

@manders85-2 so sorry you're going through this, I hope it is not ectopic. I had one in May, they're a special kind of hell. Please go easy on yourself until your betas are down to zero. If there is any silver lining in this situation, they caught it early, and there's a good possiblilty your body could resolve it on its own. If not, there are non-surgical, very effective options available.

manders85-2 · November 2017

Thanks for all the advice, @acunamatada and @dpjennifer and @kathrenne. I am still awaiting my darn blood test results from yesterday and am anxious to get them. Fingers crossed the hcg is going down.... Even though we could be catching the ectopic early, I know that I'd have to be 'benched' at least three months after the methotrexate. I'm really hoping I don't have to take that and we can try again. This was my first positive ever.

I have had a HSG. I had it last year and it was normal. No blockages revealed. I'll let you know my next beta when I get it!

manders85-2 · November 2017

Just got my 6th beta back. Sheesh. It went up to 107 from 96.5 after 3 days. Not good. This is more than likely looking like an ectopic, huh?
The doctor wants to do an ultrasound when I'd be 5 weeks and 5 days which is pretty much now.... I imagine they won't be able to see much since my HCG is so low. This is so odd! Fingers crossed it's just a slow growing about to demise pregnancy versus ectopic but it's not looking good.

kathrenne · November 2017

Speaking from personal experience, a "clear" hsg is only a marginal indicator of finding blockages. My own hsg showed completely normal flow through the left tube and into the pelvis, twice, actually, but when my OB finally went in to look at it, my left tube was completely severed, and it was only that the section of tube that was connected to my uterus was open and pushed directly against my ovary so sperm could get to it, but eggs had no clear bath once fertilized.

There is likely some sort of smaller blockage that can accommodate liquids, but is having a harder time with solids, regardless of how miniscule it is.

I'm not trying to be negative, so please don't take it that way, I just try to give what insight 15 consecutive losses has given me.

With that in mind, and while understanding that I get your hesitation regarding the wait time of methatrexate, it sounds, at best, abnormal, and at worst, ectopic. The part that you really have to look at the pros and construction of is that the longer it lingers, if it is ectopic, the more likely it is that it will build up scar tissue, because ectopic pregnancies are an acute physical trauma. So, the question only you can answer is, is it worth the risk of excess scar tissue and potential further and possible indectable blockages to start trying again immediately? One factor to consider is that it's possible, given this length of time, it may take you body that amount of time to get regular again.

I get it, I really do. I'm on my 16th pregnancy since August of 2014, and it's the first that's been visualized in the right place, but it required a lot of blood, sweat, and tears, plus expensive out of pocket surgeries to remove scar tissue. It's hard to be patient, but sometimes, it's better.

manders85-2 · November 2017

I'm so sorry to hear about 15 consecutive losses, @kathrenne and I really appreciate your advice. I can't even imagine going through this 15 times. My fingers are so crossed for you that this pregnancy is the one for you.

I had an ultrasound today and there was nothing seen in the uterus and nothing visualized near by ovaries or tubes besides a small cyst indicative that I ovulated from my left ovary. My doctor sounded confident that this was just an early demise that would pass soon. I have not bled at all. I'm five days off of progesterone suppositories.

I go in for another beta HCG on Friday to hopefully see some dropping numbers. I'm of course on the lookout for any one-sided pain. I really want to trust that this isn't an ectopic. One piece of advice I got from a family friend to figure this out sooner is to go in for a D&C and then check betas to rule out ectopic. If I don't bleed in a few days, I may consider it. My Nurse said my lining was *very* thick and would be a doozie of a period when it flows. Hmmm.

manders85-2 · November 2017

Beta hcg rose on Friday- 147. They want to do a MVA (manual vacuum aspiration) on Monday after one more ultrasound. I'm kind of nervous about it.

acunamatada · November 2017

@manders85-2 I hope your procedure went well. I'm assuming they're testing for evidence of an interuterine pregnancy? I hope you get some answers soon.

holly321 · November 2017

I am sorry for all you are going through. Hopefully you don't need methotrexate, but I would do some research and discuss with your doctor the wait time. I am currently getting methotrexate weekly for a molar pregnancy and current research is now indicating that you are safe to TTC after 1 ovulation cycle.

manders85-2 · November 2017

Just to follow up, we got th MVA five days ago. It was painful but quick. My beta hcg two days later dropped in half! So they think I’m out of the woods for ectopic and will test again Monday to be sure.

galactickates · November 2017

@acunamatada - I just had ectopic surgery Monday 11/20 you are completely right about it being a special kind of hell. I was 9 weeks, measuring 8+2 the day of surgery. I am sorry you had to go through that too. Did you have surgery? I know it's only been a week but I swear I feel like I've been dealing with the physical recovery for 10 years. Every minute moves so slow. I had to buy pads for the first time in my life after surgery and just sobbed in Walmart because I had no idea what I was doing and got so mad that I was going through this. Seeing it typed out it seems silly how upset I got, but it felt like the end of the world in that moment. I've been off oxy for two days but feel like I'm not ready to leave the house for long periods of time yet. How long was your physical recovery if you don't mind me asking?

acunamatada · November 2017

@galactickates ugh I'm so sorry you had to go through that, did you have any pain before hand? I'd say it took me about a week to be ready to really go outside and be a productive human. I remember the gas being really really uncomfortable.
I had a laparoscopic surgery after a rupture, followed by MTX a week or so later. The biggest problem for me was blood loss I think. I lost 2L, I could have gotten a transfusion but I opted to take iron instead (mistake). Plus there was still residue in my tube (doctor left it) and I was cramping from that too until I got MTX. After all was said and done I don't think I went back to work until about a week and a half after surgery but I have a very low impact job and I honestly just needed to get out of the house at that point.
Go very very easy on yourself, EP is so so hard. It does get better. Every day I felt a little more myself and now 6 months later I can barely see the scars.
M/c in general is really so unfair, to have to go through such a traumatic experience all while your hormones are still raging. I hope your recovery goes smoothly and you start to feel more normal soon.

galactickates · November 2017

@acunamatada - I did have pain. I thought it was all from a bladder infection but turned out my bladder was perfectly healthy. I was begging my DH to take me to the ER though Friday or Saturday before 11/20. The Dr on call reassured me that since my US came back with great results that it was just bladder spasms.... so when Monday and the truth of what was really going on was revealed.... I was horrified at what kind of damage had been done.

I don't how about you, but the time between "you need surgery" and surgery was torture for me. I haven't had my post op appointment yet, so I have no idea how I'm actually recovering. They did some blood work this morning but no results yet.

On the transfusion note, that's a hard call and I would have probably done the same thing. I didn't expect it to be.. in my head I always thought no big deal.... but when I was going into surgery and they said "do you agree to a blood transfusion if needed" I had major pause. I agreed if it was life saving of course. When they discover what's going on everything is an emergency at that point and happens so fast. Since I haven't had my follow up appointment I really don't know how bad everything was. I'm sorry you had to go through that too.

acunamatada · November 2017

@galactickates wow I'm sorry I couldn't imagine being blindsided like that. I knew mine wasn't viable from pretty early, like 5.5 weeks, I had weird bleeding and got an u/s but they saw nothing. My hcg dropped really fast so they assumed early m/c- it continued to drop but when I ruptured my hcg was only 55. The ER docs actually didn't believe I was on EP watch and kept telling me it was probably my appendix. Jokes on them I guess. As soon as I almost passed out in my bathroom from bloodloss I knew something was wrong, and it had to be EP. For me I felt like it took forever to get to the surgery part even though it was "emergent" because I was in soo much pain, I don't even remember them asking me about a blood transfusion before hand.

galactickates · November 2017

@acunamatada - that's awful about your ER docs... when the one I first saw plus the on call Dr made those mistakes it made me question all the Drs. Does anyone here know what the hell they are doing????? The Dr that actually did my surgery and figured out wth was going on - my DH nicknamed the juggernaut lol I made her my primary care. They wanted me to go straight into surgery but I decided to have breakfast before my appointment. They told me I had to come back in 8 hours... I felt like I had a bomb inside me. When I finally got to check in they asked me over and over again my name, birthdate, and why I was there.... my DH got so mad after that I had to keep saying it out loud because I could barely whisper it each time through the tears. Just awful.... even if I know it's for a good reason. I was even warned... didn't matter. But anyway.... thanks for talking to me about it. I need to go watch something funny now.

acunamatada · November 2017

@galactickates I know what you mean, I had to tell the ambulance drivers and 3-4 separate doctors my entire story in the middle of everything, like they don't know how to communicate with eachother. Feel better!

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