Slow rising hcg with 'possible sacs' but on ectopic watch at 7.5 weeks??

[Dogearer]

Hi everyone! I'm hoping someone has an anecdotal story to help me sort this out, as I am a bit of a mystery to my provider right now and I am scared. I am about 7.5 weeks pregnant (LMP 3/15 but positive ovulation indicator on 4/5, ovulation symptoms until 4/8, and only once that whole cycle on 4/5.) My hcg have been as follows: 4/18 79, 4/25 676, 4/30 1700, 5/3 2700, 5/7 4500, 5/14 9000. I was placed on progesterone once my level fell from 22 to 13.5 over the course of the bloodwork. Doctor didn't love my levels but since they were climbing, has not been ruling out viability. I had some very bad localized pain near my left ovary starting 5/4 so, given my levels, they brought me in for suspected ectopic on 5/7 at around 6 weeks for u/s. The u/s showed two interuterine areas of interest, a cyst on my left ovary (where I was having pain) and a CL on my right ovary, but my tubes were clear. So, we figured the pregnancy was failing and that my hcg levels would go down...except they doubled. The next ultrasound on 5/14, at around 7 weeks showed the same two areas, except now they have doubled in size. Doctor is still not referring to them as definitive gestational sacs, mind you, and still nothing can be seen in my tubes. So, they still can't rule out ectopic as they can't even call the two areas that have gotten larger sacs yet, but my tubes are (apparently and hopefully they are right) clear. I know ectopic pregnancies can produce pseudo sacs but my provider hasn't claimed they are those either and didn't know of pseudo sacs grow...these are the exact same size, round, and both doubled in size. I am on ectopic watch: any pain, go to the ER. So far, no pain (aside from cyst) or bleeding but I feel like a bomb about the go off 😣...anyone have any experience? These sacs don't have the DDS sign they look for in declaring a gestational sac but I can find no information of what happens with pseudo sacs over time...I am 39, I have 3 lovely daughters, 6, 4 and 18 months, and have had one missed miscarriage 2.5 years ago at 10 weeks. I have all my fatigue, food aversion, sore breasts as with my healthy pregnancies but needless to say, being unable to find a definitive something with 9000 hcg is scaring me silly...

 

[BunnyN]

Sorry I don't really have any insight to offer. I just wanted to send you hugs. It must be driving you crazy not knowing what is going on. Is there any chance you are not as far along as you think?

 

[Dogearer]

Thanks BunnyN for the kind words�� my first positive test was on 4/15 and although it was very faint, it was there. So using 4/8 as conception day is probably in the right ballpark. The doctor's best guess is it a failing twin pregnancy but the fact that my hcg doubled is throwing off his theory...it's been 2 weeks on ectopic watch and it's exhausting to think you might explode any second. �� But moreso, the lack of information regarding pseudo sacs is frustrating. I really appreciate you taking the time to respond.

 

[VALiz]

Gosh, that sounds so bizarre. No real advice. At 7 weeks you should see something if it was a viable pregnancy I would think. I also have a cyst on one ovary and a corpus luteum cyst on the other and I’m almost 8 weeks pregnant. My only thought would echo the pp, that you aren’t as far along as you think but sounds like that’s not the case. Was a sac seen in the uterus at all?
Hope to you get to the bottom of the mystery soon. Uncertainty is the worst. Hugs!

 

[red_head]

I hope I don’t seem insensitive saying this; I really hope it’s okay for you, but if it is a twin pregnancy as the two sacks indicate, the levels should be quadrupling I think, rather than doubling? So it wouldn’t be rising quick enough which would indicate they aren’t okay. If you’re still taking progresterone I think that stops the body naturally miscarrying.
I’m really sorry.

 

[Dogearer]

Thanks VALiz and Red_head! Red_head: From what I understand, hcg levels are not indicative of twins per se, and everyone processes it differently, so past a certain point, US becomes a better indicator of what is going on. I've read and been told twins start off with higher hcgs but also they sometimes start off abnormally slow and play catch up as they grow. So it all depends. And I *think* progesterone supplements will slow down a miscarriage but only once hcg levels fall. VALiz: I could be a few days earlier I suppose and if this is a case where one twin stalled and the other is now picking up steam, the hcg starting slowly yet doubling makes sense maybe. I go for another US today and as of yet, nothing has exploded. I will update later! And, for anyone looking for info on pseudo sac differentiation, I found a great radiologist website-- the DDS is seen in about 60% of sacs. So not finding one doesn't mean your sac isn't gestational. Doesn't mean all is progressing well necessarily but doesn't mean you have a pseudo sac either.
I really appreciate you guys taking the time to respond. And a happy and healthy pregNancy to you VALiz!😁

 

[Dogearer]

Oh, VALiz,I meant to include: yes, 'the areas of interest that may be sacs' were found in my uterus. They were also a bit more to the side than central, which also is a sign of gestational as opposed to pseudo. One is perfectly round whereas one is a bit less perfect. Pseudo sacs tend to be elliptical or tear drop shaped. And both sacs doubled in size, and are the same size. Still no info on whether pseudo sacs continue to grow or, in the case of multiple pseudo sacs, if they tend to be the same size as each other.

 

[BunnyN]

When do you get your next scan?

 

[bdb84]

If I'm reading correctly, you are 7.5 weeks but cannot see the embryo(s)? What about yolk sacs? Are you positive of your dates?

Progesterone CAN stop your body from miscarrying if the pregnancy is not sustainable. I was on it with my pregnancy that did not progress and my body did not begin the miscarriage process until I stopped taking it. It was a very hard decision to make as I felt like the progesterone was giving me hope.

I can only imagine what all is running through your head right now. When is your next scan?

 

[Dogearer]

This afternoon! Hoping for something more conclusive. I will update as soon as I can.😊

 

[BunnyN]

Will be thinking of you. Hugs.

 

[red_head]

Good luck - I’ve got everything crossed it’s good news for you x

 

[Dogearer]

Hi BDB84! They won't even call the two areas gestational sacs yet, just 'areas of interest' because the areas lack gestional sac characteristics: early on, before the yolk sac is visible, 60% of gest sacs have a DDS, which looks like a double ring, and that is usually good enough to declare it is gest sac when it is too early to see the yolk sac. But, I should be past this ultra early stage-- usually by 7.5 weeks, you would see a definitive gest sac, yolk sac, maybe even a fetal pole...it varies a bit from person to person. I haven't found many stories like mine �� A few ectopic stories where hcg was high enough to see a baby but it was missed in the tubes despite monitoring but those usually had spotting throughout the pregnancy and low progesterone from the start. I haven't had any bleeding and my progesterone has fluctuated but never been rock bottom, as my nurse called typical ectopic cases. I've also read a few similar situations to mine where the ladies ended up having twins despite the slow rise and inability to visualize something definite at 7ish weeks. I go back today for another ultrasound and probably another blood draw. My doctor had said the progesterone will prolong the miscarriage if the hcg starts to fall but, as of my last draw, my hcg doubled, so he wants me to stay on progesterone so long as my numbers are rising. I've never been on it before. Wow, it makes me exhausted! I'm also still breastfeeding a needy 18 month old (or should say: a newly needy 18 month old since I've been pregnant) so I'm sure that isn't helping my progesterone. I will update later ��

 

[Dogearer]

Thanks for all the warm wishes ladies! I can't overstate how much it means when you are in limbo. I've always appreciated these threads...stalked them when I had my mmm a few years back. We can be such a great source of information to one another, especially when doctors are uncertain. Hugs to all!��

 

[Dogearer]

Hi ladies! Just wanted to update: the ultrasound showed just one area this time, and it had a more defined DDS. Tech confirmed it was in the right place in my uterus too, less suggestive of ectopic. I could see development in the sac but it was too small to measure. The sac itself doubled in size again to just u er 1mm. So, even though ectopic isn't completely ruled out because the yolk sac and fetal pole is still apparently too small to measure (and seeing those things in the sac is the only way to completely rule out ectopic) the odds have gone down dramatically. I am still well behind where I should be for 7.5 weeks but I'm hopeful that there is a baby in that sac, and that he can play catch up now that the twin sac is gone. Thank you all so much for your prayers and kind words! I go for another ultrasound Thursday and I will continue to update this thread for anyone who is looking for answers regarding pseudo sac differentiation.��

 

[Brightxeyes]

To be fair, maybe your dates are slightly off?

I was semi confident about my dates, but we almost failed to see anything at all. It was just before they were about to give up looking that they saw a gestational sac which was behind on size in comparison to my estimated dates. I also had a very tilted uterus, making it not only harder to find, but it can also throw the measurements off.

Follow up scan showed an incredibly tiny fetal pole, 8 days later. I was put up to a week behind my original dates.

Then by my 12 week scan, I was dated 2 days ahead of what I originally thought I was, so baby had caught up by a week!

My fingers are crossed for you!

 

[Dogearer]

Thanks Brightxeyes! I appreciate the thought. Unfortunately, I've started to miscarry naturally. I had some bleeding two nights ago and went in for an ultrasound, which showed the empty gestational sac did not progress past last week's scan. Doctor is thinking blighted ovum. I feel fortunate to be miscarrying naturally and that the pregnancy was not ectopic, despite so much inconclusiveness over the last 5 weeks. Thanks everyone for your prayers and good wishes.

 

[BunnyN]

So sorry to hear that. I am glad that at least it seems to be resolving naturally even if that is a small comfort.

 

[red_head]

I’m so sorry x

 

[VALiz]

So sorry.