Why Would HCG Double, But No Gestational Sac?

QUESTION

Dear Ms Ultrasound,
I took a home test and got a positive result on June 4th and June 5th. My LMP started on May 22nd. On June 5th I went to the ER due to spotting. They did a Beta HCG with a result of 2.4 and an US showing nothing and referred me to my OB.

On Monday June 7th another BHCG was done with a result of 4.7. All seemed to be progressing well but I was still spotting. On June 14th due to spotting my OB did another BHCG with a result of 3083. A UTI was detected during that same visit and I was placed on Keflex. On June 19th I was having a constant abdominal pain and returned to the ER another BHCG was performed with a reading of 7287 and a 2nd US showing nothing.

The pain was attributed to my UTI and I was sent home. On June 22nd I started bleeding a bit heavier and passing small clots the blood was and is bright red. June 23rd the bleeding got pretty heavy and I returned to the ER. A BHCG was done the reading was 8438 and an US was done.The radiologist said that since there was no gestational sac visible that it did not appear to be a viable pregnancy. I am still bleeding but there has been no cramping, honestly it feels like a normal period. My OB just said everything still looked ok just to rest and take it easy.

I am scared.

I am 35 and have been told for 18 years that I would never conceive due to PCOS so this is definitely a wanted surprise. Do you feel that this is a viable pregnancy?

ANSWER

Hello, My first thought after reading your story is how wonderful it is that you conceived after 18 yrs! You now know you are able to conceive.

From the dates you gave me, you seem like you were premature in doing your first pregnancy test. A LMP of May 22 only puts you on June 4 at conception. Did you give me the correct LMP? If these are the correct dates, you might consider the bleeding you had early June was implantation bleeding. Sometimes when the egg implants into the uterus it causes some light bleeding.

Next you explain that your HCG is increasing appropriately. This would all be OK if on the ultrasound a gestational sac was seen. A sac should be seen with a 7000 HCG level. In your case I am worried that your hormone levels are increasing without a gestational sac in the uterus. When a woman presents with a positive pregnancy test and HCG levels at least doubling every 24 to 48 hours, a tubal or ectopic pregnancy must be taken into consideration. A tubal pregnancy is when the fertilized egg stops progressing through the fallopian tube and begins growing in the tube.

Has your doctor talked to you about that possibility? If not it would be prudent to ask about the possibility. I would hope that your doctor has already considered this and ruled it out, but I would still ask, especially if your pain and cramping continues. The answer is easily found with another HCG level taken. If the levels are considerably lower, then you have had a miscarriage. It they are the same or still increasing, another ultrasound should be done to show the pregnancy is in the uterus.

Before anyone can tell you about viability more tests must be done.

-- Jane, RDMS

P.S. My pet peeve is when doctors tell women they will never conceive! I have seen too many miracles to count, from women who have been told they will never conceive and have presented with normal pregnancies!

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Jane Foley

Jane Foley has worked as a Sonographer (Ultrasound Technologist) since 1979. Jane has lived and worked in many parts of the world including Saudi Arabia. She is a Registered Diagnostic Medical Sonographer or RDMS. She pulls a wealth of information from her experience in the field of Radiology and her interactions with such a broad cross-section of cultures she has visited. She now makes her home on the island of Maui with her English husband, Michael.

Jane is also one of the nations leading experts in what she calls Pregnant Dreams. A pregnant dream is a dream about an unborn child that has accurate, predictive information about the baby or pregnancy. She has been researching the predictive value of dreams surrounding pregnancy for many years. Jane has found her ultrasound clinic to be the perfect laboratory for the study of dreams and pregnancy. She has been asking her pregnant patients for many years about their dreams. The stories they share are definitely book worthy. Jane's website, www.Janefoley.com explains the Pregnant Dream phenomenon and shares sample stories from around the world.

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