very high slow rising HCG level, vanishing twin or ectopic?

[suziqz]

Hi,

I had a miscarriage on Sept 27th at 5.5 weeks.  Not realizing I could get pregnant so soon I had unprotected sex on Oct 4. On oct 13th I noticed slight spotting so I took a HPT (at 9:00PM) and it was very positive just 9 days after the possible conception.  The test line appeared faster and was much darker than the control line, I had a similar experience with my first pregnancy that started out as twins.  I went to the doc on Oct.18th (~4 weeks preg?) had an ultrasound and HCG test. The Doc saw nothing on the ultrasound, but the HCG levels were almost 1200.  I went back two days later had another ultrasound and HCG test.  Once again the ultrasound showed nothing and the HCG "haven't risen as expected". He seems to pushing the idea that it is a failed or ectopic pregnancy.  

My questions are 1) Isn't an Hcg of 1200 very high for 4wks and possibly indicitive of a multiple conception?  2) Is it that unusual not to see anything on the ultrasound at 4 weeks?  3) Is it possible that my unchanged HCG level 2 days later have something to do with a "vanishing twin" situation rather than an ectopic pregnancy.  I am going back to the doc in 1 week.  He seems eager to treat for ectopic, I know time is of the essence and ectopic pregnancies can be dangerous but I am almost 37 years old and I have had 3 miscarriages this year.  If there is a chance this is a normal healthy pregnancy I do not want to take the drastic measures of treating an ectopic.  Any advice would be appreciated!

[adgal]

An ultrasound done at 4-5 weeks will usually show at least a sac, especially if done through transvaginal ultrasound.  However, being uncertain about your dates, you may not be where you think you are.  

The challenge here is is that if it is in fact etopic, that is nothing to mess around with.  While I can understand not wanting to rush, you also don't want to leave it too long.  If this were me, and I wanted to make sure, I might seek a second opinion, or request a 2nd ultraound fairly quickly.  At 5 weeks there most definately would be something seen on a transvaginal ultrasound.  Also with transvaginal, at 1200 they can usually see something.  

I wish you well, and hope all is ok.  Please let us know how you are doing.

[trying43]

I believe your hcg levels must be over 2500 to see anything on ultrasound.  You may be a 3 day riser instead of two.  I wouldnt rush into anything just yet.  As long as you arent in pain or bleeding I think you could wait a week or two to see if your levels rise and if anything shows up on ultrasound.  Good luck

[Mandi218]

I would listen to what your body is telling you. Do you FEEL pregnant? Also, if it is an ectopic pregnancy, it should show on the ultrasound. 4 weeks is very early for an ultrasound and that is probably why nothing showed up. As for your HCG levels... that does sound kind of high to me, but i'm not a doctor. If I were you I would start taking precautions as if you are pregnant. Most importantly listen to what your doctor is saying because he is there to help you and for your protection! Good Luck and Keep us Posted!!