Low Early Pregnancy 'Hormone' Levels: hCG and Progesterone

Saturday, December 22, 2007

Kenneth F. Trofatter, Jr., MD, PhD

The two recent readers shared their stories with us regarding early pregnancies complicated by “low hormone levels” and subsequently loss of their babies. Many questions arise regarding what it means to have low human chorionic gonadotrophin (hCG – the ‘pregnancy test’ hormone) or progesterone levels and what can be done about it, if anything? Do low levels mean you will lose a pregnancy? Can low levels indicate other potential problems with a pregnancy? All of these are frequently asked questions relevant to many of our readers and I will try to address them after responding to our readers’ questions below…

• At Thu Dec 20, 03:24:00 PM 2007, siniamejia said…

I am approximately 5 weeks pregnant, and had my levels of hCG checked (because I was bleeding). My doctor said my levels were really low and also my progesterone levels were low and that it looks as if this pregnancy will not turn out to be healthy. My levels were 114 Saturday and only 145 today (5 days later). He says that I should have a D&C but I refused, so he told me that I will miscarry or should. I am so upset right now because I do not want to be the one to make the decision to have that done. I feel like maybe there still is hope and maybe a couple of days from now the bleeding will stop and the numbers will increase. I am still praying and I still have hope that my baby could still make it, but my doctor really doesn’t think so. I am so hurt, I never even imagined this. I have a 8 year old son and a 5 year old daughter, which were both high risk pregnancies. My son was born at 24 weeks and weighed 1 pound at birth. He is completely healthy and normal. With my daughter, I had early contractions the whole pregnancy, not to mention that I couldn’t hold food down and needed an IV everyday in the hospital. Could this mean that my husband and I can’t have anymore children. I am still young and I lost a lot of weight. I exercise and maintain a healthy life, why could this be happening to me? It’s so painful, emotionally. Please help. Thanks.

• At Fri Dec 21, 05:54:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To siniamejia Dec 20: There is always hope, but I am afraid your doctor is correct in telling you this pregnancy will not make it. Your hormone levels are not only low, they have not risen appropriately. You have had two other children, and even if those pregnancies were complicated, that probably has nothing to do with what is going on with this pregnancy. The most common cause of an isolated miscarriage in a woman who has previously had successful pregnancies is a chromosomally abnormal baby. Fifteen to 20% of all pregnancies miscarry and MOST of those are babies that are not chromosomally normal. It is still your baby, and I know you will be sad and you will go through wondering about what "could I have done to prevent this and what could have been", but this is certainly no reason to think that you cannot ever have another baby.

With regard to a D&C, as long as you are not bleeding heavily or have any evidence of infection, you are not in any danger and don't need to do anything else at this time. Waiting is just fine under these circumstances. My only other concern is with your history of weight loss and hyperemesis with your last pregnancy. Some women who lose an excess amount of weight (and I do not know if that is true in your case) will become nutritionally depleted and/or hormonally ‘imbalanced’ and not ovulate regularly. This could also deleteriously impact your pregnancy success but if you are having regular cyclic periods, then this is not likely to be the issue in your case. My best wishes to you and thanks for reading.
Dr T

• At Thu Dec 20, 10:58:00 AM 2007, Anonymous said…
Hi, my wife just miscarried our 7 week old baby. Her hCG levels were about 2,000 at that time. The doctors said that her levels were pretty low when we did the first the pregnancy test two weeks ago. My question is could we have been able to prevent this miscarriage if they placed her on progesterone supplements early on in the pregnancy? Could there have been anything we could have done to prevent this miscarriage?

• At Fri Dec 21, 06:00:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Dec 20: Progesterone probably would not have helped at the point it was found to be “low” and may actually have been contraindicated. If you have had other children, the most likely reason for the miscarriage is that the baby was chromosomally abnormal. Most of those babies are lost in first trimester. If this was a first pregnancy, or if your wife has any other medical problems, there may be other explanations - usually hormonal or immunologic in nature. I am sorry for your loss, but this is one situation in which you should not kick yourselves for having done anything 'wrong.' Miscarriage is always sad - wondering what was, what could have been, and what could we have done different, but if there are no underlying medical conditions to have contributed to the miscarriage, then the odds are you will be successful in the future. My thoughts and best wishes are with you. Thanks for reading!
Dr T

*******

As a focus for further discussion related to these queries, let’s start with progesterone. Following ovulation, what’s left of the follicle (the corpus luteum) begins to make the hormone progesterone that helps to prepare (decidualize) the lining of the uterus (the endometrium) to receive the fertilized egg, aiding attachment and implantation of the early embryo. With implantation, the fetal trophoblast cells start producing the hormone hCG that sends a ‘message’ back to the corpus luteum to ‘stay healthy and keep making progesterone.’ Production of progesterone by the corpus luteum is necessary to support the development of the placenta during the first 7-8 weeks of the pregnancy. After that point under normal circumstances, the placenta itself takes over progesterone production at a level sufficient to maintain the pregnancy.

Decreased progesterone production following ovulation or inadequate production of hCG or placental progesterone has been found to accompany pregnancy abnormalities that result in miscarriage. Defective production of these hormones may precede by weeks the identification or loss of an abnormal pregnancy (Hahlin, et al., Hum Reprod 1990;5:622–626) or ectopic (tubal) pregnancy (Yeko, et al., Fertil Steril 1987;48:1048–1050; Ledger, et al., Hum Reprod 1994;9:157–160). Indeed, there is good evidence to suggest that serum progesterone measured in early pregnancy is the most reliable single predictor of pregnancy outcome in natural conceptions (Al-Sebai, et al., Br J Obstet Gynaecol 1995;102:364–369; Daily, et al., Am J Obstet Gynecol 1994;171:380–383) even in the absence of a pregnancy detected by ultrasound (Elson, et al., Utrasound Obstet Gynecol 2003;21:57–61). Ioannides and colleagues (Human Reprod 2005;20:741-6) demonstrated that even in IVF pregnancies supplemented with progesterone, a single serum progesterone on day 14 post-oocyte retrieval and fertilization (4 weeks gestation), could “highly (but not completely) differentiate between normal and abnormal pregnancies.” Women with viable intrauterine pregnancies “had significantly higher serum progesterone levels (median: 430, 95%CI: 390–500 nmol/l) compared to those who had either an abnormal pregnancy (72, 48–96 nmol/l; P<0.001) or failed to conceive (33, 28–37 nmol/l; P<0.001).” It is interesting to point out that as the result of their findings, they hypothesized “that endogenous progesterone is already sufficient in viable pregnancies and that exogenous progesterone administration will not rescue a pregnancy destined to result in a miscarriage.”

Although progesterone is highly effective at differentiating normal from abnormal pregnancies, it is still not routinely used at most institutions for this purpose because of the expense, inexperience of provider interpretation, and the more widespread availability and high reliability of quantitative hCG testing. hCG can usually be detected by routine blood assays within 10-11 days following conception (7-8 days by highly sensitive assays) and in the urine at 12-14 days (just preceding or coincident with the time of expected menstruation). Serial quantitative blood testing of hCG is a useful approach to evaluation of early intrauterine pregnancy viability and ectopic pregnancies. In 80-90% of normal pregnancies, hCG levels will double every 48-72 hours, peak at 8-11 weeks gestation and then fall off to a stable lower level for the rest of the pregnancy.

If hCG levels are low for a calculated gestational age, this can indicate a nonviable or ectopic pregnancy. However, it is generally recommended that decisions regarding viability not be made by a single hCG level alone. It could be low simply because the pregnancy is not quite as far along as expected (e.g., in circumstances when women ovulate later in their cycles than expected or are not “sure” of their last menstrual period) or as the result of normal variation in hCG levels in different women and different pregnancies. More ominous are situations in which the hCG is not rising appropriately over time.

However, at low levels of hCG, the woman is rarely in immediate danger, even if she has an ectopic pregnancy, so the prudent approach in situations in which the pregnancy is desired is to simply wait, repeat the hCG levels periodically, every 2-3 days, and perform an ultrasound to look for evidence of an intrauterine pregnancy when the hCG level is at the point where that becomes possible. Usually a gestational sac can be seen within the uterine cavity between 4 and 5 weeks and when the hCG is in the range of 1000-2000 mIU/mL. By 6 weeks, a ‘fetal pole’ is usually visible and the hCG is > 5000 mIU/mL; and by 7 weeks, fetal cardiac activity is readily detectable and the hCG is > 20,000. I can relate many personal experiences with patients who started out with an unexpectedly low hCG that went on to have normal, healthy pregnancies, so patience is a virtue under these circumstances.

Labels: early miscarriage, hCG, progesterone

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462 Comments:

At Sat Dec 29, 08:11:00 AM 2007, Anonymous said…

Dear Dr Trofatter,
Thank you very much for your informative and sensitive blog. Might I seek your opinion on my situation?
I am 24 years old. In the last year I have had a missed miscarriage (9 weeks) and two early miscarriages (5 weeks). No previous successful pregnancies. My clotting blood tests, taken just after the 2nd miscarriage, were normal. We are awaiting the peripheral blood karyotyping results. Thyroid function and CD3 / CD21 bloods normal. Laparoscopy excision of stage 1 endometriosis from the uterosacral ligaments; some endo left on bowel. HSG shows both tubes clear. Hysteroscopy and ultrasound confirm no structural uterine abnormalities.
We are terrified that we will never have a successful pregnancy. Aged only 24, this is an especially unexpected outcome to face. Consequently, I have two questions:
In your opinion, do I have a chance of achieving a successful pregnancy?
During my next pregnancy, what kind of prophylactic protocol might be considered? I live in the UK and there is basically no provision for the treatment of RPL. However my husband is a General Practitioner and his colleagues are willing to prescribe and help in any way they can e.g. with heparin, progesterone, prednisone and such.
Many thanks for your time and in anticipation of your response.
Liz Evans (United Kingdom)
At Sun Dec 30, 10:24:00 AM 2007, Anonymous said…

When I was pregnant with my son, who is now 19 months old I had several problems and was not provided with any answers. I recently had a miscarriage at about 6 weeks so I am growing increasingly concerned about the causes. The complications were as follows. I had the quad test done and was told I had a 40% chance of having a baby with downs--I opted to have an amnio done and that ruled out any chromosomal abnormalities--I was never told which levels were off. Then at about 26 weeks I went into premature labor and was told my placenta was beginning to calcify. I was able to hold on with the help of medication until 37 weeks. During the course of the pregnancy I had biweekly ultrasounds due to the lack of fetal movement. My son was 5 lbs. when born. I was never given any answers and I am starting to become increasingly concerned that I will not be able carry another pregnancy full term. I am just hoping you can provide any insight into my situation. Thank you!!!
At Fri Jan 04, 06:20:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Liz Dec 29: Thank you so much for writing Liz. At your age, do not panic. The overwheming odds are that you will achieve a successful pregnancy. The reproductive endocrinologists with which I work firmly believe that endometriosis contributes more to recurrent early pregnancy loss than most practitioners realize, so that may or may not be the problem in your case. Your doctors might consider 6 months of Lupron therapy to shut your ovaries down and help shrink the endometriosis and/o ovulation induction with letrazol (an aromatase inhibitor.) Another alternative is to simply begin, as empiric therapy, taking a baby aspirin (81 mg) daily with supplemental folic acid, using progesterone support starting in the second half of the cycle (even before confirming a pregnancy) and starting heparin as soon as a pregnancy is confirmed. If that gets you through first trimester, you can stop the progesterone at that point and probably stop the heparin by 20 weeks. These are just some thoughts. Good luck to you!
Dr T
At Sun Jan 06, 06:23:00 PM 2008, purrpplee said…

I have PCOS, Anti Cardiolipin Antibodies, Anti Thyroid Antibodies, and MTHFR.

We have been TTC for 2 years. I suffer from early miscarriage and I am currently going through my second one.

The first baby was conceived on Clomed and then when we lost that baby we started IVF treatment in the hopes that it would be the answer to the issues.

The second try was right after my IVF egg retrieval and they put 2 embryos in. I had taken an HCG injection for the retrieval so I couldn't do a pregnancy test for 2 weeks. I never really knew if I was pregnant because 2 weeks is all I need to conceive and miscarry and after the 2 weeks the test came out negative.

The third try they put 2 more embryos in and I didn't have to take HCG since it was a FET so the pregnancy test came back positive in 8 days. I am loosing this pregnancy as well 12/28 was day 8. The HCG was 107 on 1/2 and 74 on 1/4.

The pregnancy tests always come back positive with in 8 days and then by the 12th day my HCG levels are diminishing. I don't get it. I am on Lovenox, Foltx, PNV, Baby Aspirin, progesterone in oil shots, estrogen and synthroid.

I have 2 large bio hazard boxes with all of the needles I have been stuck with in addition to all of the bruises on my stomach and butt. I am tired of being told it is the baby when only 1 out of every 3 babies has a genetic defect that causes early term miscarriage. I have had 5 babies in me and all of them have died! There must be something missing from my treatment plan. I have 6 more frozen embryos and I don't want to put them in me if they are just going to die. Please help. Jaime
At Mon Jan 07, 03:31:00 AM 2008, archie said…

Dear Dr Trofatter, I cannot thank you enough for your extremely informative blog. It would be great if you could give your opinion regarding my condition: I am 27 years old, with a history of irregular periods. However around the 29th of december i had some spotting. Doing a home pregnancy reflected a negative result after which i met my docter who prescribed progesterone tablets to be taken thrice a day for 5 days.she said it could be to early to say anything, so after five days of medication i started bleeding but its been very light and I also have cramps. Wat would you suggest the best thing for me to do? Is something wrong with me.
At Mon Jan 07, 11:15:00 PM 2008, Kirdler said…

Hi Dr T,
Thanks for providing a great Blog. Here's my story:
I first got pregnant in Dec 06 only to discover in Feb 07 that I'd had a complete Molar pregnancy. Unfortunately even after 2 D&Cs my hCG kept rising (it was around 500,000 at one stage) and I began IM shots of Methotrexate which lasted for 4 months. I was finally given the all clear in May 07 and told to wait 6 months before trying again. In November 07, I took a faint positive home test and went to the Dr. My hormones never went above 35 before starting to drop again, and I had a couple of days of very light bleeding. We were advised to wait until my hormones returned to normal, especially given my history - however my husband and I decided to take the risk and leave it to the gods that be. My hCG went from 35 to 30 to 22 to 12 each week and then rose up to 59. I was quietly excited as I assumed I was pregnant once again, before I had even menstrated from the last miscarriage. 3 days later they were 116 and nearly 4 days after that they were only 216. One full week later they are at 817 and my ultrasound today showed nothing but a very tiny 3mm 'something' in my uterine lining. There was no sign of an ectopic pregnancy either. I would expect to be at 6 weeks pregnant at the very least so this does not seem normal - but what could be happening?
I have an appointment with my Oncologist/Gyn tomorrow who is looking after me given my Molar history. I expect I will need more blood tests over the coming weeks before we really know what is going on.
Any thoughts?
At Thu Jan 10, 09:17:00 PM 2008, Anonymous said…

Dear Doc,
I am so relieved after reading your blog. I had a USG at 7.2 weeks. Baby was perfectly normal with a good heartbeat of 154 bpm but my doctor told me about my deficient corpus luteum and put me on Susten 200 once daily for upto 14 weeks of pregnancy. SO i was really worried about the future of my pregnancy. But after reading your blog, i am really relieved as now i know that it might have started shriking in the 6th week itself. Thanks a lot. Doctor, can you please tell me what are my chances of continuing because of defficient corpus luteum.This is my 9th week of first pregnancy.I am 25 yrs old.
At Sun Jan 13, 08:18:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Purppllee Jan 6: I understand your frustration and what you have had to go through. You have lost all of these pregnancies VERY early. This suggests that there is something that something is going on that is very unfavorable to even early implantation. You could have endometriosis or some structural abnormality of the uterine cavity that is contributing to this. If you haven't had hysteroscopy done within the past year, that can be considered a place to start. If you have not been placed on metformin, that is another place to start. The REI folks I work with have found that aromatase inhibitors (letrozole) to induce ovulation(sometimes used after 4-6 months of ovulatory suppression with Lupron) can up-regulate key receptors in the endometrium and increase your chances for a successful implantation. If that failed, you might consider one of the older methods for modulating the immune response to pregnancy, prednisone therapy, white blood cell transfusions or IVIg therapy. Discuss those options with your doctors. Of course, you might actually be one of those rare cases where there is a 'genetic' incompatibility with your partner and pregnancy will not be successful. I would probably try some of the other things listed above, however, because of your PCOS, before I considered donor sperm. BTW, I am presuming you and your husband have had chromosome studies done? Best of luck to you. I know this has been rough. Dr T
At Sun Jan 13, 08:24:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Archie Jan 7: It sounds like you arre miscarrying a very early pregnancy. If you have irregular periods, there IS something wrong with you, but that is not usually something that cannot be overcome with treatment. Irregularity of menstrual cycles can put the time of fertilization out of synchrony with the 'preparation' of the endometrium (the lining of the uterus) to receive a fertilized egg. If there is a 'hormonal imbalance', that can also affect endometrial receptivity. You should probably have your doctor look for simple causes of ovulatory dysfunction, such as thyroid conditions, PCOS, elevated prolactin levels, etc. as a place to start prior to conceiving again. Thank you for reading and best wiishes to you in the future. Dr T
At Sun Jan 13, 08:28:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Kirdler Jan 7: It could be an early (but probably not normal, unfortunately) intrauterine or ectopic pregnancy. My greater concern, and I am sure that will be the concern of your oncologists, is that this is a return of your choriocarcinoma (hopefully NOT). If no pregnancy is seen by the time the hCG is in the range of 2000-5000, they will probably recommend restarting your chemotherapy. I really hope that is not the case. Thanks for reading, your questions, and the kind words. Dr T
At Sun Jan 13, 08:31:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 10: eyond 9 weeks, the corpus luteum contributed very little to support of the pregnancy because the placenta should be large enough to take over that function. The success of your pregnancy from that point on will depend on whether or not the placenta has implanted and grows properly. Sounds like you are well on your way to a successful pregnancy, so best wishes and thanks for reading. Let us know how things turn out! Dr T
At Sun Jan 13, 08:14:00 PM 2008, Anonymous said…

Dr. T.,

I am writing to see if you have any suggestions that my RE might not have mentioned.

Here is my history: 2/3/05 I had a healthy baby girl via c-section with no complications during pregnancy, 1/06 I had a misscarriage at 9 weeks and no chromosomal abnormalities were found with the fetus, 10/06 I had a miscarriage at 5 weeks and no fetal tissue testing was done bc it was so early, 8/07 I had a miscarriage at 11 weeks and no chromosomal abnormalities were found with the fetus. I have had chromosomal testing done on myself which came back normal. I have also had my prolactin, TSH, cardiolipin, and lupus anticoagulant tested and they all came back normal. I have also had a hysterosalpingogram (sp?)done and that showed nothing abnormal with the uterus and both my tubes were open.

I suspect that something is not allowing my pregnancies to form correctly, altho it has been proven that it is NOT due to a chromosomal abnormality. They have been able to tell at each of my miscarried pregnancies that something was wrong when they did the first ultrasound at 8 weeks. My RE also does not think that progesterone levels are the cause either.

Do you have any thoughts on what is causing my miscarriages or any more tests that I should have done?

Thank you for your response.

Robin
At Sun Jan 13, 11:54:00 PM 2008, Anonymous said…

Dear Doctor,

Anonymous here again. Thank you so much for your reply. I had USG again today. The baby is perfectly fine with a good heartbeart of 169 bpm and 22 mm CRL at 9W1D. Also, they have found corpus luteum of 2*2 cm in my right ovary though it may not be needed now. So i am really happy now.I can't thank you enough for relieveing me in my tough time:)
At Tue Jan 15, 10:32:00 AM 2008, coupleinlove said…

Dear Doctor T,
My wife is 41 years old and has had miscarriages (3) in the past. The last pregnancy went to 12 weeks and the baby's heart stopped beating. A D&C was ordered. We are currently overjoyed at being pregnant again. However during her second blood test to check Hcg levels, were told that it had only risen from 4600 to 4700. We are in week 7 day 1. We are doing are best to keep positive but with past history this is very difficult. She has another blood test scheduled for next week and we will see the Dr at that time as well. We are absolutely afraid of losing our baby. Is there any information you can offer concerning her age and level of Hcg and its meaning if any.
Thank you so Much for your time.
Jesse and Rosie
At Tue Jan 15, 11:35:00 PM 2008, Kirdler said…

Hi Dr T,

Well low and behold following my nervous last post regarding my low hCG levels and possible returned choriocarcinoma, my hCG levels have gone from 817 to 5000 and now to 22,700 in just over 1 week and my scan today has revealed an intrauterine pregnancy dated at 5 weeks 5 days. We didn’t see a heartbeat (which of course would have been nice) but there was a gestational sac with volume 0.7ml, containing a yolk sac and possible early fetal pole (the previous ultrasound also showed a smaller gestational sac of only 0.1cc 4 days earlier).

I just wanted to update you on my news as the excitement is slowly creeping in as I allow myself to think that I may have finally achieved a successful pregnancy. I know I still have the usual risks of miscarriage however ectopic and molar pregnancies have been ruled out, so my Oncologist is happy to refer me back to my Obstetrician for regular follow-up in 2 weeks time. There’s nothing much more we can do now other than wait!

Thanks for listening - I hope to report back with more good news in the coming months!
At Wed Jan 16, 07:22:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin Jan 13: I am not sure Robin. Is the father of your child the same as that of the pregnancies you've lost? Do you have any other medical problems? Did you go to the RE because of your losses or was he/she treating you for other causes of 'infertility.' Do you have regular periods? Have they tried any kind of empiric therapy to date to help you get through first trimester, e.g., aspirin, heparin, folic acid, metformin. Our RE folks firmly believe that subclinical endometriosis is a more common cause of early pregancy loss than has been previously recognized. They will oftern try 'ovulation induction' with letrazol as a form of 'empiric therapy', or a six month course of Lupron to suppress ovulation (and presumably endometriosis) followed by letrazol. I wish I could be of more help right now, but if any of that sounds good, ask your doctor about these options. Best wishes! Dr T
At Wed Jan 16, 07:23:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 13. Glad to hear it Girl! Let us know how things turn out. Best wishes. Dr T
At Wed Jan 16, 07:26:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Jesse and Rosie Jan 15: I am afraid that would be a rather low hCG for 7 weeks and I am especially concerned by the lack of normal increase. I think you =r doctor could answer the question with an ultrasound at this time ratehr than more blood tests. I hope I am wrong and best wishes to you both. Dr T
At Wed Jan 16, 07:29:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Kirdler Jan 15: Thanks for letting us know the good news. Sounds like you've successfully 'dodged a bullet' (at least more methotrexate!). Let us know how things turn out. I will be waiting to hear back from you! Dr T
At Thu Jan 17, 08:02:00 AM 2008, Anonymous said…

Dr. T.,

Hi, it's Robin (Jan 13) again! I just wanted to respond to some of the follow up questions you had for me on Jan 16.

Yes, the father of the babies is the same person for all of my pregnancies. No, I do not have any medical problems. I was referred to an RE because of my 3 consecutive miscarriages, not for infertility. I have regular menstrual cycles, ranging from 29-32 days in length and ovulating every cycle between days 14-16. The only time I have every gone over 32 days was because I was pregnant!

Here is an important update to my situation since I last wrote you...I am pregnant again! I am currently 5 weeks along. This will be my 5th pregnancy including my one surviving daughter. The only thing the RE has put me on is progesterone suppositories. They have also been monitoring my HCG levels which have been doubling every 2 days like they are supposed to, so that is a good sign. However, when they measured my HCG levels with my last pregnancy they were at 22,000 at 9 weeks and there was no viable pregnancy and I subsequently had a D&C. So, I will not feel comfortable with this current pregnancy until the first ultrasound, which will take place in 2 weeks.

I just wanted to update you on my new pregnancy but I am still interested in finding out your opinion about my situation. My doctors have never mentioned endometriosis to me. How is it diagnosed? Would they have been able to see it on the ultrasound or hysterosalpingogram that I had?

Also, my RE has not mentioned putting me on aspirin. Would it be beneficial to talk to my RE about taking that now even though I am already 5 weeks pregnant?

Also, what would the purpose be of taking letrazol for ovulation induction since I already ovulate regularly on my own?

Thank you for your response and I will be sure to update you with the results of my ultrasound in two weeks. Fingers crossed!

Robin (Jan 13)
At Thu Jan 17, 11:46:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin Jan 17: Well, congratulations, that IS good news. For the time being, just ask your doctor if it's okay to take the aspirin. I will answer your other questions if this pregnancy doesn't work out! Hopefully, I won't have to! Best of luck to you. I have my fingers crossed too, so let us know what happens! Dr T
At Thu Jan 24, 05:02:00 PM 2008, Anonymous said…

I am also have a question on this topic. I am 39, have tried for almost 4 years to get pregnant with my husband with no + until now. We went to 2 RE's, did several rounds of clomid and IUIs. All the testing came back normal except for a slightly lower sperm count - so unexplained infertility. Because of our lack of pregnancy, our last RE gave us a 1% chance of getting pregnant on our own and suggested IVF with doner eggs. I have 2 children ages 11 and 13 with my previous husband (no problems conceiving and only pre-eclampsia with the first) and an 18 yr old stepdaughter who live with us. We decided IVF wasn't for us. However, I did a pregnancy test a around the 14th of Jan after a few days late, got a positive, made an appointment with the doc and got in on Tues. They did an vaginal ultrasound and saw nothing - so they said it could just be too early, did a pap, and then took my blood for a HCG test and progesterone test. My results yesterday on the HCG were 582 and my progesterone was at 3.2. They prescribed 1 200 mg prometrium pill by mouth every night before bed. I started the progesterone last night. I went in today to do the second blood tests and they won't be in until tomorrow. However, earlier this afternoon was the first time I ever spotted in or outside a pregnancy and was really scared (although haven't had cramping and the spotting has stopped). When I called the doc, I was told most likely I would miscarry. Just wondering what the odds are of miscarrying and if so, what our chances are to have a child in the future without IVF? (assuming now I must need progesterone to sustain a pregnancy) I thought we had hit the jackpot with this 1% pregnancy, but crushed that I am not really given any hope for now or the future with this latest news. I asked if I should take a progesterone pill in the evening and morning, but was told no, they didn't think it would help. Do you think it would help now and if I do miscarry, what tests should I get or when should I take progesterone after we start trying again - 21 days from LMP? (I am really regular with 26-29 day cycles). Is there anything else that might help or I should try?

Thanks for any help you can give! It is really appreciated.
Trisha
At Fri Jan 25, 11:36:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Trisha: Right now I would have no other sugegstions. The hCG level was appropriate and I would not have expected to see a pregnancy at that level of hCG. he spooting does NOT mean you are going to have a miscarriage at this point. many women will have 'implantation' bleeding early in pregnancy. So, take a deep breath, continue the progesterone, and what happens will happen. Why don't we hold on your other questions until we see how this pregnancy turns out. I wish you the best of luck! Dr T
At Sat Jan 26, 03:19:00 PM 2008, Anonymous said…

Thanks again for your help. Two days later the results were 728 HCG and 4.3 progesterone and today 726 HCG - so it for sure is a miscarriage. The doc wants me to come in on Monday to discuss DnC unless I miscarry before then. Hopefully we will hit the 1% chance the last RE gave us again.

Thanks again, Trisha
At Sun Jan 27, 07:29:00 PM 2008, Anonymous said…

Hello Dr T:

First I have to say this is one of the few web sites I have found that actually gives some sort of hope, here is my story, I have a very healthy 7 year old girl, who I concived with no problem at all, but bleed right threw the pregnancy(didn't even know I was pregnant for three months), then Jan of last year found out I was pregnant again, but lost the baby only 2 weeks later, had a D&C and everything was fine, well we "tried" every month for the year and then Dec 23 I found out I was pregnant again, I had an HCG at 8w4d and my level was 151 thousand, had an u/s and the tech said she saw the babie and there was a good heartbeat, but did not tell me what it was, my question for you is with my level like that and seeing the heartbeat, is the risk of miscariagge less?
At Mon Jan 28, 06:03:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Trisha Jan 26: I am sorry Trisha. Let us know how things finally turn out. Dr T
At Mon Jan 28, 06:05:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 27: With a normal hCG, a normal size baby, and a heart beat, you are well on your way to a successful pregnancy. Chance of loss from this point on is probably only about 1%. Congratulations and let us know how things turn out. Dr T
At Tue Jan 29, 06:04:00 AM 2008, shreya said…

Dear Dr.Trofatter,

I am 25 yrs old. Right now iam i my 6W4D. I did the urine test and it came negative. When i did a blood test i got a HCG of 185. Dr sait it is very low. She wrote a scan on coming saturday. Is my pregnancy at risk. This is my first pregnancy.
At Tue Jan 29, 05:48:00 PM 2008, Anonymous said…

After 2 days of really bad cramping and spotting, I had a doc appt today and they first did an ultrasound and couldn't find a sac or remains anywhere. She also examined my cervix and found it closed. The Doc recommended a D&C since they still weren't sure if it was ectopic or not. When I got to the outpatient sugery today, they checked the HCG levels and they were 364. I am now on Ibuprofin (pain) and methergine (to shrink the uterus). After resting for the last 5 hours since getting home, physically I feel much better, emotionally I am still a wreck. I am hoping this random crying stops soon. I have a follow up apt with my doc next week and the following week. She is recommending another RE and said to not bother waiting any time to try again. Our first RE was wonderful, then we moved a little over a year ago found another that wasn't. After one visit with the one in the town we moved to, we had completely given up. Looking forward to talking with this RE and if we aren't able to get pregnant again, then we have given it one last shot. If we ever get pregnant again, I will be sure to comment again and until then, really appreciate all the information you give. Thank you,
Trisha
At Tue Jan 29, 07:53:00 PM 2008, Anonymous said…

Hi Dr. T!

It is Robin again. I had my 6 week ultrasound today and I just wanted to give you an update on how this pregnancy is going...

The RE saw a gestational sac but had a really hard time seeing if there was an embryo inside of it. Once in a while he thought he saw a flutter which could be the embryo's heartbeat, but it was so faint he said it could also just be from me breathing/moving.

He wants me to go for yet another blood test tomorrow just to make sure my hormone levels have not dropped or stayed the same (which would be a sign of miscarriage). The RE said he could just be having trouble seeing the embryo on the ultrasound because I am not very far along yet so he wants to give it another week to form. So, I have an appt for a repeat ultrasound on Monday and hopefully he will be able to see things a bit better or at least tell if this pregnancy is viable or not.

So, once again it is just another waiting game. This is so frustrating! Please continue to keep your fingers crossed!

I will be sure to update you after Monday's ultrasound.

Thanks,
Robin
At Wed Jan 30, 07:11:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Shreya Jan 29: Yes, the hCG is very low, but there is always the possibility that you rare not quite as far along as you thought either. That's what I am hoping at this point. Firts pregnancies are at greater risk for miscarriage, but keep you chin up and let us know what you find out. Thanks for reading. Dr T
At Wed Jan 30, 06:07:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin Jan 29: All fingers and toes are crossed. You should have your answer in a week. Keep your chin up, Girl! Dr T
At Thu Jan 31, 04:17:00 PM 2008, Anonymous said…

I am 7weeks 6days and my levels tripled for first week or so and then stopped. Have only gone up by 1000 in 3 weeks.
So was told to expect m/c 3 weeks ago, but with only a little spotting went back to doc to schedule D & C and scan showed pregnancy with heartbeat of 156 normal growth and size. Said only thing that looks wrong is the sac around the baby only measured 6w1d.
Have not had HCG levels done for a week so not sure what happening...
My doc said he is surprised with HCG levels only around 4000 that baby developed at all. He also said that corpus cyst thing looks healthy.
So I have had a little brown discharge and some bleeding after scans but nothing even near a normal period. Not enough enough to fill a pad in a whole day.
What do you think?
At Sat Feb 02, 05:10:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 31: Odd sequence of events. I am wondering if you were not quite as far along as expected and actually started off with a twin pregnancy and subsequently lost one of the babies very early. We frequently see 'vanishing twins' early in pregnancy. Anyway, I certainly wouldn't do anything more right now other than wait to see what happens. So, let us know what does! Dr T
At Mon Feb 04, 09:47:00 PM 2008, Anonymous said…

Hi Dr. T., it's Robin (Jan 13) again!

Here is an update to my situation...

I had my follow-up ultrasound today and it was not good news. The RE stated that I have a blighted ovum, the gestational sac formed but the baby never really formed (although he thinks he did see a little fetal tissue on the ultrasound). I have stopped the progesterone and am waiting a week to see if I start to miscarry on my own. If I don't I will have to decide if I want to take the medication to help me miscarry or if I want to go in for a D and C. I have done both of those things before with previous miscarriages and they were both fine, so I am not sure which one I will choose this time.

The doctor stated that most blighted ovums are caused by a random genetic abnormality. So, here is my question to you...given my history of 3 consecutive miscarriages before this current one, do you think this one (#4) is due to a genetic abnormality or do you suspect something else? 2 of my previous miscarriages were tested and no genetic abnormalities were found. They will also be doing testing on this miscarriage as soon as it occurs.

In the meantime, thank you for all your comments and I will be sure to let you know about the genetic results on the fetal tissue as soon as I receive them.

Thanks,
Robin (Jan 13)
At Sat Feb 09, 10:00:00 AM 2008, Anonymous said…

Dr Trofatter - I am a 29-year-old, type 2 diabetic. My last A1C draw 6 weeks ago was an astounding 8.9 (highest ever for me), but for the past 4 weeks, my glucose levels are at an all-time low: almost completely normal. I am 4 weeks and 3 days pregnanct; my progesterone level is only 8.7. I have one healthy daughter, but that pregnancy was followed by 2 miscarriages. One we don't know what happened with the first, and the other was a confirmed blighted ovum. My nurse midwife fears that I am facing another BO and assumes that my first m/c was a BO as well. I've all but lost hope here and am fearful to fact a 3rd loss. Is there any hope? Am I experiencing BO's because of my diabetes? Is progesterone therapy a waste of energy?
At Sun Feb 10, 07:16:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin Feb 4: I am sorry Robin. From what you have told me, it does not appear the babies have had chromosomal abnormalities, but they could still have been lost for 'genetic reasons' if you and your partner happen to share heterozygous (each of you having one normal gene and one abnormal gene) 'autosomal recessives' (one dose from him and one dose from you causing the baby to have a lethal combination or 'homozygous' (both bad genes) problem. I do NOT believe that that is a common cause of recurrent miscarriage, although it does occur in some couples. In your case, I would be much more inclined to proceed with some 'full court press' empiric therapy (see my post in April of last year on this subject), including ovulation induction with progesterone support, even if your cycles are fairly regular. Best wishes my friend, and thanks for letting us know what happened this time. Dr T
At Mon Feb 11, 12:24:00 PM 2008, Anonymous said…

Dr. Trofatter,

I had IVF and tested positive after 14 days with hcg of 14 tested 72 hrs later hcg went to 39. What should I make of this?
At Thu Feb 14, 08:59:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Feb 9: It certainly could be your diabetes, but there are many other possibilities as well. If you lose this preganncy and are serious about wantimng anothe baby, with the number of losses you have now had, I recommend you see a specialist in Reproductive Endocrinology or in Maternal-Fetal Medicine with an interest in recurrent early pregnancy loss. Good luck! Dr T
At Fri Feb 22, 06:50:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Feb 11: Be patient. Even though the hCG levels are low, there was still an appropriate 'doubling' over time. Wishing you the best of luck! Please let us know how things turn out. Dr T
At Thu Feb 28, 09:24:00 AM 2008, Anonymous said…

Hi Dr. T. It is Robin again! I just wanted to give you an update to my story...

Just to remind you , I have one surviving child from my first pregnancy and have had 4 consecutive miscarriages (all with my husband). Two of those miscarriages were tested and no genetic abnormalities were found and my RE has been unable to find any reason for my miscarriages. I was waiting on the genetic results from my most recent miscarriage (#4).

I had a D & C a few weeks ago and I just received the genetic results on this pregnancy. This miscarriage was actually due to a genetic abnormality, the fetus was found to have 95 chromosomes instead of the normal 46. So, my RE described this last miscarriage as a "random genetic event". Given my history, this was very surprising to me!

I am giving my body a few months to rest and then I will be trying to get pregnant again. My RE is putting me on Clomid and progesterone support. I will also be asking him about taking baby aspirin and extra folic acid in addition to my prenatal vitamin.

Thank you for taking the time to read my posts. Hopefully I will have some happy news to report to you in the upcoming months. Fingers crossed!

Thanks,
Robin
At Thu Feb 28, 07:08:00 PM 2008, Anonymous said…

Update: I ended up having a DnC on Jan 29th. No issues from the DnC and was told by the doc that we could try again after I was checked out at my apt 10 days after the DnC, by that time my HCG had gone to 0. We didn't get pregnant this month as I started my period a few days ago. However, not sure if it is related to the DnC or not, but I barely have any cramps at all with this period. I used to have cramps so bad for the last 20 years that I would have to take 2-4 advil every 6 hours for several days just to function at work. My flow is very similar to how it has always been, but my cramps are minimal. I was just wondering if the change in cramping has anything to do with the DnC, the progesterone I took while pregnant, or something else? Have you ever heard of this before? I am hoping it might make it easier for us to get pregnant again or at least perhaps continue to not hurt as much. Any thoughs are appreciated! Thanks again, Trisha
At Tue Mar 04, 06:51:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin Feb 28: Thanks for the feedback. Best of luck to you and please, stay in touch! Dr T
At Tue Mar 04, 06:54:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Trisha Feb 28: There is a possibility that you have 'endometriosis' that caused your cramping and even set you up for your miscarriage. Many years ago, I wa staught that "one cure for endometriosis is pregnancy", so maybe you are correct. The combination of the pregnancy and the D&C may give you a better shot the next time around. Maybe you shouldn't wait too long though! Good luck and please stay in touch. Dr T
At Wed Mar 05, 04:23:00 PM 2008, Sarah said…

Dear Dr. Trofatter,
I am very confused - I just finish IVF and they transferred two blastocysts. On day 16 my hcg level was 45.8. My doctor had me retest 3 days later an dit was 154. Everything I've read states my hcg should be a lot higher. Am I doomed to have a miscarriage? Why didn't my doctor say anything? Please help!
At Thu Mar 06, 11:01:00 AM 2008, Anonymous said…

Hello,
I am 9 weeks and 6 days pregnant and about a month ago when I went to my first visit they drawed blood to run the tests they do and yesterday that I went to my second doctor's visit, my doctor told me that the results for my hormone level was low. He prescribed me progesterone vag. suppositories and he told me I had to take those up till I turn 16 weeks. But should I be worried? I did have an ultrasound yesterday and I saw the baby's heart beat. The doctor told me that everything looks good. Thanks.
At Thu Mar 06, 08:20:00 PM 2008, Anonymous said…

Dear Dr,

I want to tell my case.

I am 8 weeks 2 days of pregnancy. I discovered I was pregnant when they performed some blood tests. The lab test showed that my levels of progesterone were high but HCG was negative even though my urine test showed positive. My last period was on January 8th 2008, and my first blood test was performed on February 2nd . The general doctor suggested me to go directly to the gynecologist.
My first visit was February 18th, I told my history to the doctor and he thought I was experiencing an ectopic pregnancy he inmediately order a blood test that day and another one on the 21st, and an ultrasound on the 22nd.My first results showed that my levels were of 11,900 and my second one showed a decreased 11,500. He performed an ultrasound and he saw two sacs and discard an ectopic pregnancy. The doctor told me that this pregnancy was not viable but he order another blood test on the 28th with an other ultrasound on the 29th. My results were as follow; The HCG levels increased to 14,000 but still the doctor could not see any fetuses inside the sacs so he suggested me to perform a D&C this week but I did not do it because my HCG levels were still increasing.
I have seen a new doctor this week on Monday 3rd an another blood test was performed. My results of this last blood test showed that my HCG levels increased to 16, 234 but on Wednesday of this week I started experiencing some lightly spotting (lightly brownish spotting) no pain, no fever, without symptoms of miscarriage. I am concern if I am experiencing a miscarriage or there is still hope. I talked with the nurse today and she order new blood tests, I will have an ultrasound this coming Monday but I am still concern about my situation as far as I know if my HCG still increase , that shows that I am not experience a miscarriage instead this level should decrease. Could you please let me know if this still could be a normal pregnancy and if my hormone levels are normal increasing and if it is normal to spot .

Thank you so much
At Fri Mar 07, 04:41:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Mar 6 11:01: The placenta usually makes enough progesterone by 10-11 weeks that you do noot need to take addirional progesterone. However, what you are taking shoul not hurt the baby either. I think it is a good sign that the baby is growing well and has a normal heart beat. The odds sre in your favor that things will turn out alright. Be patient and please let us know what happens. Dr T
At Fri Mar 07, 04:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Mar 6 08:20 PM: You will be more than 9 weeks at the time of your next ultrasound. If no baby is seen at that time, then this was not a successful pregnancy. Under normal circumstances, the hCG may continue to rise for awhile even if the baby does not develop. The hCG is made by placental cells called trophoblasts that may survive and continue to grow for awhile without the baby. I wish you the best of luck, but I am afraid what you have told me so far is not good news. I'm sorry. Dr T
At Sat Mar 08, 04:52:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sarah Mar 5: Those are relatively low hCG levels, but you had a normal increase in the hCG on a percentage basis over 48-72 hours. Perhaps your doctor is hopeful that the pregnancy just got off the ground a little late and is going to be alright. Stranger things have happened in this business! Please let us know how things turn out and best wishes. Dr T
At Fri Mar 14, 08:16:00 PM 2008, Anonymous said…

i have 2 kids one 5 and the other 3 both bys but the past year i have had 3 miscarriage's the first one at 13 weeks but the baby stoped growing at 6 weeks the other towo were before 6 weeks and were already lost before i ever knew i was pregnent. it took me months of avoiding people i knew were pregnant and rethinking everything i had done wondering what i could have done different. well about 2 weeks ago i found out i was pregnant and the tested my blood and my hcg levels were grest but my progestrone was 13 and they said they wanted it to be about 20 so i take progestrone 2 x a day and take a baby asprin and i go in 13 days to get a ultrasound to see if they can find a heart beat so my questin is i am only 6 weeks was my progestrone levels already to low and am i heading down the same road again? or could my baby still be alright ??
At Fri Mar 21, 06:48:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Mar 14: Yes, your baby could "still be alright" and hopefully that will be the case when you have your ultrasound done in a few weeks. Best of luck to you, thanks for reading, and let us know how things turn out. Dr T
At Thu Mar 27, 09:40:00 AM 2008, Anonymous said…

I am pregnant for the fifth time, first four were uneventful through the first and second trimesters. My quesion lies in that I suspect I am about 6 weeks along, my OB/GYN ran Hcg levels becuause dating of the pregnancy has been difficult because of my irregualr periods. When done it was 815 on Friday 1021 on Mon and 1236 today. WIn doing an ulrasound the pictures were unclear because of an extremely retroverted uterus but there apperared to be a gestational sac but not much else could be seen because of the picture quality. The ultrasound was taken last Friday with the first Hcg level. What are your medical thoughts on this pregnancy, could this pregnancy be threatening a miscarriage because of the lack of doubeling Hcg levels??? I am so worried that I may be loosing this pregnancy although I have no spotting or cramping, no history of miscarriage or ectopic pregnancy (none was seen on ulrtrasound)? Pleasse any help would be greaty appreciated!!
At Thu Mar 27, 05:55:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Mar 27: It could be that you are not quite as far along as you thought or that this realy is a pregnancy that eventually will miscarry. About 1 out of every 5 pregnancies is lost in first trimester and when that happens in someone that has previously had successful pregnancies, it is often because the baby had a chromosomal abnormality. Your doctor should be able to tell you for sure if this is a viable pregnancy in 7-10 days by another ultrasound, but he/she may need to do a vaginal ultrasound to see adequately if your uterus is retroverted. Good luck to you and let us know what happens. Dr T
At Wed Apr 02, 10:01:00 AM 2008, IS said…

Dear Dr T,

Thank you very much for your blog. I am 33 years old. My husband and I are healthy and active adults with no known medical issues. We started actively trying for a baby in September 2007 and got pregnant right away. I stared to spot a little at six weeks and rushed to the ER and was told that my HCG levels were quite good but the gestational sac was empty. The ultrasound at 7.5 weeks did show an embryo. However, the age of the embryo was dated at around 5 weeks. I had another appointment with my doctor again at 10.5 weeks. At this appointment my doctor did another ultrasound and found that the baby died at 6 weeks 3 days. There was no blood flowing to the baby. I had a medical abortion two days later. This was in November 2007. My HCG levels took 3 weeks to come down. My HCG level on December 7, 2008 was 6. I got my period three weeks later. My second normal period in January arrived 32 days later. (I normally have 28-32 day cycles). We started trying again in February 2008. However, my period arrived almost a week early this time. This is very rare for me. Things became weird after the period ended. There was little or no cervical mucus (CM). A week after the period ended I started getting dull pull pains in my lower back (Particularly on the sides). For the first time I got one of those ovulation predictors to time our baby making. Although there were days when there was wet CM, the ovulation predicator indicated no LH surge until the 19 day. We did try to conceive that day. My period did not arrive on time. I got suspicious and did a home pregnancy test on day 33. It came back negative. I tested again on day 35 and it came positive. I went to the doctor the next day (3/24) and got my blood work done. The results came back two days later to show every low HCG levels 111. I got another blood work done on 3/28 (five days after the fist). The HCG levels dropped to 26 (progesterone 3). I started to bleed on 3/31 and here I am going through my second miscarriage in a row.

After my first miscarriage I told myself that miscarriages are common and got on my life. This second miscarriage did affect me deeply and left me wondering what went wrong. While the low hormones were not an issue in my first miscarriage, I am puzzled by the low hormones during this pregnancy. Why does this happen?

I am also very afraid about the prospects of the future pregnancies. Could you please advise me on what steps I need to take avert another miscarriage?

Thank you so much!

IS
At Thu Apr 03, 03:28:00 PM 2008, Anonymous said…

Dear Dr.Trofatter,

thank you so much for your site and most useful information. I am 34 y.o., I'm now in my 6th week and this is my first pregnancy. I did blood test yesterday and beta-HSG came at 9 111 mE/l, progesterone came at 18,4 ng/ml. I was diagnosed with hyperandrogenism prior to my pregnancy (no cystic ovaries though) and my doctor suggests that the progesterone level is too low (the norm for this laboratory is between 9.3-33.2 mg/ml for the first 12 weeks) and I must begin taking progesterone supplements in order to avoid a m/c. Doctor, do you think that the level is indeed low and I really must start this therapy? I realize that giving an answer over internet is rather difficult thing to do but I am just extremely confused- my other doctor says that I should not worry and the level is quite normal. Please, please, please help. Many thanks, Helen.
At Thu Apr 03, 05:22:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Helen Apr 3: Progesterone levels are very difficult to interpret and their significance in different women is different. But, you know what? It will NOT hurt to take it and by 11-12 weeks you won't even need it because the placenta will be making plenty by then. So, consider taking it since it has been offered and you do have some evidence of PCOS that puts you at increased risk for miscarriage. Best of luck to you and let us know how things turn out! Dr T
At Thu Apr 03, 06:01:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To IS Apr 2: You cannot assume at this point that the miscarriages were for the same reason. At your age and with the recent history of delayed ovulation, there may be some underlying 'hormonal' problem, such as occurs with hypothyroidism or polycystic ovary syndrome, that contributed to one or both losses. These are easy things for which your regular doctr might begin an evaluation, or ask to be referred to a specialist in Reproductive Endocrinology and Infertility. Good luck to you. Dr T
At Thu Apr 03, 06:58:00 PM 2008, Anonymous said…

Hey Doc. Have reviewed these posts at length and found them most useful. Hoping you can give me some feedback. My girlfriend and I had relations just prior to her period starting (4 days) and perhaps just near or after the LMP. Nothing since that time.

She was on birth control, but was probably not perfect use. Her period appeared roughly on time a month later although it was somewhat on and off. She now has horrible pregnancy symptoms of nausea, tiredness swollen breasts and the like.

When she previously was pregnant with her first child she had a negative urine and blood tests at 4 weeks. Later when tested at what they believed was more like 7 or 8ish weeks those levels had risen to 13,000. She delievered a healthy girl, but the doctor told us that she is one of the few women that consistantly has and tests low for hcg.

We recently had two negative urine pregnancy tests (42 days from LMP) and just blood tested today (now some 45 days from her LMP) and were told her HCG was 0. I didn't know it could ever officially be as low as zero itself.

The doctor then said that it wasn't unusual to see this result considering her medical history and she might now just be 4 weeks along with consideration of late coneptualization and implantation happening (four days for fertilization ten days implantation, etc.) days later after the period.

The suggestion was just to test blood again in two week and that we should accept that with the symptoms the test just can't detect what her body already knows.

I've done some research, but the subject is very complex. Do Hcg levels this low actually exist in some women early pregnancy around where we might be?

Just asking because I am worried about the possible health of our child or if there is some other health thing going on with my girlfriend that could cause the symptoms.
At Fri Apr 04, 03:58:00 AM 2008, Anonymous said…

Dear Doctor,

thanks so much for your comment on my situation. It's Helen again.

The thing is it was proven that I don't have PCOS- both by ultrasound and blood tests. My hyperandrogenism was diagnosed by the urine tests which showed a deviation from the normal hormone levels.

Basically, the first doctor which suggested taking utrogestan to increase my progesterone levels said she is doing that because of my age (34) and my possible hyperandrogenism. She said that the age is even more crucial then hyperandrogenism per se.

Sorry, I keep dwelling on that, but I am suddenly put in the situation when one doctor says the level is just fine and I shouldn't really worry, and another doctor says in cold blood that if I don't want this pregnancy then I can refuse utrogestan but repsonsibility will be all mine.

On the other hand, I feel that taking hormonal medicines during the first term and the effects thereof are yet to be fully understood and no clinical data is available to support the theory that it really helps to prevent a m/c.

What do you think? What is the norm for progesterone levels and what would you tell your patient if she had my level of progesterone and beta-HCG?

Many, many thanks for your invaluable help,

Helen.
At Fri Apr 04, 01:51:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Helen: Ultrasound cannot rule out PCOS, and if your doctors really believe you are "hyperandronized, what do they think is the source of the excess "androgen" - the ovaries or the adrenal glands? But that is really irrelvant at this point. Your progesterone level is well within the range of normal variation for early pregnancy. And I would not ordinarily recommend progesterone under those circumstances unless the early obstetrical history was very poor and that was included in the 'empiric therapy' for recurrent pregnancy loss. My other point, however, is that this is natural progesterone, just like your ovaries and the placenta make (except in a form that makes it esier to administer). There should be no reason this would harm a baby in early pregnancy and has been used extensively in early pregnancy with no significant fetal problems of which I am aware. Hope this answer your questions. Dr T
At Fri Apr 04, 04:24:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 3: I doubt she is pregnant at this time, but she may have developed some sort of hormonal imbalance, such as hypothyroidism or polycystic ovary syndrome, and others, that may be causing her to ovulate irregularly. If the next pregnancy test is indeed negative, I would suggest further medical evaluation before trying to get pregnant again. Thanks for reading and let us know what you find out. Dr T
At Sat Apr 05, 10:13:00 PM 2008, Anonymous said…

Dear Dr. T, I am 30 years old and have suffered three recurrent pregnancy losses in the last two years. I have never been able to maintain a pregnancy beyond 6-8 weeks. I was diagnosed with a fibroid in my uterus with my first pregnancy and so it was possible that my first loss could have been an implantation issue. A couple of months after my D&C, I had the fibroid removed by a reproductive endocronologist and I was given the green light to try again. I got pregnant again a few months later (the same month that I tried) and I suffered a second miscarriage, naturally this time. I went back to the endocrinologist and he performed an extensive "work-up" and diagnosed me with prolactinemia. I had an MRI and no adenoma was discovered. I was put on Dostinex and told to take the empiric therapy of baby aspirin and Prometrium for the next pregnancy. All of my lab work was insignificant except that I am heterozygous for MTHFR, although my homocysteine levels are normal. And so I got pregnant again without trouble and again it ended in an early loss. This time, karyotyping of the embryonic tissue was performed at the time of the D&C and it returned a normal study. My husband and I both had our karyotyping done and it too returned a normal study. My prolactin levels now are also within normal range and I haven't been taking the Dostinex since I was told the third prenancy was not viable. I had a hysteroscopy done 6 weeks after the D&C and everything looked fine. I have had every test done that is associated with an extensive infertility work-up and everything has come back normal, again with the exception of the heterozygous MTHFR but with normal homocysteine levels. I have been told to try again for the 4th time but this time trying Clomid along with the baby aspirin and Prometrium. What are your thoughts about this protocol?
At Tue Apr 08, 04:59:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 5: I am presuming if you had hyperprolactinemia, then you also had thyroid studies done and they were normal? Do you ovulate regularly on your own or have any evidence of polycystic ovary syndrome? Regardless, from what you have told me, I think a few cycles of clomid with prometrium are very reasonable under these circumstances. I would also suggest taking the baby aspirin and 2-4 mg folic acid daily. If you conceive on that regimen and miscarry again, the next step in empiric therapy would be to add heparin or low-molecular weight heparin to the regimen. I know this has been tough, but there is a very good chance you will eventually be successful. Best wishes to you and thanks for reading. Dr T
At Fri Apr 11, 05:24:00 AM 2008, Anonymous said…

Hi Dr. Trofatter,
I am 34 years old and have had 5 IVF procedures with ICSI over the past 2.5 years and now have a 2 year old daughter. We recently had our 5th IVF/ICSI procedure done and was told that I have a very low HCG count (27). My nurse mentioned that they would like to see the HCG level double every 2-3 days. My question is have you seen cases where a pregnancy goes to full term with low HCG numbers?
At Sun Apr 13, 05:46:00 PM 2008, Anonymous said…

Hello Dr. T,

Thank you for your informative blog. I am 28 yrs old and in my first pregnancy. I am 11 weeks and my Doc said I have low HCG 10500and low progestron levels 15.2. He did an ultrasound and vaginal check up and every thing was fine, the ultrasound showed his heart beat at 156 bpm was good, and the size of the baby was right at 11 weeks. He put me on progesterone 200mg. I am just really confused and scared for my baby. Will he make it through this pregnancie? What are his chances, and what can I do to increase my hormone levels to take care of my baby? Also, what are normal hormone levels at this stage of my pregnanie? Thank you, Scared and Confused
At Mon Apr 14, 08:39:00 AM 2008, Anonymous said…

Dear Dr. Trofatter,
I am 27 years old, I have had 2 successful pregnancies with one miscarriage inbetween. My youngest daughter is now 3.
I had a possitive hpt in January, then some bleeding at the end of January (which I believed to be an early miscarriage) I took another possitive test at the end of February, went to see my OB who confirmed a pregnancy. I started bleeding again around March 9th, she tested my hormone levels that week and informed me they were dropping...miscarriage #2. It is now April 14 and I just took another possitive test. My question for you is...Is it possible that even though my hormone levels dropped, that the pregnancy from last month actually "survived" or is it more likely that I just happen to be pregnant again?
At Tue Apr 15, 06:29:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 11: I am afraid that hCG level is so low that chances are this will simply be a "chemical pregnancy". I am sorry if things don't turn out. You have been through a lot. Best wishes. Dr T
At Tue Apr 15, 06:36:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To scared and confused: If the baby is alive, well, and appropriately grown to this point, then you have a good chance of carrying the pregnancy. The placenta takes over progesterone production from this time forward and there is nothing you can do to affect that. The progesterone your doctor has put you on will certainly not hurt. I would recommend that you have a "first trimester screen for aneuploidy" or a "quad screen" done at 16 weeks. Your doctor can explain what those tests are all about. Good luck with things a let us know how everything turns out. Dr T
At Tue Apr 15, 06:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 14: You oculd be pregnant again, although my greater concern is that you still have pregnancy tissue remaining from the last 'miscarriage'. Under those circumstances, it could be that you have the residual of a molar pregnancy or even choriocarcinoma (gestational trophoblastic neoplasia). You need to have a quantitative pregnancy test done and if that level is high enough, another ultrasound to evaluate the uetrus and the fallopian tubes (because the other possibility is that you could have an ectopic pregnancy). Good luck and please let us know what you find out. Dr T
At Fri Apr 18, 02:18:00 PM 2008, Anonymous said…

Dear Everyone,
In march of 2005 I found out I was pregnant. I went in to see my doctor and of course was scared this being my first. They drew up my blood to check my hcg levels and told me they were not doing what they were suppost to and also in the sonogram at me being at 10wks things didn't seem to be the way they should. My doctor then explained it would be best to do a DnC and I firmly told her no she continued to ask and I then switched doctors considering the way she handled several things. I then waited and went in and amazingly I heard the heartbeat and a strong one at that and my hormone levels stayed very low they then took my blood to see if the baby would have in chromosome problems and it came out that my baby would have trisomy 18 and not live long after he was born. They asked if I wanted to do an amneocentisis (however you spell it) and I told them no and also a no to doing a DnC and not to ask. I felt as if it was ment for something to go wrong it would. I went in for an emergency C-section due to my diabetes and high blood pressure and now have a COMPLETELY HEALTHY BOY who is 2 1/2 and he is wonderful. I give great respect to doctors and what they do but not always is every woman by the books you know. I am now a week late and of course the at home test are saying no but if its ment to be it will work out. Thanks for reading and I wish everyone the best of luck on everything..
At Sun Apr 20, 06:53:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 18: Thanks for sharing. As the great philosopher, Yogi Berra, said "It ain't over til it's over." Glad things turned out well and thank you for reading! Dr T
At Wed Apr 23, 08:45:00 PM 2008, Anonymous said…

Hi Dr. T! It is Robin again!

It has been almost three months since my last D & C and we are ready to start trying to get pregnant again. I will be taking clomid and progesterone. I asked the RE nurse about taking one baby aspirin a day and she said that they did not recommend it, that it is only for people with hypocoagulation problems (or is it hyper, I can't remember) and that I should not take it.

What is you opinion on this?

Thanks,
Robin
At Thu Apr 24, 04:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Robin: Different doctors have different philosophies on this. I usually offer patients in your situation the baby aspirin every day simply because it is very unlikely to cause any harm and may help in certain situations. We still have not learned about ALL of the different 'hypercoagulation' states that might contribute to pregnancy loss. Discuss it with your doctors, even if you decide to take aspirin against their recommendations. It is important that they know. Good luck this go-around and please stay in touch!
Dr T
At Sat Apr 26, 02:14:00 PM 2008, Melissa Rayne said…

Dr. Trofatter, thank you for your time and this blog. I would sincerly appreciate your thoughts. I am a healthy 39, mother of a 3 yr old, and am currently 7 weeks 3 days into my 2nd pregnancy. This is my 2nd day taking 50 mg progesterone suppositories twice daily due to good HCG level with very low 4.2 progesterone level taken at 7 weeks. I am seeing only minute trace of brown discharge at times now. At 6 weeks 5 days I began seeing an abundance of brown discharge and light pink spotting due to light bleeding, my HCG was 3935 and ultrasound indicated viable pregnancy with 109 heart beat per minute, and no free fluid within pelvis. The sac was visible "looked small" but not measured for .51 cm crown rump length (estimated gestational age 6 weeks and 2 days versus 6 weeks and 5 days using 1st day of last menstruation which was 3/5/08). What is the likelihood of the progesterone helping my levels increase to a normal range? OR when is it likely that I will miscarry since I am taking progesterone? My concern is that I do not want to prolong an inevitable miscarriage and I don't want to have a non-viable embryo inside of me. What is your advice?
At Wed Apr 30, 06:11:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Melissa Apr 26: Right now your baby has a heart beat so it is currently alive and potentially 'viable'. Just keep taking the progesterone. The longer you carry, the greater the likelihood of a successful outcome as the placenta grows and takes over production of the progesterone for you. I know things are hard right now, but keep your chin up. Dr T
At Sun May 04, 06:20:00 PM 2008, Megan said…

Dear Dr T,
I took a positive pg test 3 weeks ago after having two days of bleeding. I went to my Dr. and had a hormone level done 34.4, two days later it was 34.9 and two days after that 44, two days after that 76 two days after that 113 and 7 days after 550. My dr doesn't really know what is going on. Ultrasound shows no sac yet but a thickening lining. I'm not real sure on my dates since I had a Mirena IUD removed just one month prior to this and had one period on 3/8/08 lasting 5 days and another bleed on 3/17/08 for two days. I took a pg test on 4/8/08 that was negative, started bleeding 4/9/08 for two days and took a positive pg test on 4/12/08 could this still turn out to be a normal pregnancy. (BTW I have two children with two miscarriages in between them, one a 9 weeks, one at 5 weeks.) I would appreciate your opinion. Thanks!
Megan
At Tue May 06, 07:25:00 PM 2008, Melissa Rayne said…

Hi Dr. T, this is Melissa again. Thank you for your response. I have continued spotting and today I had my second ultrasound and I was believed to be 8 weeks and 6 days pregnant. It was determined that the demise occurred at 7 weeks. I am relieved that my miscarriage occurred sooner than later and take comfort knowing that biology prevented the further continuance of an abnormal pregnancy. Since I find carrying non-viable matter gross and unnecessary I am insisting on a D& C to remove it as soon a possible since my cervix is still closed. I took my morning progesterone suppository (this was my 12th day on it) and I will cease its use. I'd sincerely appreciate your advice as to whether I should wait and if so how many days for my uterus to naturally expel the embryo or should I insist on a D&C? My main concern is the possibilty that I may need a D&C anyway and I don't like having the non-viable matter in me and I also fear an anaphylactic reaction to medication or anesthesia complications. I had an epidural for the birth of my first child which went fine. I've never had any type of surgical procedure other than my episiotomy so I am very concerned. I look forward to your response. Thank you.
At Thu May 08, 10:31:00 AM 2008, sofiagrace said…

Dear Dr T, I'm completely new to this site so hope I manage to firstly write my question, and hope that you find the time to reply (as this is by far the best site after trawling the web for the last 24hrs!) I'm 42, and by my calculations my LMP was 28 Mar making me 6 weeks pregnant tomorrow Friday 9th May. I have just left the local hospital in tears after the doctor told me in no uncertain terms that they would have to 'abort' my foetus or whatever it may be.

My HCG's have been very low, 28 approx the due date of my period, rising to 258 at 5 wks my LMP, and now at nearly 6 weeks of pregnancy it has slowly risen to 386. I began to spot very slightly yesterday Wed 7th (nothing else since ) which is why they did the last blood test. They did a vaginal scan and it showed something very small which is only 3mm, although I could clearly make out two round shapes like a little head and body.(I live in Spain and there is a slight language problem so can't tell you anything else about what they could see on the scan.) Today I was called back and was given the latest result as per above, and was advised that as they were so low it 'doesn't look good, that they would probably have to abort it at some stage, but to come back in 7 days time for another blood test!'

My first appoinment with the local midwife had to be cancelled due to attending hopsital yesterday so I have had no other experience or advice from anyone else in the medical profession regarding my pregnancy so far.

Am I to assume that the news is all bad news, or is there a possible glimmer of hope? I really don't know how I can manage to stay calm and composed for the next 7 days which I'm sure will seem like an eternity!

Many thanks in advance for any advice that you, or anybody else may give me.
At Fri May 09, 06:27:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Megan May 4: That is not a normal rise in your hCG levels so I would suspect either a nonviable intrauterine pregnancy or, perhaps, an ectopic pregnancy. If your hCG levels reach the 2000 range and nothing is seen in the uterus, then the latter becomes more likely. Please let us know what happens and thanks for reading. Dr T
At Fri May 09, 06:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Melissa Ma6 6: I am so sorry. Unfortunately, it could be weeks before your body realizes the baby is not alive and you actually begin to miscarry the pregnancy. One option besides an operative procedure is to have your doctor prescribe a drug called misoprostol. It is very effective under these circumstances and may save you the D&C. Again, I am sorry for your loss and wish you the best in the future. Dr T
At Fri May 09, 06:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To SofiaGrace. May 8: I am sorry, there is always a glimmer of hope, but from what you have told me (the low hCGs and the ultrasound findings), this pregnancy probably stopped developing very early. At your age, the most likely reason is that the baby had a chromosomal abnormality. Most babies with chromosomal abnormalities do not make it through the first trimester of pregnancy. You are certainly in no danger at this point, so for peace of mind it is reasonable to wait for the next ultrasound. I wish you the best of luck and thank you for writing. Dr T
At Sat May 10, 12:11:00 AM 2008, sofiagrace said…

Dr T, thank you very much for taking the time to reply and explaining the situation. At least I understand now what's been going on as the Spanish doctors over here haven't been forthcoming with a description of what's happening.

Mnay Thanks
At Tue May 13, 06:54:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sofia Grace: You are welcome and thank you for the kind words. By the way, I love your name! Dr T
At Wed May 14, 01:39:00 PM 2008, Nicole C said…

Hi Dr. Trofatter,

What a wonderful service you are providing for us anxious mothers. I have a concern about my current pregnancy. I've had a history of chemical pregnancies (3) that have failed to increase with their HCG. Imagine my delight when my number went from 78 HCG & 36 Prog on 3W5D to 212 HCG on 4W. I had my levels repeated again today (4W4D) and the HCG is 1893. My question is this: need I be concerned that today's progesterone was only 29, in light of the fact that it was 36 almost a week ago? I'm scheduled for a sonogram next Friday, but am a bit nervious given my history. Thank you in advance for any advice you can provide. Kindest regards,
Nicole
At Wed May 14, 07:23:00 PM 2008, Melissa Rayne said…

Hi Dr. T, it's Melissa again. I can't THANK YOU enough for your sensitivity and most of all for your time! I sincerely appreciate the time that you have taken from your personal and professional life to respond to my post. This has been one of the most difficult times in my life and finding this blog has kept me from falling into a dark place. I decided to have a D&C despite my fear of the anesthesia. (I just kept reminding myself that my fear was irrational.) Thankfully the procedure was successful with NO complications. It has been 6 days since the D&C and although I am still sore I am so relieved that the bleeding stopped almost immediately. The absence of spotting/bleeding has put me at ease and I welcome this long needed respite. I returned to work and am looking forward to continue my "mummy duties" for my 3 year old who I relish even more. Again Dr. T., thank you so very much. I wish you and your loved ones a loving and fulfilling life. Sincerely,
Melissa Rayne :-)
At Thu May 15, 05:37:00 PM 2008, Megan said…

Dr. T.-It's Megan again. Here is an update on my situation. I had two ultrasounds that showed an irregular shaped "something"- my Dr. thinks is probably placental tissue, but no baby. My HCG fell from 1748 to 1400 since last week and am having a D&C scheduled for next Tuesday. Thank you so much for taking the time to hear me and give your opinion and advice. This is a really wonderful site and I really appreciate your help. Hopefully next time things will go better for me although this is my third miscarriage, I'm not sure the odds are in my favor, but I believe God knows the reasons why things happen and we will be trying again as soon as we are able. Thanks again for listening and God bless!
At Fri May 16, 02:39:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nicole C: It wouldn't hurt to ask your doctor to place you on some progesterone in view of your history and the lower level on the second study. It is very safe and may help in your case. Good luck and let us know how things turn out! Dr T
At Fri May 16, 02:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Melissa: Thank you for your kind comments. Come back anytime you need someone to hold your hand! Dr T
At Fri May 16, 02:42:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Megan: Thank you for letting us know and I am so sorry. You are able to conceive and there are things that can be done, empirically, to help your chances for a successful pregnancy, so please do not give up hope. Kind regards, Dr T
At Sun May 18, 08:36:00 AM 2008, Rosalind said…

Dear Dr Trofatter

I wonder if I could ask your advice on my situation. I have one son who is 18 months old, conceived through a combination of IUI and Clomid, after a period of unexplained infertility.

Since his birth, I have managed to get pregnant 4 times without medical intervention, though have lost the pregnancies early.

This last one is very confusing. I believe I ovulated about day 9 of my cycle (it's usually about day 11) and I got a definite positive on a pregnancy test 13 days later. When I went for an US scan at 6+1, the sac was only measuring 4 wks. I had bloods taken and the hCG levels were 4700. I had a follow-up blood test 48 hours later, which gave a level of 4600, so obviously a failing/failed pregnancy.

I've since been contacted by my hospital saying they'd like to do a further scan and blood test 3 days after the second one, just to clarify things. They seem to think I might have got my dates wrong, but even so, surely a reduction, even of just 100, in the hCG level would mean the pregnancy had ended.

I should also say, I've had multiple tests done to establish why I'm miscarrying recurrently, and all have come back clear, including the chromosome tests for both myself and my husband. I am 40 though, so strongly suspect this has a lot to do with things.

Thank you for your time.

OlderMom
At Thu May 22, 12:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Rosalind: It certainly could be your "age" to some extent. There are so many different ways that that can contribute to infertility. But, I think one of your problems is that you are ovulating irregularly and not at the ideal time of the cycle for implantation. Since you were successful on clomid, you should probably give some serious thought to returning to that or some other means of ovulatory induction that would put ovulation closer to days 13-14. There are some other forms of empiric therapy that could be combined with that including progesterone support, aspirin, and even low dose heparin. Best of luck to you and thanks for reading! Dr T
At Fri May 23, 02:45:00 PM 2008, Angie said…

Dr. T,

I apologize in advance for my long question(s).
I am 31 years old, and my husband and I have been trying for almost 5 years now. The good news is that I have been able to get pregnant with every attempt. I have a 28-day cycle (almost to the minute), we generally try on days 12-14 (once we were successful after trying only on day 12). However, the bad news is that I have not successfully carried a child to term in any of 6 pregnancies. Last year, they finally did a progesterone level (at 5w1d) and it was 7.9. They immediately had me start using progesterone suppositories, but ended up with a blighted ovum and miscarried naturally at about 10 weeks (I have always opted to miscarry naturally).
I am now pregnant again, but will probably miscarry again due to my most recent blood test. I just had a postiive home pregnancy test on 5/20 (4w1d), using a test sensitve to 25mIU/ml HCG. Today (4w4d), my quantitative HCG level was 37.4 and my progesterone was 8.9. I'm back on progesterone suppositories, this time 2x/day, but it seems pretty clear that the pregnancy is already not viable. Also, based on my research, it appears that progesterone could only prolong what is already inevitable by "faking" my body into thinking that I'm still pregnant. Is it possible for the pregesterone to also cause my HCG levels to continue rising (albeit slowly)?
I'd like to hear your feedback on my situation and would love any suggestions. My RE has suggested starting progesterone at day 18, but the one time I did, my cycle was all messed up (5 days late) and, given my history of absolute regularity, I didn't think that was the best outcome.
If you've gotten to the end of this, I appreciate your time and consideration.
Angie
At Sun May 25, 12:26:00 PM 2008, Rosalind said…

Dear Dr Trotaffer

Thank you very much for your helpful response. I should have said, I already take low-dose aspirin on a daily basis, but wasn't offered any of the other drugs.

This last pregnancy/miscarriage has my doctors a bit baffled. A third blood test, 72 hours after the second (which showed a drop of 100) showed that the hCG levels had then doubled! The pregnancy sac was also increasing in size though, which I guess would account for the bloods rising. The current diagnosis is a possible blighted ovum, as there is no sign of even a yolk sac, though the drs still think I have miscalculated my dates and that there may still be hope so won't do surgery to remove the pregnancy sac until after I've had yet another scan a week after the last one.

Thank you for your suggestion of Clomid again; I will mention the idea to my consultant when I see her next.

Many thanks again for your reply.

Rosalind
At Tue May 27, 01:29:00 PM 2008, Char said…

Dear Dr. Trofatter,
I had a quantitative blood test done last Tues and the results were252, then another done on Thurs. They told me today that the levels had dropped to 201. My husband and I are on an emotional rollercoaster. I have an appt. with my doctor on June 2nd. I am going crazy until then. Could I still be o.k. and go on to have a normal pregnancy or could this be a for sure sign of a miscarriage?

Char
At Tue May 27, 06:18:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Angie May 23: I am presuming if you have an REI physician, you and your husband have had chromosomal studies done and they were normal. I am also presuming you have had a sonohysterogram and/or hysteroscopy to rule out any obvious Mullerian defects or intrauterine abnormalities and that your husband has had a reassuring semenanalysis. All that said and done, you may still have endometriosis and I am now firmly convinced that that is associated with recurrent early pregnancy losses. Also, even though you are ovulating on schedule, you are having a very poor progesterone response so something ain't right. It might be worth a trial of ovulation induction to improve the quality and perhaps quantity of the ovulatory response. Our REI docs have found a very good response to the aromatase inhibitor letrazole in women like you. Just a few suggestions. Good luck and thanks for writing! Dr T
At Tue May 27, 06:43:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Rosalind May 25: Thanks for getting back with us and best wishes to you! Dr T
At Tue May 27, 07:44:00 PM 2008, Angie said…

Dr. T

Thank you so much for your response. We have been able to rule out any intrauterine abnormalities with a sonohysterogram (or at least what could be ruled out) and, you were also correct in assuming that chromosomal studies have been normal as well as my husband's testing.

As far as endometriosis is concerned, is it possible to have it without having ever had a symptom? The main symptom I'm aware of is cramping, yet I've never had a menstrual cramp in my life.

However, I did recently read something about "late luteal phase" defect, where the progesterone drops later than what would be expected in a "normal" luteal phase defect. Have you heard of this at all?

And finally, I might actually have some amazing news. After 4 days of progesterone suppository supplementation, my progesterone level went from 8.9 to 29.8. Likewise, my hCG level went from 37.4 to 358. Are progesterone and hCG completely independent of one another? Or, could the progesterone supplementation actually be CAUSING the hCG to rise?

Again, thank you. This is by far the most informative and intelligent discussion I have found on the web regarding this subject.

Angie
At Wed May 28, 04:45:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Char May 27: Usually the hcg doubles every 48-72 hours in early pregnancy, so that would not be a good sign if the same laboratory did the studies. How many weeks pregnant are you supposed to be? Dr T
At Wed May 28, 04:58:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Angie: Progesterone production and hCG are NOT independent of each other. Progesterone is made by the corpus luteum after ovulation and helps to prepare the endometrium for implantation of the embryo (blastocyst) and once that occurs, the trophoblasts (early placental cells) start secreting hCG that then keeps the corpus luteum functioning (and making progesterone) until the placenta itself takes over that job by about 10 weeks. Good luck and let us know how things turn out. Dr T
At Sun Jun 01, 02:47:00 PM 2008, Alicia said…

Hello Dr. Trofatter,

I've been looking for answers online and I came across your blog. Reading all the posts have made me so much more aware. I just wanted your advice on a situation.

I am 24 yrs old, LMP was April 19, 2008. I first found out i was pregnant on May 16, 2008 using First Response Early test. I went to see my dr on May 21 where she did bloodwork and urine test. The bloodwork came back with a level of 719. As of May 21, I would have been 4 wks, 4 dys. My dr's office called me back and told me that my #s were low and she wanted me to retest. Anyhow, I had already had a scheduled transvaginal ultrasound for May 28, which would have made me 5 wks, 4 dys. After the u/s, i went back to my dr's office. The ultrasound findings were 1 inch gestational sac which was consistent with a 5 week intrauterine pregnancy. No fetal movement detected as too early to see anything. My dr said that everything looked good so far. She said still too early to tell but looks good. That evening i went home and when i peed i noticed small amt of very very very light pink spotting. The next morning, May 29, spotting still there. Still extremely light, with no accompanying pain so I was worried. That night I went to my local emergency room. They did bloodwork on me and the dr also gave me a transabdominal ultrasound. The blood work shows an hCG level of over 11,500. Which the emerg dr said is perfect for my gestational age and is clearly doubling as per my previous results. Ultrasound same thing, gestational sac seen but no embryo as too early. Since then the very light spotting has stopped. The problem I have is the worry that they could not see an embryo. I know all ultrasounds were done before 6 weeks but the spotting was making me nervous. Also my breast tenderness which is pretty much my only real syptom comes and goes. Like today would be no soreness but yesterday I can't even touch them. Based on what I have told you, can you please let me know what your thoughts are on this pregnancy and do you think it's going to be ok. I thank you so much in advance.
At Tue Jun 03, 06:06:00 PM 2008, Alicia said…

Dr. Trofatter,

Alicia here again. I noticed you hadn't responded as yet so I will take this time to add to my previous post. So I've still been randomly spotting since then. (Now 6 days). Nothing enough to even stain my underwear but enough that when I wipe about 2 times a day I see a bit. So I returned to the hospital last night and again had some blood work done. This time (3 days later, my hCG levels were 28,243. That's since the 11,000+ that it was before. So the ER dr said my levels are clearly doubling and increasing. My real questions for you are...why do you think I'm spotting? Because I have not engaged in any sexual activity just due to me being paranoid about the bleeding. And 2...with rising (doubling) hCG and being 6 weeks, 4 days pregnant...what do you think my chances of miscarriage are? I appreciate any input while I wait to see my dr.
At Tue Jun 03, 06:52:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Alicia; It is not unusual to have spotting after a transvaginal ultrasound. Your hCG levels are good. Within the next week they should be able to answer you question because an embryo with a visible heart beat should be clearly present by 7 weeks by ultrasound. So, Best wishes! Dr T
At Wed Jun 04, 11:06:00 AM 2008, Mikaela said…

Thanks for your reply doctor. I had an appt to follow up today and the dr did another ultrasound. They saw the embryo and the heartbeat so I hope everything is fine now. Thanks again for your timely response. Alicia
At Wed Jun 04, 07:36:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Alicia: Great! Good luck with the rest of the pregnancy! Dr T
At Fri Jun 06, 10:06:00 PM 2008, Anonymous said…

Dear Dr. T.,
Thanks for all the great information on your blog! I was wondering if I could get your opinion on my situation. I'm 37 y/o and had 2 healthy pregnancies and now have a 4y/o and a 5y/o. About 1 and a half years ago I had a miscarriage at about 6 weeks. I have just found out that I'm pregnant again and what a surprise! We weren't even "trying" - but it's a happy surprise! I haven't been keeping track of my periods but by guesstimating I would say the last one was around April 17. So that would put the pregnancy at around 6 weeks, I think. My first hcg level was 64 and that was three days ago, June 3. So I figured, sadly, another miscarriage. My second hcg level taken three days later, June 6, came in at 512, which is still low for 6 weeks. My question is: is there any hope that this pregnancy could turn out healthy based on the 800% increase of hcg in 3 days or can this increase still happen during a miscarriage?
Thank you so much for any thoughts!
Karen
At Tue Jun 10, 09:47:00 AM 2008, Anonymous said…

Dr. T,

This is Karen again. Just an update before you respond. I had my hcg level checked again 3 days later and it went to 3160. I don't want to get my hopes up that this pregnancy could work out if it's destined to miscarry because of initially low hcg numbers. What do you think? Thanks so much! Karen
At Sat Jun 14, 10:40:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi karen: With those increases in you hCG, it is more likely you are just off on your "dates." You could have ovulated later than you realized and that is not at all unusual. So, things sound good for now. Have you had an ultrasound done to confirm the intrauterine presence and, perhaps even the viability, of the baby at this point? Your doctors should be able to tell you that by an ultrasound! Best wishes and let us know how things turn out. Dr T
At Sat Jun 14, 10:30:00 PM 2008, Anonymous said…

Dr. T,

You were right to say I was off on my dates. I recently lost my mother (last month) and the trauma has apparently really messed with my head. There's a few weeks that I just seemed to erase from my memory and I was off by three weeks on my estimated date of conception. So when the hormone levels were coming back saying 3 - 4 weeks and I was sure it had been 6 or 7, I thought something was wrong. But I did get an ultrasound on Thursday that showed a gestational sac that measured about 5 weeks. There was no embryo showing in the sac but the technician told me that was normal for 5 weeks. And the ultrasound estimate of 5 weeks matched up with the latest hcg levels. So I hope everything's ok - I'm still paranoid after what happened last time. Was the technician right about the empty gestational sac being normal at this time? Thank you for your reply! Karen
At Mon Jun 16, 05:48:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi again Karen: About all you can see at 4-5 weeks is the gestational sac. At 5-6 weeks you should see a yolk sac and perhaps a very tine embryo; and, between 6 and 7 weeks you should be able to see an embryo with a heart beat. Good luck Karen and so sorry for the loss of your mother. Best wishes. Dr T
At Tue Jun 17, 11:46:00 AM 2008, Anonymous said…

Dear Dr. Trofatter,
What a wonderfully informative blog. I would appreciate your opinion of our situation if you have time.
My husband and I have have been trying to conceive for over a year. We began when I was 33 and am now just 35. I have had 4 very early miscarriages back-to-back, as well as a few other isolated miscarriages. We have had many tests done and everything appears to be in order for both of us. We are both very healthy and take good care of ourselves. I believe I am pregnant again. We have a 2-year-old who we conceived without a problem on our third attempt.
Although, my body was not the same after I had my son. My cycle remains consistently 26-28 days depending on when I ovulate. My PMS symptoms, however, are much more pronounced and much longer after being pregnant. Before pregnancy I would have symptoms 9-10 days post ovulation, now I have symptoms 3-4 days post ovulation. Our doctors feel our problem is chromosomal. We have been given the options IVF, trying on our own, but increasing the number of eggs in a cycle and hoping we do not end up with several viable eggs, or trying without any intervention and hoping it works one of these days. Do you think our problem is chromosomal? In your opinion, what are our chances of having a successful pregnancy at this point?
Thank you so much for your time.
At Wed Jun 18, 09:07:00 PM 2008, Anonymous said…

Dear Dr. Trofatter,
My husband and I have been trying to get pregnant and recently completed our first round of clomid. My doctor had informed me that we probably wouldn't concieve on the first try so you can imagine our excitement when we got a positive test result after only one round. Unfortuantely, I had a lot of cramping in the first few weeks and had some bright red bleeding during week 5. Of course I called my doctor as soon as possible and was sent to take a blood test to measure my hCG levels which had to be reapeated again in two days. After recieving my results my doctor called and sent me in for an emergency ultrasound because my levels weren't rising as quickly as she had hoped. The first ultrasound turned out normal so they sent me home and asked me to return in a week for a follow up ultrasound. When I went back for the second ultrasound the ultrasound tech said that she couldn't tell me anything but that I needed to go directly to my doctors office where the doctor was expecting me. I knew it wasn't going to be good news and sure enough my doctor told me that the gestational sac was low in my uterus and that she felt that my body was already preparing for a miscarriage. She added that I should start bleeding within the next week. This took place on a friday and so I obviously spent the weekend in a very depressed and devestated state. Monday morning was very different though. I got a call from my doctor who was apologizing because she had just recieved the complete report from my last ultrasound and she said that after reading it for herself, the results weren't as bad as she had assumed. She clarified that she didn't want to give me false hope (because the sac was low) but that there may be a possibility that this pregnancy wasn't over yet and she wanted me to wait two weeks and go in for another ultrasound. She also mentioned that during the last ultrasound the tech had detected a heartbeat but that it was only 63bpm...she felt that this low rate might be a result of the fact that I wasn't that far along in my pregnancy. I'm in that two week waiting period now and I'm going crazy. I've wanted this baby for so long and I would be crushed if I lost it. I'm terrified that I'm going to get more bad news and I've spent hours searching the internet looking for someone who has had a similar experience but I have yet to find one. I was wondering if you may be able to shed any light on this situation based on the information that I have provided.
At Fri Jun 20, 01:49:00 PM 2008, Anonymous said…

I am doing ivf and had ER on 6/7. On 6/10 ET was 2 grade 1 embryos. today 6/20 my hcg level is only 10.3. I am currently doing PIO and suppositories 3x daily. Is it too early or is this not a viable pregnancy?
At Sat Jun 21, 05:44:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 17: Have you had a sonohysterogram and hysteroscopy performed to evaluate the uterine cavity? The most common cause of sporadic miscarriage is chromosomal abnormalities, but it sounds like you have more than that going on. What sort of 'empiric therapy' (e.g., aspirin, folic acid, heparin) have you been offered? If this current pregnancy is unsuccessful, then ovulation induction and/or IVF should be considered more seriously, even if you are ovulating regularly! Best of luck. Dr T
At Sat Jun 21, 05:49:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 18: Many, many, many women have been through exactly what you are going through now. The only thing I am sure of from what you have told me is that the outcome cannot be predicted at this point and there is not anything you can do to affect that outcome. Things may turn out well and then again they may not. It is encouraging that your baby still has a heart beat, so try to hang in there. Please let us know how things turn out. Dr T
At Sat Jun 21, 05:51:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 20: It really is too early. Check back with us in a week or so and let us know how you are doing. Good luck! Dr T
At Mon Jun 23, 12:23:00 PM 2008, Anonymous said…

Dr. Trofatter,
Thank you for your response. I have had both sonohysterogram and hysteroscopy performed. My first pregnancy was emergency c-section with some complications following. These were the first tests done. Last cycle we did ovulation induction. The egg was a good size and was fertilized. On day 8 following the 2nd HCG injection I had a progesterone level of 2.9 and an HCG level 13.1. It obviously did not work out. I have not been offered any 'Empiric Therapy'. I, however, have been taking a folic acid supplement and prenatal vitamins since before we started trying, have never smoked and cut out both alcohol and caffeine. I will certainly try adding the baby aspirin. This cycle I did an HCG injection to boost progesterone. I go in for a BETA test Wednesday. If I am pregnant should I try another shot? We went with the HCG because the progesterone tablets prescribed by my doctor were very expensive and 100% out of pocket. Is there a progesterone supplement you would recommend? My doctor has been reluctant to do progesterone support, he believes if the egg is viable the progesterone should not be an issue. This was something we pushed for this cycle. I truly appreciate any input and thank you again for your response.
Anonymous June 17.
At Tue Jun 24, 06:24:00 AM 2008, Anonymous said…

Dear Dr. Trofatter,

Thank you for your blog. I recently had a miscarriage at what we thought was 12 wks, but an ultrasound revealed the baby stopped growing at 8 wks. I had two ultrasounds prior (7 & 8 wks) Both times we saw a heartbeat. I have two other children who are completely healthy. however, when I was pregnant with them I began spotting at 6-7wks and was put on progesterone suppliments both times until 12wks. The bleeding stopped after taking progesterone. With this baby I switched doctors because of location and they believed the baby would be OK w/o progesterone suppliments. they tested the level which was 10 at 6 wks. They did not feel it necessary to test again and I trusted them, epsecially b/c of all the ultrasound info. With my second child the progesterone levels were 11 at 6wks but dropped in week 7. I feel I should have pushed for the suppliments with this baby. We are back and forth about trying again and I would feel better if I had more knowledge about all of this first.
At Tue Jun 24, 07:52:00 AM 2008, Anonymous said…

Dear Dr. Trofatter,
I'm 45 years old and pregnant with my 3rd child. first son I was 23 and had gestational diabetes at 7 months - we were both fine after birth. Second son I had premature birth at 7 months, 11 months after my first son. He had no problems and is very healthy.
This pregnancy was a surprise I thought I was in menopause since I had no periods for over 4 years. My HCG at first testing was 14, I don't know how far along I am so I had a ultrasound and they couldn't see the baby. A 2nd HCG test at time of ultrasound was 11. The third HCG three days later was 9. The doctor is sure their is no ectopic pregnancy. I assume this is not a viable pregnancy. I heard low HCG could mean no morning sickness but still could complete the pregnancy. I haven't had any symtoms and didn't have morning sickness with my other two pregnancies. any ideas if this will still work out?
Thanks, Diana
At Wed Jun 25, 12:38:00 PM 2008, nina said…

I've only just found this site so I hope I use it correctly. I wonder if you could give me some advice please. I have 1 daughter (Dec06) and have since had 2 chemical pg and 1 miscarriage at 7weeks. My Dr has put me on progesterone pessaries and I'm in my first month of trying. I started taking the progesterone 2 days after ovulation and I'm now 18days post OV with no sign of my period and only negative pregnancy tests. My Dr said my period will come if I'm not pg so I have to keep taking the progesterone, but I thought that I have to come off my progesterone for my period to come. I'm confused, can you offer any advice? I'm taking 2x200mg per day (It's Utrogestan). Thanks so much.
At Thu Jun 26, 10:06:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 17/23: Progesterone can be given in various ways - tablets, suppositories, creams, shots. I do not know if any one way is truly better than any other. However, it would be unlikely to hurt either! If you are not happy with your care, need clarification or answers to your questions, or would like to explore other options, it is always best to discuss those with your doctor first. You can always go somewhere for a "second opinion" to help put things in perspective if that approach doesn't work. Best of luck to you. Dr T.
At Thu Jun 26, 10:10:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 24: The most common cause of an early loss under these circumstances is still related to a fetal chromosomal abnormality rather than a low progesterone level. You should express your concerns to your doctor though and ask if he/she would be willing to use the progesterone with a subsequent pregnancy. It is unlikely to causes any problems and will give you some peace of mind. Dr T
At Thu Jun 26, 10:12:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Diana: From what you have told me, your assessment of the situation is probably correct. This is most likely a nonviable pregnancy and the most common cause at your age is a pregnancy with a chromosomal abnormality. I am so sorry. Best wishes. Dr T
At Thu Jun 26, 10:15:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nina: Sooner or later, if you are not pregnant, you will get your period, even while using the progesterone, but some women are more sensitive than others. Perhaps you just ovulated later than you thought this cycle and really are 'just' pregnant? Good luck to you. Dr T
At Thu Jun 26, 10:44:00 AM 2008, Anonymous said…

Dr. Trofatter,
Thank you again for your response. Our current doctor is our second opinion. I guess our issue is we are reluctant to do IVF and that is the most emphasized option given. We want to do everything we can before doing IVF - which could still not lead to success. I have read almost your entire blog. I want to say I think it is really a gift to people coping with infertility that you take the time to write so extensively here and respond. It is so hard to take in the information your doctor gives you and ask the question needed during appointments. Sometimes I spend the whole appointment just trying to maintain composure. The information you have here is really wonderful and very helpful. It did not work for us this time, but we will keep trying. One of these times it will. Thank you again,
anonymous June 17/23 - Elizabeth
At Thu Jun 26, 12:49:00 PM 2008, Sofia said…

Hello Dr. T,

I am currently 8w1d pregnant, my hcg levels are not doubling as they should. In 8 days my hcg levels doubled and in two days they have not risen significantly. I have had a miscarriage in the past(4/07)it was an ectopic pregnancy and had cysts on both my ovaries. On 6/16 an u/s was done the fetus is in the uterus and there are no cysts on the ovaries. Today I had another u/s and there was a strong and healthy heart beat of 136. Even if my hcg levels didn't double from 2 days ago, does this mean I may have another misscarriage? Does it make a difference wether there was a strong and healthy heart beat vs. the not significant rise of hcg levels? Please, help us understand, thank you! Sofia
At Thu Jun 26, 07:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Elizabeth: Thank you for the kind words. Best wishes to you for the future. Dr T
At Thu Jun 26, 07:32:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sofia: Think positively right now. The baby is normal size and has a good heart beat. Why are you getting such frequent hCGs at this point? Dr T
At Sat Jun 28, 12:33:00 PM 2008, Anonymous said…

Dear Dr. Trofatter,
Thank you for all of the information in your blog, it is useful to read. I have had 4 mc's and had every test under the sun done (twice!). I tested postive for anticardiolipin, 2 copies of a MTFHR gene and insulin resistance. My husband and I had good chromosonal result and everything is good with my uterous. One of my losses was tested and came back as chromosonally abnormal with triscomy. I have been taking lovenox, baby aspirin,prednisone since day 5 of my last cycle. I have also been taking foltix, prenatal vits and metformin. I am 4 weeks pregnant and had my first two HCG levels. On 6/25 my HCG was 32 and progesterone 20 and on 6/27 my HCG was 64 and progesterone 18.7. I am worried that my levels are so low and that my progesterone has dropped some. I am expecting another loss. Is there anything else that you think I could ask my fertility Dr to do? I am worried he is going to say PGD is the last option because I just can't afford it.
Sarah
At Sun Jun 29, 06:30:00 PM 2008, Colleen said…

Hi Dr. Trofatter,

I'm in line with everyone saying thank you for your blog. I'd quite appreciate your feedback on my situation.

I'm 41. Have been pregnant 3 times, once in my 20's (not to term), have a beautiful 4 year old daughter from 2004, and had a miscarriage at 4 or 5 weeks this January.

My LMP was May 23 2008, have 31 day cycles normally. Got a pos home pregnancy test on June 18 (CD 27), I think I ovulated around CD 17.

My hCG levels are low and not rising as expected. CD 28 (week 4), hCG: 27; CD 35 (week 5), hCG: 91.

Doctor is sending me for U/S on July 8 (CD 47; week 7).

I have the same pregnancy symptoms I had with my daughter - sore breasts, bloated, morning sickness on and off, super tired.

I know that some women have low levels and have healthy babies. Do you have any thoughts? Is it still possible?
At Mon Jun 30, 02:41:00 PM 2008, Cathy said…

Dear Dr T..
Thank you so much for your blog, I have found it very informative.
I am a 39F (40 in 3 weeks!) who is trying to get pregnant for the first time. I had a chemical pregnancy last fall. My tubal dye x-ray was showed tubes are open. FSH was 8.6 (day 4).
I completed my 2nd round of Clomid last month and my 21 day progesterone was 3.2. I started progesterone suppositories on day 23 and assumed I had not ovulated that month. Imagine our surprise when I had a positive pregnancy test on day 27! My numbers were:
day 21 progesterone 3.2
day 27- HCG 60, progesterone 16.2
day 29- HCG 159

My breast tenderness decreased significantly over the weekend and now I'm concerned the pregnancy is not viable (because of initial 3.2 progesterone reading)
My questions:
Which reading is more predictive, the 3.2 21 day progesterone or the 16.2 day 27 progesterone (taken after I'd been on supplements for 4 days)

Is a pregnancy with initial low progesterone levels always doomed?

Can progesterone supplements mask the symptoms of miscarriage (ie prevent spotting/bleeding etc)

My next appointment is not for 2 1/2 weeks and I'm a bit of a nervous wreck trying to figure out if we should be happy or worried.

Thank you very much for your input, I appreciate it!
At Mon Jun 30, 02:42:00 PM 2008, Cathy said…

Dear Dr T..
Thank you so much for your blog, I have found it very informative.
I am a 39F (40 in 3 weeks!) who is trying to get pregnant for the first time. I had a chemical pregnancy last fall. My tubal dye x-ray was showed tubes are open. FSH was 8.6 (day 4).
I completed my 2nd round of Clomid last month and my 21 day progesterone was 3.2. I started progesterone suppositories on day 23 and assumed I had not ovulated that month. Imagine our surprise when I had a positive pregnancy test on day 27! My numbers were:
day 21 progesterone 3.2
day 27- HCG 60, progesterone 16.2
day 29- HCG 159

My breast tenderness decreased significantly over the weekend and now I'm concerned the pregnancy is not viable (because of initial 3.2 progesterone reading)
My questions:
Which reading is more predictive, the 3.2 21 day progesterone or the 16.2 day 27 progesterone (taken after I'd been on supplements for 4 days)

Is a pregnancy with initial low progesterone levels always doomed?

Can progesterone supplements mask the symptoms of miscarriage (ie prevent spotting/bleeding etc)

My next appointment is not for 2 1/2 weeks and I'm a bit of a nervous wreck trying to figure out if we should be happy or worried.

Thank you very much for your input, I appreciate it!
At Mon Jun 30, 04:08:00 PM 2008, Sarah said…

Hello Dr. Trofatter,

I sent you a message on Saturday 6/28 and I thought I would update you on my levels today. My HCG was 120, so it almost doubled onver 3 days but my progesterone is up to 20.7. I still feel in limbo!
Sarah
At Tue Jul 01, 11:21:00 AM 2008, Anonymous said…

What an informative blog! I am hoping you might be able to shed some light on my situation.

After my third cycle with 50mg of Clomid and got a positive HPT on 9 dpo, and subsequent positives on 10dpo, and 11 dpo, though the posotives were much much lighter. On 12 dpo I had a beta test run and my HCG level was 14 and my progesterone level was 11.8. I took another HPT, same brand as before today at 13 dpo and it was a much darker positive then any previous test. I questioned my doctor about the possablity of prescribing Progesterone supplements with such a low Progesterone lvel and was told he wouldn't do that with a level above 11.

While, I realize there is not much hope here for a good outcome, I would think, at this point, the supplements couldn't hurt, but might help.. Is that erroneous thinking? I go for a follow up beta tomorrow at 14 dpo.

By the way, I miscarried 6 months ago at 6 weeks, my beta level was only 131 and my progesterone was 3.4.

I have also had progesterone counts on my clomid cycles, on 7 dpo at 7.1, 7.4 and 7.9, which seem low for a medicated cycle.

Thank you kindly for any light you can shed on this for me
At Tue Jul 01, 06:25:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 28: Are you ovulating normally or was the pregnancy conceived by ovulation induction? If so, what did they use to stimulate ovulation? If they used clomid, another possibility is to try letrazole (an aromatase inhibitor). I do not think you need IVF, or IUI, or ICSI if you cannot afford those at this time. I wish you luck! Dr T
At Tue Jul 01, 06:28:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Colleen: Anything is possible, but those really are low hCG levels, so this is probably not going to be a successful pregnancy. I am sorry. Thank you for reading and I hope that I am wrong. Dr T
At Tue Jul 01, 06:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Cathy June 30: I would be encouraged by the rise in the progesterone. The loss of symptoms may or may not be significant at this time. Progesterone may delay recognition of a miscarriage, but usually not for long. I wish you luck my friend and thanks so much for reading. Dr T
At Tue Jul 01, 06:33:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To sarah: Well, that IS good news. Sounds like you are on your way! Thanks for the follow-up, good luck and let us know how things turn out. Dr T
At Tue Jul 01, 06:35:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 1: Your doctor is "going by the book" and really can't be faulted for that, but I'm like you...if it ain't gonna hurt, what's the harm of trying. Good luck and I hope things turn out! Dr T
At Fri Jul 04, 10:40:00 AM 2008, Anonymous said…

Dear Dr T,

Your blog is wonderful - I feel as though I have come across someone who really knows. Here is my situation: HELP...Should i panic about a miscarriage?
I am 6-7 weeks pregnant and had an internal ultrasound today which showed the foetus' early heartbeats and gestational sac...and... the doctor said that the 'trophoblast' was detached and that I should take progesterone to ensure I don't miscarry.
I am panicking. I have never heard of it and can't find any info. online. Also, i called another doctor who said it is too early to start taking such medication and i should let nature take its course. Can you explain this to me at all or so you have any experience of this? I'm so upset and confused.
Ms H
At Sat Jul 05, 07:15:00 AM 2008, Anonymous said…

Hi, I am 38 yo and 7.1 weeks and I was spotting on Tuesday and I had a US that showed that the baby only had 87bpm (which the dr said was very low), but my original progesterone levels were at 9 and when tested on Tuesday it dropped to 6. My HCG level was 15 and now has dropped down to 9. I was placed on progesterone supplements and seemed to have stopped spotting. My dr said that I will probably miscarry very soon. My next US is on Tuesday, I am sooooo scared and worried that I will miscarry, but I know that God can turn it around, is there any possibility that I will have a normal health pregnancy?
At Mon Jul 07, 12:28:00 PM 2008, Lisa said…

Dear Dr. T,
I hope you will be able to help. I feel like everyone is treating me like I am crazy or a liar and I just don't know what to think. My husband and I started trying for a baby June 21st and a few days later I felt different (swollen breasts). Around June 25th I started feeling cramping in my uterus. The following Monday I started feeling nauseated when I tried to (unsuccessfully) eat my breakfast. I went into the doctor's office that afternoon and had a urine test and a blood test done, both of which came up negative. The cramping and nausea continued and on July 1st I started spotting. The bleeding steadily increased until Saturday when I woke up, I passed a huge blood clot and continued to pass clots all morning. I became extremely weak and doubled over by the cramps. I called the doctor's office (spoke to the doctor on call) and she said that I probably had an early miscarriage. I took a home pregnancy test the following morning and it came up negative. The cramping and nausea have gone down significantly compared to the previous week and I feel like a different person, in a good way. But when I called the OB/GYN office this morning, the nurse told me that they would not acknowledge that I was pregnant, let alone had a miscarriage because the results from the blood test revealed <1 hCG in my blood at the time of the test. They said that I probably had a "weird" menstrual cycle. I know what my body went through and it was very traumatic for me. Is it possible to go through something like this and not be officially diagnosed as pregnant? Please, any thoughts on this would be helpful. Thank you so much!
At Mon Jul 07, 09:51:00 PM 2008, Jill said…

Dear Dr. T,
Thanks so much for your blog! My story: I had a FET and 9 days afterwards my hcg was 19 (very low!). A repeat beta 4 days later is 127. I have been spotting. Prognosis? And thanks for your time!

Jill
At Wed Jul 09, 02:50:00 PM 2008, sarah said…

Hello Dr. Trofatter,

I am just writing to give you an update on my situation. My HCG levels have been increasing but not doubling and I have also had some pain, so this one is ectopic. I am going to be treated with the injection to end the pregnancy this afternoon. I have now had 4 miscarriages and 1 ectopic. I am starting to think that my chances of ever having a baby are very slim. Thanks for your advise
Sarah
At Wed Jul 09, 06:04:00 PM 2008, Colleen said…

Hi again, it's Colleen here. So yesterday I had an ultrasound, that showed a gestational sac of 7mm, and a yolk sac of 4.3mm. Dating suggested gestational mean of 4 weeks 4 days. So I probably ovulated around CD 20 (I have cycle lengths about 31-33), and probably took a week or so to implant. HCG levels from yesterday (July 8 2008) were 2647, which means they doubled every 2.5 days (12 days earlier they were 91). I've had no bleeding and still feel pregnant. My doctor is sending me for a repeat ultrasound on Monday (July 14), it might be better later in the week but I can't take time off work any other day next week. He said today that he thinks the HCG is where it should be, the rise looks normal, we'll see what the next u/s brings, but he thinks it's a go and that the results are encouraging. I wondered if you had any thoughts to add - does this look like a normal rise to you?
At Wed Jul 09, 08:36:00 PM 2008, Anonymous said…

hi i am new here and hoping i am posting correctly. i had ivf with 3 5day b;asts implanted got a positive test 6/27 with a beta of 218. 7/1 my neta dropped to 155 and dr said preg not viable i was devastated. then 7/3 195 7/7 703 7/9 850 with u/s sac and yolk at 6w4d they still expecting me to miscarry. is there any hope?
At Fri Jul 11, 09:43:00 AM 2008, Anonymous said…

Dr T thank you for all of the prior responses - they are helpful to compare situations. I lost a baby in week 21 - heart stopped beating but there was no cause determined. All tests on the baby and on myself showed all was fine. I am 2 days late on my period and having similar symptoms as the last time when I was pregnant - but have had pretty significant craping over the last three days. I have taken pregnancy test as late as this morning - all negative. Am I just being too overly anxious at this point. I am worried that not testing positive yet is a sign that my HCG levels are too low.

Thank You
Stephanie
At Fri Jul 11, 12:02:00 PM 2008, LeeAnn said…

Dear Dr. T

I must start by saying how wonderfully compassionate you are and I'm truly grateful to find evidence of a caring physician that would devote such time and patience so a pack of hormore ridden women! A prince among men :-)
I have a situation that I would greatly appreciate your second opinion on. Here are the facts:

In 2000 I delivered my first child. Also first pregnancy.
In 2002 I delivered my second child. Also my second pregnancy.
In 2003 - 3yrs 4months ago I had the BPD/DS (Biliopancreatic Diversion w/ Duodenal Switch) this is a weight loss surgery that is successful due to the bypassing of the duodeum and shortened (100cm) of intestines, coupled with the removal of the greater curvature of the stomach leaving a 3oz fully functioning stomach w/ pyloric valve.
As you know, progesterone needs "healthy enviroments" to increase and sustain. My body has been deficient in protein and other nutrients due to the weight loss surgery procedure.
On May 26th I had my Last Menstual Period. Ovulation/Impantation dates unknown.
On June 19 I had a negative pg test.
On June 29th I had a VERY light (nearly invisible line) with a generic Rite Aid brand pg test. That same day I had a digital YES+ with a First Response Gold pg test.
On July 2nd (last Wednesday) my GYN ordered bloodwork. My HCG was 136 and Progesterone was 5.6.
On Friday the 4th HCG was 203.
On Monday the 7th my HCG was 354 and progesterone was 4.8.
That evening I began brown discharge. I was seen immediately in the ER.
A trans vaginal ultrasound was performed wherein a 4w gestational sac was found.
I was give 200mg of Prometrium 2x daily.
On Wednesday the 9th, my HCG was 465 and progesterone was 6.26. All numbers increasing.
Today's numbers are tbd. I have an order for an ultrasound this Monday with a standing order for bloodwork every 48 hours.
Please tell me your take on this situation. Hcg has been rising albeit slowly and with the assistance of the progesterone I saw the greatest increase in hcg over a 48 hr time frame.
If I ovulated late and took longer to implant... would my #'s make more sense?
And if I did in fact implate later (this past Monday with the brown discharge); how long does implatation bleeding last and would that be possible? With a 4w sac and possible implantation bleeding on this past Monday - am I truly doomed?
This baby is VERY much wanted. I've since been given the OK to double my progesterone (which I did on Wednesday). Today's test results should give me a good indication of how things are progressing.
I guess I'm asking if you would doom this pregnancy if I were your patient?
Please bear in mind, I have no pain or pink/red bleeding. No clotting either. I have MINOR cramping in AM and the brown discharge occurs then.
Thank you for any information you can provide me.
Warmest Regards,
LeeAnn
At Sat Jul 12, 05:35:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Ms H July 4: If you have not had any bleeding, the ultrasound probbaly showed evidence of a "subchorionic hemorrhage." This may or may not progress to miscarriage (I have certainly seen many which did NOT). The progesterone is safe enough to take this early, but whether or not it will prevent a miscarriage is uncertain under these circumstances. Best of luck and I hope things turn out well. Dr T
At Sat Jul 12, 05:36:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 5: Unfortunately those are low hCG and progesterone levels, but as long as the baby's heart is beating, anything is possible. Kind regards. Dr T
At Sat Jul 12, 05:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Lisa: You are not crazy, but it also sounds like you were not pregnant. Do you have regular periods every month or are you sometines irregular? If you have been trying to get pregnant but have not been successful, you may be ovulating irregularly or not at all. You might want to ask your doctor about that. Do you have any other medical conditions such as diabetes, or thyroid disease? Regards, Dr T
At Sat Jul 12, 05:42:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Jill: Well, you had a normal increase in the hCG over those few days, so at this point the prognosis is good. Wish I had a crystal ball for you! Dr T
At Sat Jul 12, 05:43:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sarah: I am so sorry to hear that. Try to keep your chin up and we will all be thinking about you. Dr T
At Sat Jul 12, 05:45:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Colleen: Looks like a "go" to me at this point too! Good luck and stay in touch. Dr T
At Sat Jul 12, 05:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 9: ART pregnancies can be odd, so there is still "hope" although if no embryo is seen within the next week, then the pregnancy is truly nonviable. We will be "hoping" with you. Dr T
At Sat Jul 12, 05:50:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Stephanie: The urine pregnancy tests are almost as sensitive as the blood tests at this point. This may simply be a delayed period, but check again in another week and you will know for sure. Dr T
At Sat Jul 12, 05:55:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To LeeAnn: It's hard to say. You probably did ovulate late, but the hCG and progesterone rises have also not been normal. The most common reason for first trimester loss, even in a woman who has been through the surgery you have, is a chromosomally abnormal baby, so don't kick yourself and blame the surgery at this point. Let's see what happens over the next week or so. Wish you luck! Dr T
At Sun Jul 13, 06:29:00 PM 2008, Anonymous said…

dear dr t - thank u so much for ur reply. i have another scan thurs 7/17 and altho my hopes are pretty dashed i do so appreciate ur reply. of course i am holding on to any glimmer of hope but i am prepared for the worst, the last two weeks have been an absolute rollercoaster that i would wish on noone but i am so happy that my irst ivf ended in a positive and i hope for great things in my next ivf. i will definitely keep u all posted on my next scan. thanks again
At Sun Jul 13, 07:27:00 PM 2008, Jill said…

Thanks so much for your response. No need to post, but I did have a m/c in the following week. Apparently those low hcg numbers were accurate indicators, even though they doubled.

Jill
At Mon Jul 14, 02:30:00 PM 2008, Anonymous said…

Hi Dr T,
My LMP was 6/2. My hcg on 7/8 was 205 and progesterone was 10. On 7/10 hcg was 257 and progesterone 10. On 7/13 hcg was 303 and progesterone 4.9. My doctor recommends methotraxate. What do you think?
At Mon Jul 14, 07:05:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 14: This appears to be a nonviable pregnancy, either intrauterine or ectopic. The methotrexate is a reasonable approach, although if this is simply an early anembryonic intrauterine loss, it is a bit of overkill! The alternative is simply to follow the hCG levels and if they drop, do nothing or if they rise and you develop any symptoms of an ectopic or an adnexal mass, then proceed with the MTX. Best of luck! Dr T
At Thu Jul 17, 07:57:00 PM 2008, Anonymous said…

Dr. T - So I had my US on last week Tuesday and they couldn't find a heartbeat and said that the baby did not grow since the week before. There is a part of me that says maybe I should have went to another hospital for another US to make sure that there was not a heartbeat b4 I had a D&C. The hindsight is nerve racking. So, can you please let me know, I am sure that the baby should have grown in one week's time, but could there have been a possibility that the baby did not grow and still be okay and maybe have a spurt of growth thereafter, sounds crazy, I guess, but I have to ask.

Anonymous July 5th
At Thu Jul 17, 08:43:00 PM 2008, Anonymous said…

dear dr t - u replied to my 7/9 post about my ivf. i had a follow up scan today and there was a definite strong heartbeat but they said i was measuring a week behind so there was still cause for concern. however when i called back to confirm how far along i am they had mixed up my transfer date with my retrieval so they were showing me at 5 days behond schedule. my lmp was 5/30 my transfer was 6/17 (5 day) and 7/17 scan showed 6w4d so i think i am right on track - do u agree and should i start to get excited after this emotional turmoil?
At Fri Jul 18, 07:30:00 AM 2008, kbdk.2 said…

Dr T -

Your blog has calmed me down! I think, as most high risk moms, I am worrying to much. At least, that is what I am hoping. Here is my history - I am 42 and have had 3 miscarriages (all at about 6 weeks) and one ectopic (through IVF - I had my right tube removed). We always seems to get pregnant in June...isn't that funny? Anyways, I am about 6w4d and my doc has been having me get my hCG levels tested every three days. Initially things were doubling, but on this last round it went from about 8000 to 10400. My doc doesn't seem to worried as I had a US the day before my last draw and the baby looked fine - right size and HR of 109. While the rate was a little on the lower side he said it was within a good range. I am also on Prometrium - 200 mg. (I also have thyroid issues - but that is being monitored and is fine right now) No spotting, little cramping, but my doc said that is to be expected in early pregnancy. Am I being a little overworried? Thanks!!
At Fri Jul 18, 06:06:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To kbdk2: Between your age, pregnancy history, and medical problems, it is perfectly normal to be anxious. But, it sounds like things are going well, you are in good hands, and you are doing everything you can at this point. So count to 10, take deep breaths and chant OMMMMM! I wish you the best! Dr T
At Fri Jul 18, 06:35:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 17: You have every reasn to be (cautiously) EXCITED right now! Dr T
At Fri Jul 18, 06:38:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 5: I am so sorry. In experienced hands, if the baby failed to grow in a week and no heart beat was seen, the pregnancy was lost. There should have been no mistake. You did the right thing. Dr T
At Sun Jul 20, 01:17:00 PM 2008, kheerdt31223 said…

Dr T. Heres my deal, The date of my last period was may 28th, I found out with 3 digital ept tests I was pregnent on june 29th. July 1st I startd bleeding like i was having my period, doctor sent me to the er to get bloodwork done and possible ultrasound. I got there and my hcg was at 60... 2 days later i went for round 2 of blood work and it was at 138, I found out the following week my progesterone level was at a low/normal level. I just went on vacation from the 11th-20th, during vacation i was spotting a bit, nuthing really heavy but a good circle on a panytyliner every few hours. This morning I woke up not feeling as symptomatic as normal(no more breast tenderness, was never going thru any morning sickness, have a lil bit of cramping) and went and picked up some home preg tests, and 2 came out negative. I am also hypothyroid, was increased in my synthroid right b4 vacation. Did I have a miscarriage or are my hcg levels being masked thru the preg test some how? I dont understand whats up and until i go to the doctor tues for the first appointment i would like some sort of peace of mind, can you help me?
At Sun Jul 20, 05:00:00 PM 2008, Anonymous said…

Dear Dr. Trofatter
I'm 34 and have two healthy girls, 8yo and 5yo both with totally uneventful pregnancy and delivery. I have had 2 recent m/c one at 6 wks in Jan, and one at 4.5 wks in April. I think I suffer from LPD due to having only 9-10 day LP, so my Dr. put me on Prometrium 200 mg. vaginally 1x daily. I conceived again last month probably on June 29 or 30 and got + pt on July 11, at 12 DPO.
At 15 dpo hcg 43.8, prog 13.28
At 17 dpo hcg 85.3, prog 15.4
(Went to Dr. in shock that hcg almost doubled. U/S showed thick endometrium and nice corpus luteum cyst. Put me on Prometrium 200 2x daily)
At 19 dpo hcg 158.2, prog 20.7
At 21 dpo hcg 272.8, prog results pending until tomorrow.
I know these levels are not really doubling, but still increasing nicely. Is there any hope or do these levels still seem too low to be a good pregnancy? Thank you!!
Jennifer
At Tue Jul 22, 06:44:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Jennifer: Within the range of normal variation in the assay, those numbers look like they're doubling to me! Hang in there and let us know what happens. Dr T
At Tue Jul 22, 06:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To kheerdt: The EPTs are sensitive enough to pick up hCG at the level you previously had, so I am afraid there is a good chance that you had a blighted pregnancy that has miscarried. I am so sorry. Dr T
At Wed Jul 23, 03:09:00 AM 2008, longtime ttc said…

Dear Dr Trofatter, i have enjoyed your helpful blog. I had 2 day 3 frozen ICSI embryos transferred in a medicated cycle. I am on estradiol 2mg tds and progesterone pessaries 200mg tds. My bHCGs have been day 13 post transfer 694, day 15 1510, day 18 5000, day 20 11000. I spotted between days 15 and 18 and had frank bleeding as heavy as my period days 18 to 20. this has stopped for now. they say my progesterone levels have always been low - does this fit with a medicated cycle. i thought with supplementation they would be high.
I saw some tissue pink grey stuff and some cord like tissue. I cant believe that a fetus could have survived that bleeding. could it just be one fetus. could it be the remaining placental tissue and i will see an absent fetal heart at the 7 week scan? given the levels are high and ive had lots of bleeding could it be a hydatiform mole? can you get those with icsi cycles. my partner has oligoasthenospermia.

thanks a lot for your time and thoughts
At Thu Jul 24, 07:32:00 AM 2008, Anonymous said…

Hello, Dr. T!!! It is Robin again, do you remember me? :-)

Here is my history again: 2/3/05 I had a healthy baby girl via c-section with no complications during pregnancy, 1/06 I had a miscarriage at 9 weeks and no chromosomal abnormalities were found with the fetus, 10/06 I had a miscarriage at 5 weeks and no fetal tissue testing was done bc it was so early, 8/07 I had a miscarriage at 11 weeks and no chromosomal abnormalities were found with the fetus, 2/08 I had a miscarriage at 8 weeks and it was determined that it was a blighted ovum.

I have had chromosomal testing done on myself which came back normal. I have also had my prolactin, TSH, cardiolipin, and lupus anticoagulant tested and they all came back normal. I have also had a hysterosalpingogram (sp?)done and that showed nothing abnormal with the uterus and both my tubes were open. All of my pregnancies were with my husband.

I ovulate regularly on my own but my RE prescribed clomid to help me get pregnant quicker. Well, I am pregnant again! My LMP was June 23and I had a positive HPT on July 17. I am currently taking progesterone suppositories. My HCG levels were tested on July 18 (CD 26) and came back 56 and on July 22 (CD 30) and came back 560.

So, my HCG levels are increasing like they are supposed to but then again that happened with several of my previous non-viable pregnancies as well, so I am not getting my hopes up. The true test will be my ultrasound at 6 1/2 weeks on August 8.

I just wanted to give you an update and keep your fingers (and toes) crossed for me! I will let you know how the ultrasound goes.

Thanks,
Robin
At Fri Jul 25, 03:04:00 AM 2008, Colleen said…

Hi Dr. Trofatter,

I just wanted to update you on what's happening. I had a follow up u/s last week on Monday, and it showed a fetal pole, crown:rump length 4mm. we saw a heartbeat! baby was dated to 6 weeks 1 day.

So my doctor said this is definitely a viable pregnancy, and I'm booked for a 1st prenatal appointment next week. I'll be 8 weeks 1 day according to the u/s dating then.

I've done a lot of reading, and saw that the chance of miscarriage is less than 5% once I see the heartbeat? So I'm feeling fairly confident that things are going okay now. I'm 41, so I guess the next major worry is what the amnio will show at 15 weeks?

Do you agree that this seems like a viable pregnancy now? Do you know if the early difficulties with low hcg numbers make it more likely that we'll find some problems through amnio later?

I wanted to post this, becuase when I was at the point of having low hcg readings and most things i read said the pregnancy was doomed i found it very helpful to read stories where healthy babies came out of similar early circumstances. it is such an awful time, having some hope to hang onto was really important for coping.
At Fri Jul 25, 05:37:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To longtime ttc July 23: Well, at this point the hCG levels ARE increasing appropriately, so please keep your hopes up. It is possible that you miscarried or will miscarry one of the embryos ao this could simply be 'implantation bleeding.' The 'tissue' you passsed could have simply been a fibrin clot. I doubt this is a molar pregnancy. Hang in there til you get the ultrasound done and then let us know what you find out. Best wishes. Dr T
At Fri Jul 25, 05:39:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi Robin: I will keep you in my thoughts! Thank you for updating us. Again, best wishes! Dr T
At Fri Jul 25, 05:42:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hello again Colleen: Things certainly appear to be going well! Thank you for letting us know. I am glad you kept your chin up. Let us know if we can hold your hand a little bit longer! Stay in touch. Dr T
At Sun Jul 27, 03:02:00 AM 2008, Anonymous said…

Hi there

Im 7weeks pregnant

I have had bleeding on and off for the last 5days

I had a pelvic U/S on the 12july,

And they found The utrerus is anteveted, there is two fluid fill sac's, the uppermost contains a yolk and a foetus has a 5mm and heart rateof 116bpm,

which was a single live foetal at 6weeks1day,

The inferior fluid filled sac structure has a diameter of 6mm which is smaller then a 5weeks pregnancy.

No yolk sac or foetal pole within

Both ovarys were identified, the corpus luteum is on right side,

No extrauterine abnormality was seen.

How i was booked for u/s again in 10 days but have since gotted my HGC bloods and my levels in 5days have gone only from 3320-to-4240

I am now told my pregnancy is at risk, I have had bleeding when i wipe after the toilet, no clots really just small dot ones

Now with my hgc levels not doubling I have u/s moved to tommorrow,

Im not sure what to expect but have read your post and other ppl with this problem, but there levels were very low

Mine did'nt not rise just did'nt rise as much as expected.

Could you please give me any advice

Thank-you
At Sun Jul 27, 10:11:00 AM 2008, sue said…

Hello,

I have been reading through the various different stories here and seeing similarities in my situation and wondered if you could advise.

I am 38 years old and currently almost 6 weeks pregnant (naturally conceived) I was experiencing some pain at first on one side so my doctor referred me to the emergency gynaecology Unit at my local hospital and i have been having blood tests (BHCG) ever since.

My first reading was 93 (10 days ago) then two days later 81 on the 25th it rose slightly to 119 and now today my level dropped to 94. I have to have another test in two days. Aside from this I had spotting a week ago which stopped for a couple of days but has returned slightly heavier. I have had very little pain in the last few weeks and it is not one sided.
I have not had an ultarsound at all. Is there any hope?
Thank you
At Mon Jul 28, 04:35:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sue: I am afraid this rally is a nonviable pregnancy. The only question remains is if it is an ectopic pregnancy or simply a blighted intrauterine pregnancy. With the hCG being that low, an ultrasound may not help to sort that out. Let us know what happens and I am so sorry. Dr T
At Mon Jul 28, 04:39:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 27: The pregnancy may have started out as a twin pregnancy with loss of one of the babies early ("vanishing twin"). That may be an explanation for the hCG results. However, the ultrasound will probably sort this out sooner than later. Good luck and let us know what happens. Dr T
At Tue Jul 29, 11:28:00 AM 2008, sue said…

Thank you anyway for responding Dr T. The update is I lost the baby last night and this was confirmed by the hospital today.
At Tue Jul 29, 06:02:00 PM 2008, Anonymous said…

hi dr t - i am the art girl who was "cautiously optimistic" with fluctuating HCG levels and an u/s with a heartbeat. well the next u/s 7/23 we got a hb of 120 but still measuring small and today went for u/s and no heartbeat - then sent for another more in depth u/s and fetal demise at 8w. obviously after the trauma of ivf we r devastated but my rational mind knows it's for the best (i am a scientist) however my heart having ahard time catching up. i found ur site to be very informative and helpful and i hope u continue ur great work even tho i am sure ur very busy in other aspects of ur life. thank u jools x
At Wed Jul 30, 01:12:00 PM 2008, Anonymous said…

hi dr. T,
your site is wonderful with valuable info. i am 20 days out after IVF transfer. HCG showed 280 then 3 dayas later 620 and 2 days later only 700. It is increasing but certainly not doubling. No bleeding, but doc said it may be a multiple that wasn't viable. Is it promising that i continue to see the increase?? even though it was so small? i have to wait another 5 days for the next HCG so this will feel like years. Keep up the great work, thanks for the interaction.
At Wed Jul 30, 07:10:00 PM 2008, dana said…

Dr. T,
Your blog is a source of comfort, and I appreciate you taking the time to respond. I just turned 30, late last year diagnosed with PCOS "probably" (i.e., I have some characteristics, but not all the earmarks of PCOS--I'm not overweight, diabetic, etc., but have slightly cysty ovaries and didn't have my period for 4 months, so that was the default diagnosis). On my 4th month of Clomid, we conceived (I ovulated around 7/3). Dr. doesn't think though that the Clomid was what caused ovulation, b/c I only ovulated once during previous 3 cycles) and this time ov didn't happen until day 25--my Dr thinks that was too late to be caused by the Clomid.
The day I got the positive (15 dpo, 7/18), I was brought in for bloodwork. Bloodwork: HCG = 172, prog = 10.6. Dr. said a little on the low side of normal, but early in the pregnancy, so let's get some more bloodwork. Bloodwork on 7/22: HCG = 600, prog = single digits. Dr. brought me in and told me that due to the low prog, I would probably miscarry this week...then she took some more blood. Bloodwork on 7/25: HCG = 3,000, prog = 6. So, my results are a now little "confusing." I am out of town right now but returning for a sonogram and more bloodwork on Friday. I was expecting a miscarriage this week, but I'm only experiencing very mild cramping when I wake up and just before bed (as if I was going to get my period), and have had a little spotting but barely any (on TP but not in liner). No sharp pains or anything I should get myself to hospital about (given risk of ectopic). I started taking oral progesterone (200 mg) on Monday evening.

So, with all that detail, my questions are: (1) is it possible that I won't miscarry? Could the progesterone pills help? (2) If on Friday we see a viable fetus--and if it seems my prog is increasing--I've heard that oral progesterone is not absorbed as well as suppositories. Should I ask my dr. to switch me to suppositories? (3) If the fetus is still viable, and the progesterone increases, are there increased risks of birth defects or other developmental delays given the length of time my prog has been so low? Or is the prog. irrelevant?

Questions 2 and 3 probably don't matter if I do have a m/c, but I can't seem to find information on it so it would be good to know anyway. We were devastated by the news that we would miscarry, but now that nothing's really happening, I'm wondering what's going on.

Thank you so much!
At Mon Aug 04, 04:29:00 PM 2008, dana said…

Dr. T--just an update on my situation. My sonogram was normal--not ectopic--with a normal heartbeat. Bloodwork came back today, and my HCG is now over 30,000, and my progesterone is up to 22. I don't know if it was the progesterone pills or whether my body finally kicked into gear. The doc also thinks the lab may have screwed up my 7/25 results. I'm still worried about the possible effects of having a progesterone deficiency for so long, but things are looking up.
At Wed Aug 06, 02:14:00 AM 2008, Anonymous said…

I am about 3-5 weeks pregnant. We have been in and out of doctors and hospitals checking my HCG and Progesterone levels every two days, because they think I have an Ectopic Pregnancy and are trying to push Methotrexate on me. I started lightly bleeding (have not filled a pad) and cramping 5 days ago. No one has seen anything in my tubes or the uterus. My HCG levels are rising but not completely doubling every two days. My progesterone levels have dropped to around 4. My HCG levels are rising, now over 6000.
We also just discovered I have a tilted uterus.

Thanks
Kelly

We got a second opinion at a bigger hospital, and that doctor tried pushing Methotrexate as well, she said she was confident this was Ectopic, come to find out she was telling us all of this before she even looked at the ultrasound. When she did look at the ultrasound, for the first time something was seen inside my uterus. She said it was not a pregnancy, possibly a blood clot.

We go back tommorow for a more advanced ultrasound, hoping we will know something....

Any advice for us?
At Wed Aug 06, 06:52:00 AM 2008, shoom said…

Hi Dr T
Thank you for this information and your calm and preofessional comments. I am 34 and about 4 weeks pregnant after IUI. At 16 DPO my HCG level was 214 and 2 days later it was 388. I need to have another blood test tomorrow so see what's going on.
Any advice or suggestions to help calm me down? I see an increase - but is it enough? And the numbers seem very low to me..
Many thanks
Jo
At Wed Aug 06, 05:29:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Sue July 29: I am so sorry Sue. Thanks for letting us know. Hang in there. Dr T
At Wed Aug 06, 05:32:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To jools July 29: I am so sorry. Thank you for letting us know and for the kind comments. They keep me going at this. Sometimes there are just not enough hours in a day! Kind regards, Dr T
At Wed Aug 06, 05:34:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 30: Like you, I would have preferred to see a greater increase, but let's hang in there until the next hCG level. I have found that there is always hope in these circumstances and I wish you the best. Dr T
At Wed Aug 06, 05:43:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Dana: It is certainly possible you won't miscarry with that nice rise in hCG. In fact, your doctor should be able to confirm an intrauterine pregnancy by ultrasound at this point. The progesterone might also help and it certainly won't hurt. As far as I know, low progesterone levels do not cause birth defects or developmental delays, it merely reflects production of progesterone by the corpus luteum early in pregnancy. We will have to wait to see how things turn out, so please let us know. Good luck to you! Dr T
At Wed Aug 06, 05:45:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Dana (again) Aug 4: Things certainly are looking up!! Good for you. Stay in touch. Dr T
At Wed Aug 06, 05:48:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Kelly Aug 6: No other advice. At an hCG level of 6000, they should be able to determine if the findings in your uterus are more consistent with an intrauterine pregnancy or an ectopic pregnancy. Please let us know and best of luck! Dr T
At Wed Aug 06, 05:50:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Jo Aug 6: That increase in hCG is well within the normal range of 'doubling' we like to see every 48-72 hours. Good luck and let us know how things progress! Dr T
At Thu Aug 07, 01:02:00 AM 2008, shoom said…

Thanks so much Dr T! You have been sent from some higher place I think!!
I am still panicking that the levels are low - as is my own Doctor, but I will only know by sunday if they are increasing as they should.
Many thanks again and I'll keep you posted
XX
At Thu Aug 07, 04:17:00 PM 2008, KJ's Momma said…

Tell me what you think of mine...
My LMP was 6/14, so based on dates I would be 7 weeks 6 days today. As of last week, the doc was going by that because we really didn't KNOW how far I was.
On July 30th, my HCG was 5199, progesterone ONLY 5.6
I started prometrium. Had to do that with my son as well.
We had an ulrasound yesterday and only seen a sac, no baby. The sac measured 6 weeks 2 days, so they said It could be too early to see anything and said that probably I ovulated later. They repeat the blood test. Got the results back for that today and my HCG was only 11,500, and progesterone stayed the same. They advised that the outcome doesn't look good but they want to check my blood again tomorrow. They also told me to increase my progesterone, I guess in case this sticks?
I have PCOS, and I think a luteal phase defect....
What do the odds look like for me, i'm thinking the worse since my numbers barely doubled in a week, and my progesterone didn't even budge.
At Thu Aug 07, 07:40:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To shoom: I will be pullling for you! Thanks for the XXX. Dr T
At Fri Aug 08, 05:02:00 AM 2008, Anonymous said…

hello my name is daniela and i was have an ivf in jordan i was hope for a baby boy,after two weeks the doctor he was make me a blood test and the hormone levels shows 43 he was told me congratulations ,but when i came back to london i was start bleed like a normal period i was make another blood test with the result number 3,you think the doctor he was lie to me that maybe i wasnt any pregnancy at all,i am healthy and i am 27 years old,please i need to know your opinion?
At Fri Aug 08, 06:23:00 AM 2008, hopeful said…

Dear Dr. Trofatter,
I am 35 years old and had my first IVF, with 2 embryos transferred on 7/25. On 8/4 I started to bleed, with many clots on 8/5 and I saw a small piece of tissue (about 2 cm) as well. Have continued to bleed all week but much lighter now. My first hcg was 3 units/liter on 8/6 (I live in France so I think the counts are different here...) and today, 8/8 it has gone up to 4. I'm on 400 mg/day of progesterone, but missed one dose early in the week when the drs. thought my period had prob started. Is it possible that I lost one of the embryos early in the week but that I am pregnant with the other? I'm waiting for a call back from my doctor but any advice you could give in the meantime would be greatly appreciated.

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Low Early Pregnancy 'Hormone' Levels: hCG and Progesterone

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