Gynaecological Things Inside

April 21, 2008 4:30 AM

Are my bHcg levels rising too quickly and when my clinic says they'll do whatever I want, what should I ask for? Be warned, gynaecological things are inside. (Sorry, couldn't resist that one.)

I had a positive bHcg test on Wednesday April 16 it was 123.
Today it was 2066.
It's IVF. I have very long cycles. My period started on March 14. I am apparently 4 weeks 4 days (based on the day of embryo/blastocyst transfer).

My doctor and the clinic nurse say the rate rise is fine. I believe it's far too high. What should I ask my team to do? They are prepared to do whatever it takes to rest my anxieties.

I've had brown discharge/spotting/some kind of doloured ooze. I'm sorry to give so much graphic information. I'm obviously happy if it means twins, not if it means a molar pregnancy and don't quite know how I would respond to a down syndrome diagnosis. So I just want to find out more but I don't know what to ask for or when.

Please give me any ideas or input you can. I know you're not doctors, my doctors or responsible for my uterus. But please feel free to have a poke around and give it your best shot. The plural of anecdote also welcome.

posted by taff to Health & Fitness (6 answers total)

The "average" rate of hcg rise is doubling every 48 hours. That's just average though. My hcg was only 35 when taken 12 days after transfer and I had a single baby (transferred 3 embryos). Another girl who cycled the same time I did had a hcg of 17 - 12 days post transfer and had twins. Both of those levels would have indicated to some doctors that it was a "chemical" pregnancy and likely to mean a failed cycle, however all 3 children are now healthy 5 year olds. There's really no way to tell without an ultrasound exactly what is happening and this early, you really can't see much except possibly the gestational sac. I completely understand the anxiety you're feeling, but hydatiform moles are extremely rare. The spotting could be explained as implantation spotting, which happens to some people.

Congratulations on the positive!
posted by hollygoheavy at 6:08 AM on April 21, 2008

What should I ask my team to do?

Ask your doctors for a transvaginal ultrasound scan on the earliest date they are prepared to offer it. The amount of information available from the scan will depend on the quality of the scanning machines, and the experience of the sonographers. 5 weeks gestation can now often be enough to confirm a healthy intra-uterine pregancy (or two), so you might only have to wait 3 days. At this stage the scan will not however be able to definitively rule out a molar preganancy, or provide you with any indication re: Down's syndrome.
posted by roofus at 7:59 AM on April 21, 2008

Ask for sequential integrated testing; it's basically the best there is right now. You'll have a nuchal transluency US, hCG, PAPPA at 10 to 13 weeks, and then an AFP at 15 wks. It has a 93% detection rate of down's syndrome. No test is perfect, the best is the Chorionic Villi Sampling (earlier done than an amniocentesis) and an amniocentesis. But if they're not warranted, I don't know if they'll do them though. You can also get an anatomical ultrasound at 20 weeks, and if everything looks normal, the risk will cut in half for Down's. I'm not sure about the clinical aspects, but I may be able to answer questions about what tests they could do (at least for what I've learned so far-> med student; ironic that just had a test on this this morning; email in profile if needed.)
posted by uncballzer at 8:42 AM on April 21, 2008

If it's IVF, then out of all of your possible outcomes, twins is the most likely scenario with high bHcg. Why not just schedule a six-week US to have a look?
posted by DarlingBri at 10:15 AM on April 21, 2008

Hey everyone. In the interests of closure for everyone who might read this in the future.... I'm back. I've had such terrible anxiety about the viability of this pregnancy that I'm trying to pretend it's not so.... till the ultrasound next week. At that point, I will update for posterity.

I had another blood test and the doubling rate was more normal. But I'm not sure if that's ok. Or if I want a regular doubling rate. My main question was about what I should ask for in the very immediate future. I went with the hcg repeat. The dating ultrasound and nuchal translucency at 12 weeks are a given....

As I said, I'll be back with more soon. Thanks all. Really. I'm sorry I"m not mature enough to have discussed this more.
posted by taff at 3:27 AM on April 27, 2008

Hey there again..... the ultrasound showed a single foetus with an acceptable heart rate. And a source for the bleeding/oozyyuckystuff. Now we cross everything for a happy nuchal translucency in a few weeks. Thanks for everything, everyone. T.
posted by taff at 9:53 PM on May 19, 2008