Pregnancy, miscarriage, pregnancy...what is possible time-wise?
January 10, 2019 10:15 AM   Subscribe

In early November my wife and I found out she was pregnant. She had been doing the ovulation calendar thing and knew what point she was at (about a month). When we had the visit for the eighth week prenatal visit, there was no heartbeat, and long story short, a few days later she had a normal D&C procedure as a result of the miscarriage. After the 2 weeks that we had been told to abstain from sex passed, we had unprotected sex. My wife had not had her cycle yet, of course.

Last night, after getting home from her D&C followup visit (where she was told everything was fine but the doctor seemed taken aback that she'd had unprotected sex before her first cycle...which kind of upset my wife, as she'd been told this was fine) she took a First Response pregnancy test and there was definitely a second faint line (meaning it was positive). She's going to take another test tonight and use an electronic test, too.

My/our question is, how likely is it that now, exactly 4 weeks from the D&C procedure is it that this is a false positive due to the procedure? It seems like from googling it is possible it's a false positive but because my wife had not started tracking ovulation/has not started her period again, it's harder to know what's going on. Obviously time will tell but we're just trying to understand whether or not this is likely a new pregnancy or not. Thank you!
posted by rbf1138 to Health & Fitness (21 answers total) 1 user marked this as a favorite
I think she should take another pregnancy test in a couple of days and see if the line gets less faint. SInce you don't know what day of the cycle she would be (i.e. how many days past ovolation), it's possible she's pregnant and just too early for a pregnancy test to show a good strong result. If the line stays faint, presumably you will see a doctor, but consider when you see the doctor asking for a *quantitative* HCG test (i.e. a pregnancy test that doesn't just say she's pregnant, yes or not, but tells you how much pregnancy hormone she has). If she's pregnant you can do another one a few days later to see how fast the HCG is rising. The reason I say that (and I'm not a doc just someone who's had quantitative HCG tests) is that it can help tell you if the embryo is growing normally. The number should go up at a certain rate if all is well. If the pregnancy stick line stays faint, I would wonder if it's because her HCG is low (but again, it could just be because she's really early to take a test).

Note that the electronic pregnancy test is the same. It just reads the line and tells you what the line says on a little LED screen. You'll see when you go to throw out the piece that you're supposed to throw out (you keep the LED screen) that it's just a regular pregnancy test with the same old line.
posted by If only I had a penguin... at 10:44 AM on January 10, 2019 [3 favorites]

As I understand it, you will ovulate before your period after a loss. I have a close friend that became pregnant this way this year. The doctors don't like it though because it is harder to date the pregnancy.
posted by k8t at 11:00 AM on January 10, 2019 [4 favorites]

So sorry you all are dealing with this, first the miscarriage and now this uncertainty. It's really hard to know, honestly. Some doctors do say to abstain until your cycle comes back, mostly to avoid this issue rather than any other reasons.

Some women, it appears, are extra fertile right after a miscarriage. So it's not beyond the realm of possibility that she would have ovulated soon after a miscarriage. However, it's also just as possible that there are remnants of HCG left in her system from the previous pregnancy. Some women are counseled after repeated losses to keep testing after a miscarriage and to not to try again until they are getting negative tests. Not because sex or pregnancy is dangerous sooner, but again, because it helps avoid this uncertainty. Not having been told that or not being aware of that is not your fault, though. It feels like doctors don't take these things seriously until a woman has multiple losses, which is heartbreaking and feels unfair. Just know you guys didn't do anything wrong.

Time is really the only thing that will tell, unfortunately. I know that's hard. Home tests that you buy at the drugstore, like the First Response ones, are quite pricey for what they are, and the prospect of continuing to pee on a stick every couple of days while you wait it out can be devastating for some. It's a difficult thing to be patient about. If you need a more definitive answer, the only real answer will be through a series of quantitative HCG blood draws. They'll show whether the HCG is climbing or not. In a successful pregnancy, HCG should be doubling every two days. If her doctors will draw this test, it's the only thing that will give you definitive answers right now. Everything else involves waiting and watching, sadly.

If home tests are your only option, the best advice is to test every other day, first thing in the morning, not every day, so you're not squinting at faint lines and trying to decide if one is **more faint** than another. First Response Early Response tests have a very low threshold for displaying a line. Different brands will have different sensitivities. Digital tests have a much higher threshold for showing a positive, so I would not bother with that until you feel like you have a stronger line on a traditional test. The First Response normal test is said to detect pregnancy at about 22 HCG level. The First Response Early Response test can detect HCG as low as 6.8. Most digital tests are in the 22-25 range. Since you mention First Response in your question, I'll point out that if you have what they sell as the "Triple Check" package of three tests, you likely have one very sensitive test, one normal sensitivity test, and one digital test requiring a high-normal level of HCG to show positive.

While I don't always care for the tone of the conversation anymore (the culture has shifted to feel a lot more negative in recent years), there is a wealth of information at the Trying for a Baby subreddit. Many women there have been through losses and would be sensitive to your wife's concerns.
posted by terilou at 11:05 AM on January 10, 2019 [4 favorites]

So sorry this happened to you. I miscarried my first pregnancy and it was very difficult. I went on to get pregnant again 5 months later and now have two children. I hope the rest of your family-growing is as uneventful as mine was. It's sadly very common, and now that this has happened I'm sure you will learn that many of the women you know have quietly gone through it. Not to minimize, but to let you know that it's not your fault and doesn't have to mean there is anything wrong with either of you.

It is very possible that she is pregnant again. There is some evidence that women are more fertile after a miscarriage because of the pregnancy hormones still present in their bodies. It's not ideal because it makes it more difficult for the doctor to date conception, and the uterine lining may need some time to recover after a D&C. I think it's less probable that the test is picking up leftover HCG, but not impossible.

The best thing would be to test again in the morning because HCG is more concentrated in morning urine, and then from there try to get a blood test from her provider.
posted by apricot at 11:12 AM on January 10, 2019 [1 favorite]

If you are pregnant, you know the date of conception. That helps with the window of how far along you are, give or take only a day or two. :)

I wish you and your family the best. Uncertainty is so hard.
posted by jillithd at 11:33 AM on January 10, 2019 [4 favorites]

Anecdotally, it’s perfectly possible. My daughter is from a pregnancy on that schedule — early miscarriage, no intervening period. She’s nineteen now and fine.
posted by LizardBreath at 11:36 AM on January 10, 2019 [3 favorites]

I'm so sorry for your loss.

If it's a false positive due to the D&C, that is something her doctor will need to be monitoring. Pregnancy tests should be showing negative by 4 weeks after so if they're not that could be a sign of the procedure being partially incomplete. If she gets the same results from the next test she takes, she should tell her doctor and the doctor will be able to do a blood test for hCG levels to see what's going on.

However, it is entirely possible that it's a new pregnancy. Anecdotal evidence but: both of my successful pregnancies have been immediately after miscarriages, and when I was tracking ovulation I ovulated two weeks after the surgery.
posted by Catseye at 11:37 AM on January 10, 2019 [5 favorites]

I am sorry for your loss.

I've had a lot of miscarriages and we did IVF and a lot of our friends did too.

As anecdata nearly all of our IVF friends ended up with viable pregnancies from the next cycle after a loss (this was for second or third children, not the first). But none of those (prior) pregnancies were ended medically.

I had a ectopic pregnancy early on that was ended medically, where I was advised to refrain from unprotected sex until my hormones levels returned to "base", and my levels did not do that for three or four months.

While it's not impossible that your wife is pregnant, it may well be that the pregnancy test is detecting "residual " hormones from the original pregnancy.

When things like this happened to me I usually carried forward in practice (what I ate, what I drank) as though I was pregnant, while trying to prepare myself mentally that the odds were low.

An event like this is a very tough time in a marriage; be gentle with each other. And best wishes for a viable pregnancy very soon.
posted by vignettist at 11:45 AM on January 10, 2019

That happened to me six years ago. I miscarried at 11 weeks and had a D&C immediately following. In the weeks afterward, I was waiting...and waiting...and waiting for my period to show up so we could resume "officially" trying and it was nowhere in sight and I was going out of my damn mind that my body was betraying me AGAIN. I grimly took a pregnancy test to prove to myself what I already knew, that I wasn't pregnant and the universe was just messing with me...only I was. So while it certainly could be just residual hormones, in my case those levels tanked pretty quickly and I tested negative at a follow-up appointment less than two weeks after my D&C. I think it's entirely possible that she is indeed pregnant.

All the best to you and I am very sorry for your and your wife's loss.
posted by anderjen at 11:53 AM on January 10, 2019

I tracked ovulation after my two D&Cs. The first time I ovulated 17 days after the procedure. The second time I ovulated 16 days after the procedure. It's unlikely to turn a positive pregnancy test 8 dpo but it's not impossible and of course it's very possible that your wife ovulated sooner than I did.

I can't speak to whether it's more likely that your wife is pregnant vs. a false positive, but I can say that if she is pregnant, my understanding is that it is perfectly safe to get pregnant in the cycle after a D&C, and that OBs ask women to wait one cycle so that dating the pregnancy based on Last Menstrual Cycle is possible.
posted by muddgirl at 11:55 AM on January 10, 2019

It is indeed entirely possible that your wife could be pregnant and, if that turns out to be the case, it is not very difficult for a medical professional to find out when she conceived with a dating ultrasound early on.
posted by lydhre at 12:02 PM on January 10, 2019 [1 favorite]

We know the theoretical date of conception :) To get this straight, the only real "issue" here is in the very short-term; not being able to know definitively what's going on at the moment. But if she doesn't get her period in the next 2-3 weeks, she's pregnant, correct? That's easier (and cheaper) than blood tests and HCG I missing any downside to us just waiting 2 weeks?
posted by rbf1138 at 12:13 PM on January 10, 2019

IANADoctor, but I don't think there is a downside at all. Except that I'd be thinking in terms of home pregnancy tests rather than simply waiting for her period -- like, take another in a week or two, and then go to the doctor if she still shows up as pregnant.
posted by LizardBreath at 12:17 PM on January 10, 2019

It is a good idea to make sure it’s not higher hcg due to some complications from the dnc (like retained tissue) if she does get her period and her levels are still turning a positive on a pregnancy test. If she doesn’t get her period and has a positive pregnancy test in the next week or so then a call to an OB is in order, probably to schedule a dating ultrasound at that point.

Good luck!
posted by lydhre at 12:27 PM on January 10, 2019

Re your last update: Hormones get wacky after pregnancy loss, so not getting her period soon might not necessarily mean she's pregnant.
posted by metasarah at 12:45 PM on January 10, 2019

There is no downside to just waiting, no. This period of time is not actually uncommon when TTC; it's "the Two Week Wait" (TWW).

Traditionally, the baby crazed among us go to the Dollar Store and buy a ton of pregnancy tests and pee on one every morning and ponder very deeply the relative strength of the lines.

I never did, though, and found it far, FAR less stressful to consider every TWW as Schrodinger's Pregnancy.
posted by DarlingBri at 12:52 PM on January 10, 2019 [2 favorites]

If you do want to go the repeated pregnancy test route, you can buy the sticks alone for pennies on the dollar.
posted by hollyholly at 2:20 PM on January 10, 2019 [3 favorites]

I think the downside of just waiting, rather than getting a quantitative HCG is if she is pregnant and miscarries again. It's something you might want to know and wouldn't be able to rule out easily. This may depend a little on her age and family history. We did quantitative HCGs on all my pregnancies after the first one was ectopic (I was also close to 40).
posted by vunder at 2:20 PM on January 10, 2019

If it is leftover tissue that's keeping her HCG level high, waiting another couple weeks could actually put her quite a ways out from when the actual miscarriage occurred. I would want to know what was going on with the blood levels to know whether to be concerned about that hypothetical tissue.
posted by teremala at 3:52 PM on January 10, 2019

Periods are not reliable indicators of pregnancy/not pregnancy. Pregnancy tests are. I would want to know.
posted by biscotti at 4:53 PM on January 10, 2019

I admire your patience, but if you took 2-3 HCG tests at 48 hour intervals, you'd learn if the values were rising or falling, and at what rate, giving you a much clearer sense of what's going on in 5 days. In the absence of the tests, you might be wondering for awhile -- it can take awhile to get a period after a MC. I'm sorry for your loss and keeping my fingers crossed for good news for you guys.
posted by slidell at 8:11 PM on January 10, 2019

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