QuestionHi Dr. Ramirez,
I'm 37 y/o with 4 children (one natural, one from IUI, and twins from IVF).
I'm currently 5w4d pregnant after IVF. I've been worried sick this entire time that my betas started off slow and have not been doubling appropriately. Today, I'm 22dp3dt (22 days post 3-day transfer), and here are my betas/progesterone for this pregnancy:
12dp3dt = 238 / 28.5
15dp3dt = 583 / 51 (56 hr doubling time)
17dp3dt = 985 / 57 (64 hr doubling time)
19dp3dt = 2017 / 52 (47.39 hr doubling time)
22dp3dt = 4445 / 57.5 (64 hour doubling time)
My beta doubling times have been high 50s-low 60s, which has concerned me since the beginning. I only had one good doubling time last week. Plus, in my opinion my beta values are really low for this stage at 4000+. I had my first u/s last Friday to rule out an ectopic. There was no ectopic that they could see, but there was one empty intrauterine gestational sac. Today (Monday), they saw 2 gestational sacs. The larger sac that they saw on Friday had just started to develop a yolk sac (thank God). The smaller sac that was just discoverd today is about 3 days behind. I don't understand this. I was so concerned that my numbers were low and had not doubled appropriately for just a healthy singleton pregnancy. In my opinion now that there are two sacs, my numbers are for sure WAY TOO LOW and not doubling appropriately for a twin pregnancy! The u/s tech mentioned "a late implanter", but I read some studies on slow-rising hcgs and also late implantation, and they both suggest miscarriage is pretty much inevitable.....despite demonstrating 6 week viability with cardiac activity via ultrasound. I've never had a miscarriage and am scared. I've also read how many women have had demonstrated cardiac activity on a 6 week ultrasound and went back at 10 weeks, and there was a missed miscarriage. With my betas, is that a probability? Have you seen similar betas to mine that end up with a healthy, live birth?
Dr. Ramirez, after seeing my HCGs and u/s findings, what is your honest professional opinion? Please give it to me straight. My betas from my healthy twin pregnancy in 2007 (that I carried to full-term) were about triple of what they are currently, and the doubling times were much faster. Do you think the smaller second sac is not going to make it? Why did it grow over the weekend and just appear today (especially since I had another slow doubling time over the weekend)? With those numbers, are both babies in jeopardy? Like I said, I've run across quite a few articles about slow rising betas, and they weren't promising. I can't understand how a second sac showed up with that low of betas. With my previous twin pregnancy, my levels were around 15,000 at this stage.
My next u/s is Friday at 6w1d, but I just wanted your professional opinion so I can either prepare for the worse or remain hopeful.
Thank you, Dr.!
Answer
Dr. Ramirez
Hello Monica from the U.S.,
One cannot tell how a pregnancy is going to turn out just based on bHCG's unless there are drastic changes i.e. there is a downturn in values or the numbers are not rising appropriately. Eventhough we say that the bHCG's should "double" every 48 hrs, the reality is that they just need to rise by 80%. So don't make too much of the pregnancy based on the bHCG's. Certainly bHCG's that are not rising adequately can herald a miscarriage, but that is not always the case.
In addition, an early 5-6 week ultrasound is not sufficient to verify a viable pregnancy. Late implantation can certainly occur, in which case the ultrasound findings would lag behind the gestational dating, yet the pregnancy could progress normally. I have had patients like that. The only way to verify that the pregnancy is viable is to continue to follow with the ultrasound. Most 6 week pregnancies do have heart motion on the ultrasound, so not having heart motion is a bad sign. But again, it is difficult to date the pregnancy at that early stage. The margin of error for dating is +/- two weeks. That certainly would make a difference in terms of findings. Again, you cannot use this early scan to determine viability.
I would recommend that you not try to micro-analyze things for now. Let them proceed as they will. Besides there really isn't anything that can be done. You are still at a very early stage of the pregnancy. Your next ultrasound will only barely be at 6+ weeks gestational age. That should give you more information to process. With the discrepancy in sac sizes, several things could happen: it could catch up or it could disappear. You'll just have to wait and see.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
For additional information check out my blog at http://womenshealthandfertility.blogspot.com and join me on twitter at @monteeybayivf.com
