QuestionI had an intra-uterine insemination on July 25, after using a combination of Clomid and Repronex injections, and then Ovridel two days prior. Seven days later on Aug. 1, I went to the ER for the cyst pain in my ovaries (hyperstimulation ovary syndrome). They are still enlarged and have several cysts. A home pregnancy test on Aug. 10 was positive. I went back in to the doctor on Aug. 13 when the pregnancy was confirmed. I began having quantitative HCG levels (from blood) measured (8-31 was 366; 8-15 was 611.4; 8-17 was 984.5; 8-21 was 2723; 8-23 was 5587) On 8-23 I had sonogram that showed there is a gestational sac in the uterus but there is no yolk or stem. The doctor was worried it was an indication of an eptopic pregnancy, so that night (23rd) I had another ultrasound with a higher resolution machine, but the results were inconclusive. Since then, I had the HCG levels taken on 8-27 (was 8781) and 9-3 (was 20,619) and had two more sonograms which show this empty gestational sac and the ovarian cysts. The doctor is recommending a D&C. I'm also worried that there is still the possibility of something eptopic, maybe hidden among the cysts? I have had no spotting or serious cramping--any pain has been primarily on my right side where the largest cysts are. What are the risks if I just let it be, and see what happens on its own? The D&C procedure seems relatively safe from what I've read, but if there's any chance...Is there any hope that I could have a viable pregnancy?
AnswerDear Nancy,
This really is such a judgement call. Because of that, I really cannot tell you which way to go. I can, however, give you some additional information so that you go into this decision as well informed as possible.
First, as to ectopic pregnancies - Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination. Pain is usually the first red flag. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity. Any of the following additional symptoms can suggest an ectopic pregnancy:
-vaginal spotting or bleeding
-dizziness or fainting (caused by blood loss)
-low blood pressure (also caused by blood loss)
-lower back pain
If hCG levels are lower than expected for your stage of pregnancy, doctors are also one step closer to diagnosing an ectopic pregnancy.
Your hCG levels on 9/3 of 20,619 at 7 weeks from LMP (I'm estimating) was within normal (7,650-229,000 mIU/ml), though on the low side of normal.
Now, as to early development of the embryo - Typically, the gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks, with heart activity usually visualized at around 6 weeks.
If you are at 7 weeks now (or at the time of the ultrasound), and there is still no visible yolk sac, fetal pole, or heart activity, I'd say there is likely a problem somewhere. But again, I've given you the information and the decision belongs to you and your doctor.
I hope this has helped you and answered your question. I wish you well.
Brenda
