Slowly Rising hCG Levels & Pregnancy Concerns: Seeking Medical Advice

Question
Last menstrual period 4/26/06. Ovulated 5/11 -- 5/14, pain
seemed to go on for about 5 days -- but was not temperature
charting, so unsure when exactly. Positive HPT 5/27/. Have
three kids already, feel pregnant, but great! Spotting 6/8, and
sonogram revealed nothing in womb, not even thickened uterus,
but HGC of 569. 1 day later, light bleeding, saw thickened
uterus, and HG of 670. 2 days later HGC of 702 -- it is very
slow. Resident at hospital urged me to have immediate d+c
and
ectopic pregnancy pill tonight. As I have no symptoms other
than mild bleeding, and normal pregnancy symptoms, feel this
is too fast for me. Have asked for one more sonogram tomorrow
morning before a decision. I would like to wait it out until my
levels go above 1100, just to see if I have a late bloomer. But am
i insane? Do the dangers outweigh the chances?

Answer
If your last period started on April 26, the earliest you could have ovulated would be May 9 and you could have conceived if you had sex on May 8,9,10, or 11. (it could have been later if you do not have a 28 day cycle). If you did become pregnant on one of those days, a pegnancy test would not show a positive result until 14-21 days later. The best time to take a pregnancy test is seven days after missing your next period. Your next period was due on May 23, so the best time to take a pregnancy test was after May 30. You had a positive test on May 27. Your HCG values  have been rising, but slowly. On June 8 you  should have been 10 weeks 3 days pregnant, and we should see a gestational sac, a fetus, and a fetal heartbeat at that time. The  spotting may have been a miscarriage. However, the HCG is rising, albeit slowly.  I think a diagnosis of ectopic (tubal pregnancy) is a bit fast for me too, as long as you have no pain or bleeding. Nothing is seen in the uterus until the HCG is greater than 1000 (descriminatory zone). If you continue to have no symptoms, repeat the HCG test in 1 week. If  it over 1000, take another sonogram. If there still is nothing in the uterus, you have to assume an ectopic and can use Methotrexate or have a laparoscopy. I think you can safely wait another week as long as there is no pain or bleeding.If a sonogram shows nothing in the uterus and there is no abnormalities of the tube at that time, you may have had an early miscarriage. (when you were spotting).