Understanding Low Beta hCG Results: What They Mean & Next Steps

Question
I was called with the great news "you have a positive beta" but my joy was short lived when they followed with "but the number is very low, it does not look promising."

The betas that followed were:

14dpIUI - 36
15dpIUI - 45
17dpIUI - 56
19dpIUI - 59

At this point, they said there is no hope, I should expect bleeding at any time, and to do another beta in a week's time or when I start bleeding.  I asked what we were waiting for if there is no hope, she said the best case scenario is a spontaneous evacuation (which is not really a miscarriage because its not a viable pregnancy she told me) and would not speculate on what would happen should I not start bleeding and my betas continue to rise but not double.  She said I am to "wait-and-see" what my next beta shows, and then follow-up with the doctor.  

I have read that ectopic pregnancy often starts out with betas like mine, although I show no other symptoms of ectopic yet.

LMP was 07/23.

In your opinion, is there any hope?

Answer
If your last period started on July 23, then you were due for your next period on August 19. The best time to take a pregnancy test is seven days after missing your period. If you took a pregnancy test on August 26, you should now be 5 weeks pregnant (from your last period). Beta HCG values at 5 weeks range from 1000 - 50,000. Your values are very low and usually indicate a miscarriage or a non viable pregnancy. A sonogram at this time may show an empty gestational sac but it is too early for a sonogram to show a fetus or a fetal heartbeat. An ectopic pregnancy often is demonstrated with Beta HCGs that "plateau"  (do not rise or fall). I believe that a sonogram is necessary to rule out any gross evidence of a tubal pregnancy (especially if you have any bleeding or abdominal cramps). If you have no symptoms, you can, indeed, take a "wait and see" attitude.  If a subsequent sonogram shows no fetus and the HCG values do not rise, I would suggest having a D&C to make sure that the uterus is empty.  On the other hand, there is always hope. Repeat the HCG after August 26 (a week after you expected your period). Do two tests, 48 hours apart to see if there is doubling, halving, or a plateau of the results.