HCG levels rising again after post ectopic drop.

[Northey]

I had tubal surgery three weeks ago yesterday for an ectopic pregnancy. My HCG levels initially fell well, then more slowly than expected. Today's blood test showed that they have started to go back up.

Has this happened to anyone? Does anyone have any idea what it could mean?

If it were a bit of embryo left behind, would that be enough to make the levels actually rise, rather than just fail to drop?

I am to say I have actually stupidly had sex since the op, thinking I couldn't ovulate while my hcg was elevated. Could I actually be pregnant again already? If so, I can't see how it could get through my inflamed post-op tube, so I imagine it will not be good.

Could it be one of those awful situations where what they removed was a tumour rather than a baby, and it has started to grow again? Or have I just imagined that from fevered ancient googling year ago??

[nextphase]

Hi Northey,

Think our paths have crossed on a different ectopic thread. Was it you who had a previous tube removed, and then this tube saved? I would imagine that means there is little chance of you having conceived post surgery - how big is the HCG increase? And is it one result, or a trend? ie could it be a one off strange result?

I would have thought it would be placental tissue left behind which continued to released HGC, but not sure about the logistics of how long the blood levels would drop before rising again if some placenta had been left behind.

I very much doubt you ovulated when you had HCG present ( that you have DTD tho - I wasn't standing straight at 3 weeks post op). The other thing going through my mind was could you have conceived twins? One ectopic which has been removed, and one somewhere else - ectopic or uterine?

Not sure I'll have been much help there, but hopefully a bump will result in someone else commenting.

I'm assuming the hospital is keeping an eye on you? Have you got another blood appointment arranged?

Hope you get some answers soon, and it isn't bad news.
Stay strong - I've got 2 DS's conceived post ectopic. Its possible, if you are brave enough to try again.

[Northey]

Hi NP, yes, I think we've met before. And yes, I lost one tube last year, and they operated on the remaining one last month.

HCG was 1207 today, 700 ten days ago, 2500 ten days before that, and 19000 two days before that (just before op). So a slow decline with a sudden upwards swing at the end.


Yes, back in to hospital tomorrow morning for repeat blood test and presumably scan.

By the way, the sex wouldn't have won any prizes for erotic athleticism. It was the most clichédly Victorian shag you can imagine.

[Northey]

Also, could a bit of retained placenta or whatever cause the hcg levels to rise, rather than just fail to fall, if you see what I mean?

[nextphase]

Hope todays bloods bring some sense to the situation. My guess would be a mix up in the lab, or variations in the test at low levels, but thats based on none hospital testing - I work in a physical chemistry lab.

I can see if most of the placenta was removed, it wouldn't be producing much HCG, so slowly falling levels might make sense. If it then, due to existing blood supplies, manages to repair and start growing again, I guess HCG could then start rising again - its a pretty small rise tho.

I would imagine since hospitals keep you coming in post ectopic removal but when the tubes are left (either as you've found, or with meth treatment), it means it is possible something has been missed. If rises weren't possible, they wouldn't keep people coming back - I was totally discharged 12 hrs after my tube removal, and no check-ups til next pregnancy.

Thinking of you

[Northey]

Thanks. That makes sense. On way to hospital now, tryin not to fret and despair.

[Northey]

Just been seen. Need to go back tomorrow for repeat blood test (they decided not to testtoday, as they wanted to wait 48 hours).

Assuming there wasn't a mix up at the lab with yesterday's blood tests, an that tomorrow's show a rise rather than a fall, the options are 1) new pregnancy 2) twin pregnancy of which one baby remains 3) persistent tissue from previous ectopic has started growing again.

[nextphase]

Is that the hospitals summary? Or from our thoughts above?
The 48 hr thing seems to be standard for HCG, but sorry to hear you've got another 24 hrs wondering whats going on.

What happens if its option 3? Do they remove the tube? Sorry if you don't want to think about that. Might it be worth asking for Methotrexate if you want to try and save the tube?

If you want to keep in touch, its probably best PM'ing me, and I;ll reply when I can - going to have limited internet over the next week, but happy to support if you want / need.

[Northey]

It's the hospital's summary.

In option 3, if hcg is below 3000 they want to do methotrexate. If above, they want to operate.

Thank you so much for your support. I really do appreciate having someone listen and reply to my anxious wonderings.

[nextphase]

I wish I didn't have to be here replying to you - ie I wish that neither of us had suffered the pain of an ectopic, let alone your second, and now this post op issue.

However, your there now, and I was there a few years ago, and I remember feeling very alone. Not many people knew what had happened, and of those who did get told, people didn't understand what an ectopic pregnancy meant, so it was the constant explaining. It was very isolating.

Hope today goes well - should be around tonight, then the connection gets dodgy. Would have thought it would be under 3000 - unlikely to nearly treble in 48 hrs. However meth would also remove any possible twin/new pregnancy? You'll get a scan first? Tho I think 3000 is a bit early for a new pregnancy to show on a scan?

Hope you get the answers you want.

[Northey]

Morning, NP! As they have mentioned the possibility of new pregnancy, I think I would refuse meth until they were absolutely certain that it couldn't be that. They said yesterday that you should be able to see something in the uterus from 1500.

I bet though that the levels will have dropped again today and all this will have been for nothing!

[nextphase]

Hey, Hows things this evening?
Hope silence doesn't mean they have taken you back into theatre.

[Northey]

Oh well... After hours waiting for results, it turns out my hcg has risen again, very slightly. Definitely not enough for a viable pregnancy anywhere. I let them do the calculations for a dose of methotrexate, and have got tonight to decide whether I want to take it. I need to phone by 9am to say yes or no. If I say no, it's 48-hourly hcg monitoring instead, and probably ending up faced with methotrexate in a few days time anyway.

I am really resistant to the idea of taking it now - mainly because part of me is still secretly hoping it's a viable but currently invisible baby - but I know it is the most sensible thing to do. I just need to come to terms with it a bit.

[nextphase]

The temptation to hold out a bit longer must be so strong, but if it really is a tiny rise, does that suggest your best taking the meth sooner rather than later, so you don't do any more damage to your tube - assuming its placental remains?

And if you leave it long enough to rise above 3000, are you back into surgery?

So sorry it wasn't the (I assume) preferred result of a viable pregnancy somehow there.

XXX

[Northey]

It went from 1200 to 1300 in 48 hours. Nowhere near a doubling. And realistically when could I have ovulated anyway in this 3 weeks, if my hcg had never seemed to get anywhere lower than the high hundreds? It is so clearly not what I want it to be, is it?

I should just take the methotrexate and get it over with.

[Northey]

And yes, if it gets back above 3000, it's back into surgery. And frankly after two ops on a tube in a month, it would probably take it 3 months to heal properly anyway. In which case I might as well save myself the physical trauma of surgery.

[nextphase]

I'm sorry you've got to make these decisions, but it sounds like your coming round to what I suspect, and the hospital are thinking - there is, unfortunately, no miracle baby hiding away waiting to pop out in 8 months time.

Be thinking of you tomorrow.

[Northey]

Thanks NP. You've been lovely.