Ectopic or miscarriage? (Slow rising ßhCG after 2 x Day 3 embryos transferred)

[Momaki]

Hello. I’m wondering if anyone else has had a similar experience to me and what the outcome was?

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I am 5 Wks + 3 today. My symptoms are currently those of a normal early pregnancy.

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3 DPO (3 days past egg collection) - 2 x Day 3 embryos transferred

9 DPO - RHR on Fitbit starts dropping (having risen since the day before trigger injection) and keeps dropping for several days

From 10 DPO - Faint lines on pregnancy tests

From 12 DPO - Start spotting blood, like the start of my period

13 DPO - Digital P Test says ‘Not Pregnant’; RHR on Fitbit starts rising again

14 DPO - Strip dye P Test from fertility clinic has two lines, though it’s a little faint

16 DPO - Second strip dye P Test from fertility clinic has two lines, and is still a little faint, but has darkened; Digital P Test says ‘Pregnant 1-2 weeks’

19 DPO / 4 Wks + 5 - ßhCG 313.2; Blood spotting has stopped (having never progressed to more than resembling the start of a period)

20 DPO / 4 Wks + 6 - P Test line has darkened but still looks a bit too faint for when it was taken

21 DPO / 5 Wks - ßhCG 456.4 (45.72% increase over 48 hrs); Fertility clinic not sure what’s going on but not hopeful; I take the Fitbit off, even though it has been steadily increasing

5 Wks + 2 - ßhCG 497.8 (9.07% increase over 48 hrs); Fertility clinic still unsure what’s going on, but book me in for a scan at 5 Wks + 5, and essentially say it’s one of three things: viable pregnancy with unexpected ßhCGs / miscarriage / ectopic; I put the Fitbit back on and my RHR starts dropping again, so I take it off

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I have no hope that this is a viable pregnancy.

I am desperately hoping, for several reasons, that this is not ectopic.

After a long and traumatic fertility journey, that has already seen me experience a chemical pregnancy, very prolonged missed miscarriage, no eggs fertilising, poor response to fertility medication/one ovary not responding at all and with very low egg numbers, and now facing childlessness, I can’t believe that I’m hoping for a miscarriage, but I am. Of course, what I truly want is for this pregnancy to be ok, but I think that’s unrealistic, so I can only hope for the least terrible option. I can’t bear the thought of having an ectopic and what this would and could steal from me.

Has anyone had a similar experience, and, if so, what was your outcome?

Any support would be greatly appreciated.

Hi @Momaki firstly I’m so sorry that you are going through this. I’m currently nearing the end of loss four (one miscarriage, one ruptured ectopic, one chemical and another ectopic/PUL) in a year. It’s exhausting and my heart goes out to you ❤️. All my losses have been totally different even the two ectopics have been different to one another. First ectopic didn’t get a BFP until period was late and my HCG was rising slowly, 53% then 13%. Second ectopic/PUL BFP days before my period was due, HCG normal rise. Chemical the tests never got darker just always faint. If it’s slowing down it could just be an off day but personally hasn’t been good for me. Although my consultant has said every woman is TOTALLY different HCG rises differently for everybody. He said some people have nothing on a scan at 5+2 then 5+4 it’s all there. Once it’s over 1000 they should begin to see a sac. I would really encourage you to get in touch with your EPAU if you haven’t already and get a scan. Ring them and tell them you’re spotting, your HCG rises and see what they can do. Do you have pain anywhere? I would say having had two ectopics, time is of the essence, it can be life threat and you have a lot more options the earlier you catch it. First my hospital messed me about for almost a week so my only option was surgery. This time a different hospital acted quickly we have had options and chose methotrexate (and although not out of the woods yet I’m almost back to 0 and have saved my tube). I’m crossing fingers you’ll have a good outcome. Sending you lots of love. Keep me updated xxxx

@daffodilaster Thank you so much for your lovely message, and for sharing your experience. I’m so sorry you’ve had to suffer all of those losses. It’s just not fair. I really hope for good news for you, that stays good, soon.

I have my scan with the fertility clinic tomorrow. I think they want to see if they can figure out what’s going on before they refer me to EPAU, because I'm still under their care. The EPAU is such a grim experience, and I have a feeling that’s where I’ll be ending up again.

After the spotting stopped nearly a week ago, I’ve just felt normal early pregnancy symptoms (tender/sore breasts; mild and intermittent cramps; frequent urination; intermittent and mild lower backache; occasional nausea; going between constipation and diarrhoea). No pain. Though I’m anxious that could change at any minute.

If you don’t mind, I would like to understand a little more about how things have been for you, if that’s ok? I have so many questions, but I’ll try not to bombard you!

Did you have any symptoms of an ectopic? How did you find out you had ectopic pregnancies - was it via ultrasound? If so, at what stage did you have the scan/s? Is it the case that you’re not allowed to TTC for three months after taking Methotrexate?

Thank you, again xx

Hi @Momaki thank you for your kind words and wishes 🤞. I hope that this is good news for you.

No problem fire away, happy to help if I can. First ectopic the tiniest bit of pink spotting and pain on the right side just felt like ovulation (I’ve felt it that side for as long as I can remember) the ectopic was on my left, I felt nothing so all I had was referred pain. Then it started to feel like awful constipation and I was going to the loo but looking back it wasn’t normal it, it was uncomfortable. It was a scan at 5 + 4 that showed that there was a sac in my uterus but it wasn’t right (no double ring-think that’s what they said, it was a pseudo sac), mass near my left ovary and free fluid (I didn’t have a clue what this meant and they didn’t really explain). I had a dull and sore ache across my lower tummy and brown like crystals in my urine. Next day had the shoulder tip pain went in and they sent me home again as my tummy ache had subsided. Then next day my HCG rise was only 53%. Looking back day one was enough of a red flag but I trusted the doctors knew best, in reality they were understaffed and we should have pushed more for options and explanations.

My second one I was on utrogestron pessaries and started spotting, but they thought it could be them but I wasn’t sold. I had a few twinges which we high up and central so thought little of it. I just had this feeling that I needed seeing sooner than 6 weeks. So I rung EPAU told them my history and they got me a scan, it showed nothing, and my HCG was doubling perfectly. I just kept spotting a little more, so I rung again and I went in, scan at 5+6 it showed a mass near my ovary moving separately from my ovary and no fluid. They then offered me lots of options but we chose methotrexate together, it is 3 month wait after however, multiple consultants and nurses have said to us both, if we can hold off 6, as they see better success if people wait 6. It helps the body repair and helps you replenish any lost vitamins to a good level. I’m devastated about the wait but know this team so well now, I’ve asked every question and they’ve answered it. I trust that they are right. I’ve also had three doses of methotrexate so I need to wait 6. The methotrexate has made me feel rough but compared to surgery, which honestly recovery was longer than they said it would and we both found very traumatic, the wait is better for us but it’s personal. My consultants and nurses now have said that preserving my tube was most important as they’ve seen woman in my position still go on to conceive with the one tube even when they’ve removed ectopics from it!

Each time it’s been my gut feeling and if it doesn’t feel right go to the EPAU and push them. I know they’re god awful places 😞 In January I didn’t want to be a burden now I know it’s life threatening and I have options the quicker I am. So my thought is the sooner I know and sooner I get treatment/monitoring either way, the better for my health and peace of mind. Don’t wait on the clinic if it’s niggling you. Also if you don’t like you EPAU locally and have another nearby ring the other and go there. I Iive between two hospitals but my postcode and 111 send me to one I went to in January and I wish I’d walked out that day and gone to where I am now. Now I have their direct line, a consultant with a plan, plan with the team for any future pregnancies 🤞.

Sorry for the essay but hope it helps xxx

@daffodilaster Reading your experiences and advice is really helpful. Thank you so much, I genuinely appreciate it.

I know what you mean about having a gut feeling. I had that with my missed miscarriage, but just kept getting told by everyone that things were normal and nothing to worry about, right up until just before they scanned me and said my baby was too small for the dates and their heartbeat was too slow. I felt so angry when I discovered I’d been right and had just been dismissed repeatedly by everyone I spoke with (story of my life though, tbh). I had a feeling about this one too. I think actually that both times it’s been a feeling based on several signs/symptoms that weren’t looking good to me, but which were easy to explain away by others. I’d love to be wrong this time though. Maybe I’ll have an answer tomorrow.

@Momaki No problem anything else let me know. I’m sorry they dismissed your feelings, that must have been so hard. I think because they see it everyday they forget sometimes it goes either way it’s really worrying and our gut feeling is often right. Our first loss we had the same, too small but no heartbeat, it still devastates me a year on 😞 ❤️. It’s hard as you think they know best and it’s hard to be assertive to them but if your gut is saying I need checking, keep pushing. Ask for senior nurse or matron on EPAU. Your body your right to the care you want. I’m crossing everything for you today 🤞 Xxxx

Hi. Just a sad and cautionary tale.

I had a heterotopic pregnancy from double embryo transfer.

It meant I thought I was having a “normal” miscarriage but then a “hidden” twin ruptured my tube.

I’d had several scans by that point that hadn’t spotted it.

I’d caution anyone with dodgy HCG, weird symptoms and a double transfer to get them to REALLY carefully check the tubes, even if there’s something in the uterus.

I nearly died.