Pregnancy of Unknown Location

[HJB97]

I have another post going, but I’m still looking for answers.
I have been ttc for 18 months and I started off tracking my cycles, but I stopped having periods (likely due to my weight) and it wasn’t showing I was ovulating, so I gave up tracking.
This cycle I just felt different, so I took a test on 04/12/24 and it was stark negative. I still felt off the next day so took a test with FMU on 05/12/24 and it was a faint BFP. My husband couldn’t see the line but I knew it was there. Husband advised to get a digital, so I did and I got pregnant 1-2 weeks. I started my progesterone immediately which I had been prescribed by the recurring miscarriage clinic.
Two days later on 07/12/24 I started bleeding red and I just assumed I was having a miscarriage as I had had 4 previous miscarriages so I knew what to expect. The bleeding stopped after about an hour so I was utterly confused. I vaguely recall someone saying progesterone pessaries can irritate the cervix so I switched to taking them rectally. Over the next couple of days my tests were still the same, not getting and lighter but not getting any darker. I also started bleeding dark brown and this hasn’t stopped since I had the first bleed on 07/12/24.
I called EPAC on 11/12/24 and was asked to go in for a BHCG test. She rang me in the afternoon with the results and said “unfortunately your levels are really low but we need to retest in 48 hours to see if your numbers are doubling” she obviously explained that my dates could be off, but with getting my first positive on 05/12/24 I would have expected the hcg to be much higher.
I went in A&E with sickness, dizziness and lower left side pain on 13/12/24 and they did a retest. The gynaecologist said the numbers were 112 so they had only increased by 55.5% and they are looking for anything 66% and up, so it wasn’t looking promising.
I had to go in again on 15/12/24 for a further 48hour retest and the results came back at 179 (+59%) again under the 66% increase. At this point they were even more concerned about it being an ectopic pregnancy, so I was sent to EPAC yesterday 16/12/24 for a scan. She explained before she even did the scan that there was very little chance of seeing anything as my hcg levels were so low. I knew this and I have been fully expecting a miscarriage from the start, I’ve had 4 previous miscarriages and I know how it goes.
The sonographer was lovely and explained everything she was seeing as she saw it. She explained I had ovulated from the right side, so she couldn’t explain the left sided pain I was experiencing. She said nothing could be seen within any ovaries/ fallopian tubes and then scanned my uterus. Within the uterus was a tiny pin sized sac, but she said no pregnancy sac could be seen. She explained that this sac was a sac of blood/fluid and that no pregnancy could be located so it was diagnosed as PUL/ pregnancy of unknown location.
I have to return again today for yet another blood test and at this point (as awful as it sounds) I’m just praying my hcg is coming down and resolving on its own. I am in complete limbo and I am being told different things by different people.
The EPAC nurse said with such low levels it would be very unlikely to be a viable pregnancy, which I fully expected, but then the gynaecologist I saw on 13/12/24 said it was still ok because my progesterone levels are really high, I didn’t want to tell her how to do her job but I am on progesterone pessaries.. of course my levels are going to be really high. It’s kind of an artificial reading 🤦🏽‍♀️
The gynaecologist also had a go at me for starting the progesterone without a scan because I could have caused the pregnancy to implant in the wrong place. My care plan says to take from the moment of my first positive so I was even more confused and now guilt ridden that I had potentially done this to myself.
I don’t know if anyone has experienced anything similar at all, I’m just utterly fed up and confused. I’ll outline a timeline below. Thanks for reading and any advice will be greatly appreciated x

04/12/24- Stark BFN
05/12/24- Faint BFP
06/12/24- Postive Digital 1-2 weeks
07/12/24- Light Red Bleed
08/12/24- Brown spotting started.
11/12/24- BHCG 72 Progesterone 104 nmol/l
13/12/24- BHCG 112 Progesterone 114 nmol/l
15/12/24- BHCG 179 Progesterone 115.3 nmol/
16/12/24- scan diagnosed PUL

Hi,

I had a PUL earlier this year. It was weeks and weeks of blood tests and scans.

They say HCG over 1,000 should show a pregnancy. But I got to nearly 2,000 without anything on a scan. My levels went up and down during that time. I was also bleeding most of the time which I kept hoping was a miscarriage, but my levels kept rising which wouldn't happen after a miscarriage.

They wouldn't give me the methotrexate because it wasn't confirmed ectopic.

I ended up having exploratory surgery and they found a cornual ectopic. They removed a tube.

Hi @whatdoyouthink123456 I’m so utterly confused. My hcg from today has come back at 440 so it has more than doubled🤦🏽‍♀️ now I don’t know where I stand. Surely even if my dates are off and I am only 4+ weeks, my hcg should be more than 440? I’m now booked in for a scan on Tuesday at 9:30am. X

4 weeks is super early so you never know. It will just be a bit of a waiting game as they won't see anything on a scan for a few weeks. They don't like to scan earlier as even a viable pregnancy might not be visible at that point. Hopefully it all increases and your pregnancy is viable 🤞🏻

I think my first hcg at 5ish weeks was 340. Mine went up and down over 3 or 4 weeks. It would go from 340 to 480 or something like that every 48 weeks, but mine never doubled. By my surgery it was over 2,000 but they still couldn't find any sign of pregnancy on a scan. I had about 7 scans over the weeks.

I had heavy bleeding with clots at one point so I was convinced it was passing naturally, but my hcg was still going up. The whole time it raises, something is growing.

After my surgery, my hcg dropped from 2,000 to 50 overnight.

I had my first positive test on 05/12/24 so it’s highly unlikely my dates are off. By my LMP I should be 5+4 today. My bloods so far are-

11/12/24-72
13/12/24- 112
15/12/24- 179
17/12/24- 440

im very discouraged by the constant brown bleeding, pain, dizziness and the initial slow rise in hcg now a sudden more than double. And PUL- I have a scan on Tuesday 24/12/24 and I can see this being confirmed ectopic and being in hospital over Christmas. All I can do is hope and pray for the best x

Hi are you getting on? Have you had anymore blood tests?

Hey @whatdoyouthink123456 im still utterly confused. Bloods came back yesterday at 640 so gone up but still not doubled. I was called in to EPAC for a rescan. The scan shows something in the sac but it was tiny and really hard for the sonographer to see, she zoomed right in a said she thinks she can see a yolk sac but she can’t be sure as it’s really unclear. She measured the sac and it’s measuring at 5+1 so puts me back 4 days off my original date. I still think even for 5+1 my hcg is incredibly low and it’s not really reassuring that it’s not doubling. I had another big bleed last night but again only lasted 1hr and it seems that both bleeds have been on the days where I have had a TV scan. She doesn’t want anymore blood tests as she said it won’t change the outcome and at this point I just have to sit and wait. If nothing drastically changes, I have a scan on 27/12/24. She did warn however if she scans me next week and there is no change/heartbeat, this is confirmed as an unviable pregnancy.

Sadly confirmed as a miscarriage at this morning’s ultrasound- miscarriage number 5. I just hope I’ll get some answers in the future as I can’t keep going through this 💔

Hi,

That's really sad, I'm sorry.

How are you feeling?

So frustrating that it's happened so many times. Have they all been early in pregnancy? Are you able to get any tests to try find out why?

@whatdoyouthink123456
I started ttc in April 2019 - and I had a chemical pregnancy in April 2019 at about 4 weeks- a missed miscarriage at 14 weeks in 2020, then a further miscarriage at 6 weeks in June 2021. I was referred to the recurring miscarriage clinic (who I was lucky enough to see really quickly) who did all the tests and everything came back normal. I was then given progesterone, folic acid and vitamin D to take from the moment of my first positive test.
I conceived again in August 2021 and took my progesterone and other meds and was fortunate to carry to term and had my DS in May 2022.
When my son was 18m old (November 2023) we decided to start ttc again. I tracked all my cycles as we had done before and I went on to have another chemical pregnancy in March 2024. I had started taking my meds as planned but it just didn’t progress past 4 weeks.
I was tested for APS but nothing else, so I’m hoping if I get re-referred there may be some more in depth tests they can do x