Wednesday, July 25, 2007

Dear Dr. Shieh,
I had an HCG (Human Chorionic Gonadotropin) test done and it was 245 at about 3 weeks 3 days past ovulation. I had a second test done 48 hours later and it was 215. I had an ultrasound and they found nothing in the uterus. I have had some period-like cramping yesterday and today, and brown to red blood and some small clots pass. The bleeding is slowing and the cramping is not as bad as before.

The doctor told me to take progesterone "Crinone." I took it the first evening after the first HCG test just as the spotting began and again the next evening, which by then was the first real day of cramping and bleeding. Now today I will not take the progesterone.

Is it possible the Crinone made the HCG level not go down as fast as it might have over the 48 hours I used it, which coincided with the 2 HCG tests I had if I hadn't used it, or is it possible I may have an ectopic pregnancy? They saw a cyst on my right ovary, but I haven't had any serious cramping on that side. I am concerned. -- Christina

Dear Christina,
Usually the level of HCG is at least 1,500 before a pregnancy can be visualized in the uterus with an ultrasound. Your HCG is too low -- that's why your doctor found nothing in your uterus.

Now, your question is a complex one and majority of general readers would have a hard time understanding what we're discussing, but I will try to explain it in simpler terms.

For the general public, HCG is a pregnancy hormone that is positive if you are pregnant. Usually the number would increase at least 66 percent every two days. However, 15 percent of the time, the rise of this HCG can be abnormal, which can be frustrating. In addition, should your HCG rise be less than normal, there's need to be concerns about an ectopic (a pregnancy outside of the uterus) or a miscarriage.

In your situation, your HCG is decreasing, which is not a good sign. To compound your laboratory findings with symptoms of cramping and spotting, more than likely you are experiencing a miscarriage in progress. The progesterone or "Crinone" medication that's given to you usually would not have an effect on the level of HCG drop and how fast it drops in a miscarriage. Progesterone is a medication given to help maintain a pregnancy, but it would only help if your pregnancy is normal and not a miscarriage already in progress.

The cyst on your right ovary is probably a corpus luteum cyst, which is a cyst that usually appears when you are pregnant and helps maintain your pregnancy. In addition, you should know that the corpus luteum cyst usually produces natural progesterone for the maintenance of your pregnancy, but your doctor would have been able to tell you more during the ultrasound examination.

Your last question on the possibility of an ectopic is warranted. The reality is that any positive pregnancy test could be an ectopic, but in your situation, even if it is an ectopic, you probably will not need any medicine or surgery. Why?

Because your HCG is decreasing, which means it is resolving itself. Eventually your HCG should be zero. Whether an ectopic or a miscarriage, your body is handling it naturally. Just make sure you follow up with a negative pregnancy test to ensure complete resolution. If you really want to have a baby, don't give up. Keep trying, be patient and you'll be blessed with a little one someday.

Dr. Thomas Shieh is board certified diplomat of the American Board of Obstetrics & Gynecologists, and a fellow of the American College of Obstetricians & Gynecologists.


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