High hCG levels, but no heartbeat at 7 weeks?

[sarahl918]

Does anyone have any experience with a very high hCG and progesterone level but no heartbeat by 7.5 weeks?

Here's my story: I am currently 8w1d (by my count) pregnant with my first. I had a t/v u/s at 6w3d and while we saw good size sac, yolk sac, corpus luteum & all necessary 'components', we couldn't find a heartbeat. 

Went back at 7w4d and saw growth with the baby but it measured only 6w6d and no heartbeat still. Doctor told me it was not viable, wrote me a prescription for Percocet, and told me to call if I started bleeding or wanted to schedule a D&C.

I had a second u/s that same day at a different office and they confirmed the size of fetal pole and lack of heartbeat. Again told me (in gentler words, thank God!) that this may not be viable. Thankfully this Doc had the foresight to take my blood and check my levels. 

Today he called with the blood results - hCG was 74,000!!!  I was expecting much less. Doc also said progesterone was in a good range as well though I don't have that exact number. I am confused why the baby would grow but not have a heartbeat. I am going back on Weds (8w3d) to check again for heartbeat/growth.

I know there are chromosomal abnormalities that could be to blame, and am as prepared for a loss mentally as I can be, but I am shocked that the levels are so high and the heartbeat was not showing up.

Anyone have similar stories or any info to share???

[SMIR]

As far as i understand, The progesterone is produced by the placenta on implantation and not by the baby during the initial weeks. The baby takes over at a later stage. Hence, the high level of these hormones is because it is implanted . THe Hcg is produced by the cells around the fertilized egg. Both these hormones are needed to maintain a pregnancy. The growth of organs like the heart is a chromosomal thing.As there is no heartbeat, the pregnancy is not viable and is a missed abortion. You may expul it on your own or may need assistance  like a DNC or DNE. Eventually these hormone will come down and this is what the physician is expecting now. He/She may do multiple test to measure the hormones in anticipation to see lowering levels. If they do not come down, then it is a different issue ( not that you would like to know at this point of time). Hope this little knowledge helps you.

[LivingSky]

OP: Do you know when you ovulated? Do you chart/take OPKs? Or are you guessing how far along you are based on your last period? Depending on what method you're using to judge the age of the fetus, you may yet have hope. A week's difference either way can be a HUGE difference at this stage. I, personally, would not give up hope yet. Preparing yourself for the worst is fine and probably prudent, but there are just too many stories of women who had a 'not viable' pregnancy that turned into a happy healthy baby. I would give it until 9 or 10 weeks with no heartbeat before taking any kind of action to terminate - and I'm talking age from ovulation versus age from your LMP.

[boomer78]

I don't have any experience with this but didn't just want to read and not reply. I did miscarry once but my levels (both hcg and progesterone) were really low at 6 weeks (granted, I had already started bleeding at that time). I wouldn't just give up hopes yet. I have read way too many crazy stories about all kinds of issues during pregnancy and positive outcomes. It's not over until it's over. Like pp mentioned, do you have an idea of when you may have ovulated? When did you first have a BFP? Do you have any symptoms? Are they constant? Increasing? Decreasing? Hang in there.

[sarahl918]

Thank you ladies... seriously helpful to hear all your advice. I knew I would get more intelligent answers here than some of the other pregnancy websites out there!

Originally Posted by SMIR 

As far as i understand, The progesterone is produced by the placenta on implantation and not by the baby during the initial weeks. The baby takes over at a later stage. Hence, the high level of these hormones is because it is implanted . THe Hcg is produced by the cells around the fertilized egg. Both these hormones are needed to maintain a pregnancy. The growth of organs like the heart is a chromosomal thing.As there is no heartbeat, the pregnancy is not viable and is a missed abortion. You may expul it on your own or may need assistance  like a DNC or DNE. Eventually these hormone will come down and this is what the physician is expecting now. He/She may do multiple test to measure the hormones in anticipation to see lowering levels. If they do not come down, then it is a different issue ( not that you would like to know at this point of time). Hope this little knowledge helps you.

This is super informative, thank you so much. This being my first pregnancy I don't know as much as others about the process but it helps me to understand & makes sense why there could be high hormone levels but not a developed fetus (or is it technically still an embryo at this phase?) Both of my doctors have mentioned chromosomal abnormalities as a possible cause of lack of development. I forgot to mention this in my original post but they also said my placenta is abnormally shaped and may have something to do with it as well. I've already begun discussing methods of 'expulsion' with my OB. He recommends a suction D&C because of the size of the sac - hence the high numbers! It would be painful to pass on my own and while I usually like doing things the au natural way, I am scared of a risk of infection, waiting weeks to bleed out, and not to mention the pain. 

[sarahl918]

Originally Posted by LivingSky 

OP: Do you know when you ovulated? Do you chart/take OPKs? Or are you guessing how far along you are based on your last period? Depending on what method you're using to judge the age of the fetus, you may yet have hope. A week's difference either way can be a HUGE difference at this stage. I, personally, would not give up hope yet. Preparing yourself for the worst is fine and probably prudent, but there are just too many stories of women who had a 'not viable' pregnancy that turned into a happy healthy baby. I would give it until 9 or 10 weeks with no heartbeat before taking any kind of action to terminate - and I'm talking age from ovulation versus age from your LMP.

I have a rough idea but I have never charted or used OPKs. I just track my period each month so I know I am regularly a 29-day gal. We also only had unprotected sex three times total before ovulation. I THINK I know I ovulated on July 2 (+/- a day) but can't be positive. We were also in Ireland when conceiving and traveling back to the US on Jun 30 so who knows what that did to my schedule. I will likely wait at least another week before making any decision just to be sure. The ultrasound on Weds will be helpful in telling me if there is any growth at all. After that I will likely wait another 5 days to get the procedure. I think they do an u/s right before a D&C to triple check, I'm hoping at least.

[sarahl918]

Originally Posted by boomer78 

I don't have any experience with this but didn't just want to read and not reply. I did miscarry once but my levels (both hcg and progesterone) were really low at 6 weeks (granted, I had already started bleeding at that time). I wouldn't just give up hopes yet. I have read way too many crazy stories about all kinds of issues during pregnancy and positive outcomes. It's not over until it's over. Like pp mentioned, do you have an idea of when you may have ovulated? When did you first have a BFP? Do you have any symptoms? Are they constant? Increasing? Decreasing? Hang in there.

Thank you sweetie. :) I wish I knew what my levels were prior to this... the original OB I was seeing does not take blood until he sees a heartbeat. Kind of ridiculous if you ask me! I too have read those crazy stories (though I had to make myself stop as to not get too much false hope), I am planning on waiting a little while longer. I don't have an exact date of when I ovulated, I am going on my LMP and knowing that my husband & I only had 3 possible dates of conception, and they were within a 4 day window. I got my BFP on July 12, 4 days before my missed period, and I thought I ovulated around July 2. My symptoms have been consistent... fatigue, sore breasts, hunger, skin breakouts, mood swings (though I don't rely on that one ;) ), a few other things. No morning sickness though. 

[LivingSky]

OP - DTD within a 4 day window actually gives you a significantly longer possible conception window than that. Sperm can survive 48-72 hours or even longer in some cases. A 29 day cycle does not really give you any idea when you ovulate - you could ovulate on day 14 and have a 15 day LP, or you could ovulate on day 20 and have a 9 day LP, and still have a 29 day cycle, but a difference of 6 days between when you might have ovulated.

Anyway, you'll know more after your next ultrasound, and I really hope that it shows you a perfect little miracle heartbeat! And if this time doesn't end the way you want it to, I hope you get your sticky bean very soon.

[sarahl918]

Just an update for you all - had my 3rd u/s with still no growth since 7 weeks, no heartbeat, plus the sac appears to be collapsing (went from round to crescent shaped) and my corpus luteum is shrinking to boot. I am definitely counting myself officially "out." Thank you again for all your helpful advice! 

[LivingSky]

So sorry for your loss