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Expert Q&A

	By Lawrence B. Werlin Fertility Specialist

I recently had a miscarriage at 6 weeks and 4 days. This is the second time this has happened. I started having some bleeding when I would go to the bathroom. The nurse at the OB/GYN office said it was normal and not to be alarmed. It continued to occur, so I again called, and the doctor ordered a quantitative HCG analysis. I did the test, then 48 hours later did the test again. My HCG levels did not double but they did go up about 1500 points. The nurse gave me the results and said all was fine and not to worry.

I thought that early in pregnancy the levels were to at least double. They said it was fine. No other test was ordered. I asked again about the bleeding because it was not spotting – it was heavier than that. Not a true period, but a light version. I had no cramping or any other symptoms so she said I was fine. By the end of the week the bleeding was still there. I was nervous but following the advice given to me.

By the following Monday I was still bleeding. I was growing more alarmed and feeling that things were not normal, so I again called the doctor, who ordered an ultrasound. I went the next day and had it done. They couldn't find a heartbeat. The doctor said this may not be a problem but he wanted another HCG test. I went and had the test. The results had gone up only 100 points in the past week. The doctor called it a missed miscarriage. I had a D&C the very next day.

I was told by the doctor that miscarriages are prevalent and that my last miscarriage had no correlation with this one because it happened years before."

In view of the fact that you have now had two spontaneous pregnancy losses, I would recommend that you seek consultation with a reproductive endocrinologist (RE) who can do an evaluation for RPL (recurrent pregnancy loss).

Let me try to answer your question specifically about HCG levels in pregnancy. In early pregnancy, HCG levels double roughly every 60 hours until they reach a maximum of about 100,000 miu/ml, and at that time, the levels plateau. It is concerning when the HCG levels do not double appropriately; however, there can be different variations. In your specific case, it did appear that unfortunately this pregnancy was not destined to survive.

Again, I would recommend that you seek consultation with an RE who can do an in-depth evaluation for RPL, which would cover 1) genetic factors, 2) uterine factors, 3) hormonal factors, 4) immune factors and 5) microbial factors."

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