can they really see anything at 5w1d?
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Anonymous
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Our 5w1d ultrasound after FET showed no sac. Betas are low (only 255 at 5w1d), but they *are* doubling every 48-72 hours, and have been for a week. We just started off super-low.
Everything I see on the internet says they wouldn't be able to see anything until HCG reaches 1000. But has there been some improvement in technology that means the internet advice is outdated? She did have a very fancy 3-D ultrasound scanner, and she just seemed so sure that she should be able to see something. I know that with betas this low I'm grasping at straws, but I'm more confused than anything else. I came across this recent article, which does suggest that with improvements in technology the threshold is lower (390 to see a sac) but you still wouldn't see anything with 255. Anyone out there with medical expertise have any thoughts? Obstetrics & Gynecology: January 2013 - Volume 121 - Issue 1 - p 65–70 doi: http://10.1097/AOG.0b013e318278f421 Original Research Reevaluation of Discriminatory and Threshold Levels for Serum ?-hCG in Early Pregnancy Connolly, AnnaMarie MD; Ryan, David H. MD; Stuebe, Alison M. MD; Wolfe, Honor M. MD OBJECTIVES: To reevaluate both discriminatory and threshold levels associated with visualization of gestational sacs, yolk sacs, and fetal poles in patients presenting with vaginal bleeding, pain, or vaginal bleeding and pain in the first trimester of pregnancy using current ultrasonographic technology. METHODS: We reviewed the records of patients with first-trimester vaginal bleeding, pelvic pain, or both who were evaluated with a serum ?-hCG level and a transvaginal ultrasonogram within 6 hours of each other and had a known pregnancy outcome. Discriminatory and threshold ?-hCG levels for visualization of a gestational sac, yolk sac, and fetal pole were identified for all ultimately viable pregnancies. Logistic regression was used to model the predicted probability of visualizing these structures as a function of ?-hCG values using fractional polynomials. RESULTS: Six hundred fifty-one pregnancies met inclusion criteria; 366 were viable. Discriminatory ?-hCG levels at which structures would be predicted to be seen 99% of the time were 3,510 milli-international units/mL, 17,716 milli-international units/mL, and 47,685 milli-international units/mL for gestational sac, yolk sac, and fetal pole, respectively. In our population, threshold values for ?-hCG levels at which these structures could be seen were 390 milli-international units/mL, 1,094 milli-international units/mL, and 1,394 milli-international units/mL, respectively. CONCLUSIONS: Improvements in ultrasonographic technology have led to lower threshold ?-hCG values for ultrasonographic visualization of early intrauterine gestational structures. However, discriminatory levels for serum ?-hCG levels were higher than values currently used in practice. |
Anonymous
| Why are you having an US so early? I agree that you would be unlikely to see anything yet with betas that low and at such an early date. |
Anonymous
| OP here--I had some bleeding, and I guess they wanted to try to figure out what was causing it. They saw something that might have been filled with fluid that might have been causing it. The HCGs have been rising throughout the bleeding. |
Anonymous
| Only time will tell. I thought they usually wait until 2000 to see anything. 5w2d is very early. Hope you just had a late implanter. |
Anonymous
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They are probably hoping to see a sac, as slow rising betas can also be an indicator of an ectopic pregnancy.
Sounds like it has been a grueling week of slow doubling--hang in there & GL! |
Anonymous
| I always heard it was a beta of at least 2000 as well. If you're doubling appropriately it should really be only a few more days so hang in there! |
Anonymous
| OP, have they also tested your progesterone, and if so, is it in the expected range? |
Anonymous
| I had an ectopic. On US you couldnt see anything in the uterus, but there was a blob near my ovary. Even I could tell, wrong place! If they don't see anything outside the uterus, I would take it as a bit of good news. |
jindc
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I had a 5 week one and saw something, but I was still too early to tell if it was blighted or not.
Hang in there, OP. I hope you find out the answer very soon. |
Anonymous
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Thanks so much for the support and good thoughts, everyone.
1:25, they refuse to test my progesterone or estrogen--they say the numbers don't tell you anything, and that clinics only do those tests to make money. I don't know what to think. They have me on a standard protocol of Estrace and Endometrin. I just wish I understood why the RE was so sure she'd see something at 5w1d. She was very clear that if she didn't see anything at this point, this was not going to be viable. But then the rising betas surprised everyone and we're doing another ultrasound in a few days--mostly because they're worried it's ectopic. I understand that everything you read about the variability of beta numbers doesn't necessarily apply to IVF/FET, because with these procedures there's no confusion about the dates of when things happened. But I just wonder if we really understand the science of very early pregnancy that well. |
Anonymous
| I had a u/s at 5w5d with strong betas (no clear reason why they did it - it was not a local clinic) and they saw one sac. I came back two weeks later and there were two sacs (I had transferred two). Second one was just too small to see the first time, according to the RE. Hang in there and let us know what happens!!!!!! |
Anonymous
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Hi,
I'm curious to know if you had another u/s already. I'm at 5w5d and they couldn't detect the heartbeat either. This is so stressful. |
Anonymous
| 5w5d is too early for a heartbeat. By 7w you should be able to see/hear it. Hang in there! |
Anonymous
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I had an u/s at 5, 6, and 7 weeks. No detectable HB until 7 weeks (am 14 now).
At 5 they were just looking for placement of the sac. At 6 they could see and measure fetal pole. By 7 it was more clearly a fetus (though looking something like a sea horse). As PPs have said, though, if you implanted late there may not be anything at 5w1d. I think it would be pretty standard in your case to look again at 6w. |
Anonymous
I had a heartbeat at 5w5d. It was a monitored cycle so we were sure of ovulation date. However I think it's rare to hear it that early so the Pp at 5w5d shouldn't worry. |