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[quote=Anonymous]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  But has there been some improvement in technology that means the internet advice is outdated?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.[/quote]

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