The importance of early pregnancy monitoring cannot be stressed enough. All women have a chance of ectopic pregnancy, but after tubal reversal surgery, the chance is slightly higher. For this reason, Dr. Berger recommends all patients at Chapel Hill Tubal Reversal Center work closely with their home physicians to follow the course of pregnancy as soon as conception is detected. Once a tubal reversal patients gets a positive pregnancy test, she should get her first HCG blood level drawn. After this, her doctor should be drawing the blood for HCG at least twice week. When the HCG level reaches 1500, the pregnancy can be detected by ultrasound. A vaginal ultrasound should be performed to determine the location of the implantation. This greatly reduces the chance of tubal rupture should the pregnancy prove to be ectopic. Dr. Berger should be notified as soon as you are pregnant so that he can ensure you are receiving timely early pregnancy care.
The following is from the Tubal Reversal Message Board:
Posted by Kristy Isett (Member # 8861) on February 05, 2008 05:58 PM:
Hi Dr B, I just found out on 1/24/08 that I was PG again after taking 200 mg clomid. My LMP was on 12/30/05 Since then, I've had 5 hcg betas drawn. My concern is the last two I had.
My first 3 betas were
1/24/08= 19.45 Progesterone= 27.1
1/26/08= 48.64
1/28/08= 104.22
Thursday 01/31/08
hCG was 371 progesterone was 45.2 (on suppositories)
Monday 02/04/2008
hCG was 576Why the small rise?? I mean I figured it should have been closer to the 1400-1500 level.
My blood tests were done at two different labs, but I honestly don't think that there would be that much of a difference between them. I go again tomorrow for another beta.
I had an internal exam yesterday 2/4/08 and dr said there was no sign of bleeding, cervix was closed and long. He felt my uterus and said it felt normal. I then went for a vaginal u/s and the tech was unable to see anything at that point. Dr called me and told me that there was a bit of free fluid??? in my uterus but not enough to have him concerned at this point. I don't know what to think at this point. Thanks in advance!
Kris
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Posted by lori4 (Member # 11661) on February 05, 2008 06:48 PM:
Kristy, Can't answer any of your questions, but I'm praying for you girl
Lori
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Posted by Gary S Berger MD (Member # 3) on February 05, 2008 06:58 PM:
Hi Kris -Using our HCG doubling time calculator, I entered your first HCG level of 19 and the last one of 576 taken 11 days apart. The calculator shows a doubling time of 53.6 hours, or doubling every 1.36 days. This is normal. At this rate, your HCG level should reach 1500 by Friday or Saturday, and when it does, a vaginal US exam should be performed to look for the gestational sac.
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Posted by Kristy Isett (Member # 8861) on February 05, 2008 07:24 PM:
Thanks Dr. Berger, but shouldn't I be concerned with the fact that it didn't double from Thursday 1/31/08 to Monday 02/04/08??? The doubling rate from those two beta's is like every 6.30 days or every 111 hours I think.Thanks again!
Kris
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Posted by Noelle DiBernardo (Member # 8906) on February 05, 2008 10:47 PM:
Kris,
Did you have another draw today, (Tuesday)If you see this...I emailed you the information you asked for...sorry it took so long!noelle
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Posted by Gary S Berger MD (Member # 3) on February 06, 2008 04:56 AM:
Kristy - Let's wait and see what your next HCG level is.
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Posted by Kristy Isett (Member # 8861) on February 06, 2008 08:23 AM:
Dr. Berger, thanks. I go this morning for my next draw. I know it'll tell me more. I'll let you know.
Noelle~ Yeah I got your email, thanks so much my computer died yesterday, I couldn't get on for anything all day until after DH got home from work to fix it!Love,
~Kris~
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Posted by jami (Member # 9521) on February 06, 2008 08:33 AM:
kris, i love you and your little bean(s)!!! i'm waiting to see what today's labs say....
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Posted by Kristy Isett (Member # 8861) on February 06, 2008 12:05 PM:
Dr B. Ok, today my levels are 746.... what do you think is going on??I'm so confused, I thought these hCG levels were to double every 2-3 days....mine are totally not doing that.I'm so worried that this is another ectopic and I'm going to lose my only tube I have left.I'll check back later to see what you think.
Thanks again,
Kris
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Posted by mamasoup8 (Member # 11212) on February 06, 2008 12:19 PM:
Krys- I don't have any answers for you, just wanted you to know you and your lil bean are in my prayers!-Traci
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Posted by Meridith4321 (Member # 11469) on February 06, 2008 12:29 PM:
Kristy - I would call and try to get an ultrasound - I know 700 is too small to see a sac but sometimes they can see a bulge in the tube or fluid in the uterus. There are other symptoms!!! maybe I would go to the ER. One tube is just too precious to lose, not to even mention that you life is at risk here. Does your Dr. know the protocol? I have heard to tubes bursting at 700 - just to be on the safe side I would try to get an ultrasound - fake pain if you have to!!!! Talk to Berta - I know she is on some of the lists and recently posted about losses on the main page - she can tell you what her number was when her tube burst.Good luck - we are all pulling for you!!!
Meridith
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Posted by Noelle DiBernardo (Member # 8906) on February 06, 2008 01:01 PM:
I am thinking of you Kris.
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Posted by berta8133 (Member # 11188) on February 06, 2008 01:12 PM:
Kristy....Personally if it were me...I would go to the ER. It could be several things. Some need for concern, others - everything could be just fine.Numbers sometimes become stagnet (for lack of a better word)...even though raising a bit...)I think for piece of mind....get to ER for an u/s, tell them you are high risk for e/p due to TR and tell them your last number, and also that you are having pain..tell them- it's kinda tender (pick a side) and that the pain feels like it comes from the back and moves to the front.They should be able to see 'something'...whether a shadow, fluid or swollen tube...etc etc... if they can't see anything yet...then all could be fine and nothing to worry over.There was a sister on our july thread....she no longer posts, but her number never got higher than like 300, and become stagnet, dr did nothing, and she ended up rupturing and losing the tube.My numbers were higher at time of rupture.....a week before rupture they were about 6700 or so... HOWEVER there are those that rupture with a small number due to the tube becoming swollen etc etc....Get it checked. Better safe than sorry down the road. I'd rather worry about something and it turn out to be nothing, than not to worry at all and it become something that can't be fixed.Thoughts are with you and I surely do hope all is okay. Just get it checked--ok??Berta
TR 7/23/07
E/P 0/25/07
M/C 12/8/07TTC our little Z
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Posted by pumpkin_powers (Member # 9198) on February 06, 2008 01:36 PM:
Krys,
Please go to the ER. You're right that those numbers aren't doubling right and it may be just a slow starter or possibly an ectopic. It's better to be safe than to lose your only tube. I went through two ectopics last year, and with the second my numbers were right around doubling for the first couple draws then they started slowing down like yours are doing. With that pregnancy the baby ended up implanted near my bladder and if I hadn't had early monitoring it would definitely have been life threatening. Please take care, and I'll be saying prayers for you and your little bean.Lots of Love
Staci
TR 3-7-06
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Posted by Gary S Berger MD (Member # 3) on February 06, 2008 04:12 PM:
Kristy - I agree that based on today's result your HCG rise is no longer rising normally. When HCG ceases to double within 3 days on more than one occasion, I recommend ending the pregnancy with Methotrexate and continuing to follow the serum HCG until it is back to non-pregnant levels (less than 10). At your current HCG level, it is still too early for an ultrasound examination to be diagnostic about whether it is in the uterus or outside of the uterus. But when a pregnancy is no longer progressing normally, it should not be continued.
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Posted by berta8133 (Member # 11188) on February 06, 2008 04:54 PM:
Kristy, please let us know how you are doing.Berta
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Posted by Melissa In NC (Member # 8796) on February 06, 2008 11:06 PM:
Kris- just wanted to let you know that i am thinking about you & praying
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Posted by brlracer (Member # 11897) on February 07, 2008 12:56 PM:
Any news on Kris? I will keep you in my prayers!
Trish
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Posted by Kristy Isett (Member # 8861) on February 07, 2008 02:58 PM:
Dr. Berger~ I just wanted to update you on what happened, I did in fact have an ectopic. There was a 4.7 CM buldge in my tube, the Dr told me that she would do everything possible to save my tube, but after surgery she told me that there was no way to save it even though it wasn't ruptured, she felt that the tube itself was too "stretched out" she said it looked unhealthy. So, that ends my journey in TTC for now, hopefully we'll find a way to do IVF sometime in the future. Heck, I'm not getting any younger! LOL! Thanks for all of the advice and thanks for everything!Kris
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Posted by brlracer (Member # 11897) on February 07, 2008 03:10 PM:
Kris, I am so sorry for this, I just don't know what to say
Trish K.
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Posted by Amy1234 (Member # 5192) on February 07, 2008 03:17 PM:
I am very, very sorry Kris!
Amy
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Posted by lori4 (Member # 11661) on February 07, 2008 04:45 PM:
Kris, that sucks! I was really pulling for you girl. I'll keep you in my prayers. I hope one day God blesses you with a baby if it is in his plan for you.
Lori
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Posted by JulesnKev (Member # 7375) on February 07, 2008 05:54 PM:
Kris, I am so sorry you are having to go through this heart rending experience. You mentioned IVF, so when you are ready to talk about it you can e-mail me at trulyjulee1967@msn dot com. I have some information you may find interesting. Take time to heal and take care of yourself.
Hugs,
Julia
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Posted by pumpkin_powers (Member # 9198) on February 07, 2008 05:55 PM:
Kris, I'm so sorry that this has happened. Please take care of yourself. This part of the journey is so hard. I hope that you are able to persue IVF in the future. I ended my ttc journey this dec after my second ectopic within a 6month period. I just couldn't take it anymore emotionally or physically. I hope that things get back to normal for you quickly. Please take care.
Lots of Love
Staci
TR3-7-06
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Posted by berta8133 (Member # 11188) on February 07, 2008 06:03 PM:
Oh Krys....I'm soooo very sorry this has happened. Thoughts are with you definitely! I pray you will be successful in your IVF journey.Good luck always,
Berta
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