9 weeks post D&C - still positive HCG levels, anyone else w/ similar? (#cw)

[michaelmorgan]

(#contentwarning)

I had a missed miscarriage, which was discovered at my first OB appointment, roughly 8 weeks into my pregnancy. I had a D&C, it went smoothly. It has been 9 weeks and 3 days since the D&C, and my pregnancy tests are still reading positive. My HCG levels were at 36 three weeks ago, then 18 two weeks ago, and 16 most recently (this week). So they are going down, albeit painfully slow.

My doctor, who I very much like and trust, is essentially stumped. He said he doesn't really have a good explanation for why this is happening. It's certainly not typical. They do not think it's necessary to do a second D&C, so at this point I'm just waiting.

Has anyone else experienced this? My understanding is that the typical hormone response following a D&C is to get a negative pregnancy test 2-4 weeks after the D&C.

This has been so difficult for me, because we are so anxious to start trying again.

 

[mcg1102]

@michaelmorgan I know I have seen a really helpful survey over at /r/ttcafterloss where members were asked how long it took hCG to go to zero after loss, graphed by gestational age at loss. I don't recall where it was posted -- /@prelude4ws, I think it was your survey?

 

[prelude4ws]

@mcg1102 Yep!

https://www.reddit.com/r/ttcafterloss/comments/7iabty/poll_how_long_did_it_take_you_to_get_a_bfn_after

 

[mcg1102]

@prelude4ws Duh, I should have just looked at your submitted threads...

 

[socakitty]

@prelude4ws Of course you did this. I considered doing this with the data on the Molar FB group.

 

[prelude4ws]

@socakitty I made the chart before the PMP diagnosis... I think having one for molar pregnancies would be a great resource.

 

[socakitty]

@prelude4ws I may just get bored enough to sit down and do it in the next week and a half.

 

[michaelmorgan]

@prelude4ws This is so helpful, thank you.

 

[socakitty]

@michaelmorgan There are reasons for it to go down slowly. As long as it is going down, frustrating as it is, it should be fine.

The most common reason is retained tissue.

The other reasons are really uncommon. I am 6 weeks out from D&C and my hCG is at 13. I had something called a Partial Molar Pregnancy where the embryo had particularly unusual DNA, so the placenta is invasive and hangs on for longer. Levels drop much slower than usual. The treatment protocol is to monitor hCG and wait for it to fall to negative (

 

[michaelmorgan]

@socakitty I've had some infrequent spotting, but no period. I'll make sure to stay hydrated, thank you!

 

[jesscat]

@michaelmorgan I'm so sorry for your loss.

I didn't have a D&C with my loss, but similarly it also took what seemed like a very long time for my HCG to drop. It was around 7 weeks before my tests came back negative. The reason for this is that I had retained tissue, which was still producing HCG. I was almost scheduled for surgery, but my gyno was reluctant, and then I had a couple of extremely heavy periods with lots of clotting (I went to urgent care twice it was so heavy). It was only after that that my tests came back negative.

Has your doctor ruled out retained tissue after the D&C? Have you had a period yet?

It's so frustrating and hard to go through this process, and I'm sorry you're having to deal with it.

 

[michaelmorgan]

@jesscat Thank you for your kind words. The doctor said it's pretty rare to have retained tissue after the D&C, but it's possible - and that even very tiny amounts of microscopic tissue can be enough to make your body think there's still a pregnancy. So that's likely what has happened to me. I have not had a period; only some occasional spotting.

 

[johnprakashjha]

@michaelmorgan I had retained tissue after my first D&C that prevented my hCG levels from falling to zero. It's rare but it happens. I'd ask your OB what the options are for detecting and removing retained tissue; multiple D&Cs can (again, rarely) cause additional complications.

So sorry you're going through this. Be kind to yourself.

 

[michaelmorgan]

@johnprakashjha Thank you. At this point, he does not recommend repeating the D&C, because it creates some additional risk (albeit small risk, as you mentioned). I just have to wait it out. It's so hard though.

 

[jesscat]

@michaelmorgan Retained tissue is definitely a plausible explanation for what you're experiencing. I don't know if there could be another cause. I was offered misoprostal to try and get rid of the retained tissue but it didn't work for me. Eventually I got my period and the rest came out though. I hope you can get some closure on this soon.

 

[michaelmorgan]

@jesscat I actually tried misoprostal before my D&C - to hopefully avoid having to have the D&C in the first place - and it didn't work. My body is just clinging to this tissue like crazy, I guess.

 

[jesscat]

@michaelmorgan Ugh, mine did the same. I had two rounds of misoprostal and I thought the first one worked. The second one did nothing and tried it as a last attempt before a D&C. They could see retained tissue on the ultrasound but my gyno was reluctant to operate as she said it was such a small amount, and to just wait. Took two months for it to finally resolve itself.