The First Trimester and Non-Doubling hCG Levels
Inevitable Miscarriage? Not Necessarily
Due to my personal experience with two misdiagnosed miscarriages, as well as my work on the Misdiagnosed Miscarriage Site, I've learned a lot about pregnancy and miscarriage topics. I've written several articles about hCG levels, including a general overview entitled hCG Levels and Pregnancy, but for this article I'd like to focus on four sources that demonstrate that hCG levels do not need to double within 48 hours, as some doctors incorrectly inform their patients.
Keep in mind that what we know about medicine is still evolving. Many doctors are very busy with their patients, as well as with their charting and billing duties—and staying abreast of all the latest medical research can sometimes be a challenge. For this reason, I like to encourage women to learn more about their pregnancies and share what they have learned with their physicians. A good doctor will take an interest in what you have learned and will listen to you.
I believe every woman deserves to have no doubt before having her pregnancy ended.— Kay
Have you been told your hCG levels need to double in 48 hours?
Source # 1 - Research From the University of Pennsylvania
What they found: Researchers examined 293 women with viable first-trimester pregnancies. They found that in many of the pregnancies, hCG levels only rose 50% in two days.
Why is this important? Many women are incorrectly told that if their levels do not double within two days, or at the most three, they are probably going to miscarry. In fact, I get emails daily from women who have been told this. In some cases they do go on to miscarry—but many go on to continue their pregnancies.
Source # 2 - Research From UCSF
What they found: Although this is not specifically a study, there is some useful information to take away:
"Once you confirm [by ultrasound] that the pregnancy is in the uterus, there is no place for [beta]-HCG."
"Many clinicians determine whether [beta]-HCG levels have doubled within 48 hours, a sign of normal pregnancy, but sometimes they rely on this sign too far into the pregnancy."
What to take from this article: Most doctors stop measuring hCG levels once the gestational sac is viewed. While hCG levels can be a good predictor of problems very early in the pregnancy, once the gestational sac is viewed, doctors can look at other markers to determine the health of the pregnancy.
What NOT to take from this article: This article is correct that far too great an importance is placed on doubling hCG levels. However, the article also states when the yolk sac and embryonic pole should be seen. We have collected enough misdiagnosed miscarriage stories now to know this is not necessarily true. We have seen that if you have a tilted uterus, chances are you will see your baby up to three weeks (or even more!) later than most women. So, while we agree with the authors' thoughts on hCG levels, their criteria for diagnosing a miscarriage with ultrasound is not quite as valid.
Source # 3 - An Obstetrician's Blog
Blog title: HCG Levels and Ultrasounds in Early Pregnancy
About this blog: This blog by Dr. Robert Warnock again reiterates that misinterpretation can cause a lot of needless stress.
What to take from this blog: hCG that does not double every two to three days does not necessarily indicate a problem with the pregnancy
Once the pregnancy is visible on ultrasound, further hCG testing is less reliable than ultrasound for monitoring a pregnancy, as the variations in hCG levels are frequently misleading and cause unnecessary worry.
If you're not experiencing any pain or bleeding, and you are at a low risk for an ectopic pregnancy, try to avoid the temptation to monitor hCG levels.
Try not to read too much into the absolute numbers and rates of increase of the hCG levels.
Once an intrauterine pregnancy is visible on ultrasound, do not put any faith in hCG measurements.
Source # 4 - Pregnancy Website
Article title: HCG Ranges (published on the website ConveivingConcepts.com).
What you'll find here: The information found on this page is found in numerous places on the web, but I like how this site consolidates all the information on one page. You'll find average range of hCG levels as well as typical doubling time.
Most importantly, remember, typical doubling times increase with higher hCG levels.
- Under 1200 mIU/ml: 48-72 hours
- Between 1200-6000 mIU/ml: 72-96 hours
- Over 6000 mIU/ml: more than 96 hours
Are you worried about your hCG levels?
If your hCG levels are over 6,000, they can take 96 hours or more to double and still be within the normal range. In fact, as the hCG levels rise higher and higher, the rate of increase slows down and eventually starts dropping.
If you'd like to check your doubling levels, take a look here:
Do you still think hCG levels need to double in 48 hours
Video: Exploding the Myth of How HCG Levels Are Supposed to Double
This video explodes the myths of hCG doubling rates as well as diagnosing ectopic pregnancies. Great take-away message: doctors need to take their time in diagnosing. Two values and slow-rising values are not enough! If you are going through this scare, take a half hour to watch this video.
Ultrasounds May Lead to Misdiagnosed Miscarriages
Misdiagnosed miscarriages are finally making the news and, more importantly, research is beginning to be conducted on this important subject.
Time Magazine published an article in 2011 called Ultrasound Guidelines May Wrongly Diagnose Miscarriage. A snippet from that article:
"As if the worry over potential miscarriage weren't stressful enough for newly pregnant women, research released Friday shows that current guidelines for using ultrasound to determine that a pregnancy has ended may not always be accurate.
The four new studies looked at U.K. ultrasound specifications, but when the findings are extrapolated to U.S. guidelines, the researchers suggest 1 in 23 women diagnosed with miscarriage could still have a viable pregnancy."
We believe that that figure may actually be much higher. For women diagnosed with a blighted ovum, something like one in five may be much more accurate.
Important New Guidelines for Diagnosing a Miscarriage
The UK is the first country to acknowledge that misdiagnosed miscarriages are indeed a problem. The Royal College of Obstetricians and Gynaecologists has revised its guidelines. If your gestational sac is more than 25mm and/or the CRL is 7mm or more, you should wait a week to verify (if there are no complications). If the measurements are less, you are too early to diagnose. For more information (and something to take to your doctor), please, see my article: New Blighted Ovum Guidelines! You ARE Being Diagnosed Too Soon!
The information shared here is meant to supplement the information given you by your doctor. If you feel your doctor is not doing enough for you or not willing to listen to your concerns, I strongly encourage you to take what you've learned here and get a second opinion.
Have you read about other research regarding hCG levels? Feel free to leave links and your comments below.