- If your initial hCG level is less than 1,500 mIU/mL, it should rise at least 49% every two days.
- If your initial hCG level is 1,500–3,000 mIU/mL, it should rise at least 40% every two days.
- If your initial hCG level is greater than 3,000 mIU/mL, it should rise at least 33% every two days.
- The first option is to perform a D&C to see if the doctors can detect any chorionic villi that would confirm it’s a pregnancy inside the uterus. If they saw villi, they would know it was an intrauterine pregnancy, and you wouldn’t need any more treatment. If they DIDN’T see villi, they would continue to monitor your hCG levels to see if they go down. Sometimes the pregnancy is so early, the pathologist can’t find villi even if the pregnancy actually was in the uterus. But if the levels don’t go down, the conclusion would be that the pregnancy was outside the uterus. The medical treatment for an extra-uterine pregnancy is methotrexate (MTX).
- The second option is to skip the D&C drama and go right to methotrexate. Some patients who choose this end up “not needing it” (if the pregnancy was actually inside the uterus), but it’s the fastest way to start treatment for a pregnancy you know isn’t normal.
Without a D&C, doctors won’t know for certain if your pregnancy was inside the uterus or not. But once you know that the pregnancy isn’t normal, it’s okay to go ahead and start treatment. What IS normal after getting methotrexate is bleeding on and off for 6 freaking weeks. Why do you bleed so much, when your uterus looked “empty” and the pregnancy may have been stuck in your tube? The presence of pregnancy hormone in your blood causes your uterus to prepare for a pregnancy. The uterine lining starts to thicken – it’s like a padded satin pillow waiting for the jewel of the pregnancy. Even if that jewel never arrives, the thickened lining will need to shed. Hence, frequent bleeding and often cramping. It is important to keep monitoring your hCG levels until they reach <5 (or whatever your doctor considers zero), to be absolutely sure the pregnancy is over.