Why is hCG rising slowly? Why can hCG slowly rise in early pregnancy, what should I do? Hcg rises but slowly than to raise

Hello Elena Viktorovna! I have a difficult situation. There was endometrial polypropylene, successfully removed and took duphaston for more than 6 months, the long-awaited delay has come. The last menstruation was 08/29/2016, 10/17/2016 passed hCG, the doctor said the result was negative and the tests did not show all this time and did not show after. I was referred to a family planning center. On 10/28/2016 I was at a reception at this center, during the examination they immediately did a transvaginal ultrasound and the doctor said don’t worry, menstruation will come now. On this day, a rash had already begun on the forehead and mainly in the temporal part of the forehead - transparent watery pimples in a large amount, and after each meal I felt very sick, but without vomiting, I already lost two kilos in ten days, then the nausea went away, and with her, the appearance of acne disappeared. But now, a week after the visit to the family planning center, there are no periods and no, I decide to drink duphaston, because before that the attending physician said that when you get pregnant, you will take it continuously for several months. The second week has passed since the last examination, and on November 11th and 12th she begins to smear, the discharge is brown, the pain sensations are slight on the lower right. On Sunday the 13th, blood bleeds like during menstruation, but only in a smaller number of times twice (but in general I have abundant and the cycle has leveled off with difaston up to 28 days, and the duration of the days themselves is 4) the next day the bleeding decreases and seems to stop , to which I sigh with relief and pray to God that everything works out and the pregnancy is preserved. 14 in the morning I see that there were brown discharges at night, I try not to heat up, I go to work. And already at work, the following also happens in the morning: I feel a splash and a splash of fluid from me - blood, I put on a gasket, I am in shock, I try not to hysteria, and within 2-3 hours, bleeding and pieces up to 4 cm in size by 1.5-2 cm , so there were about 5-6 pieces during this time and the bleeding subsided by the evening, today we can already say it doesn’t drip, but the sensations both yesterday and today in the lower abdomen are as if the muscles were in good shape after training, although there were no physical loads at all. Tomorrow I have a scheduled appointment with my doctor, as the family planning center has scheduled a lot of tests for both hormones and smears. Why didn’t I immediately run to the doctor, but would they accept me, because the pregnancy was not diagnosed? Yes, and I began to come to myself only today, before that I didn’t think anything. Q: Was you pregnant? What happened is a miscarriage? And for what reasons could not establish whether there is a pregnancy or not? Thank you for your attention and looking forward to your answer, I want to clarify the situation for myself and see what my doctor can tell me.

Human chorionic gonadotropin (hCG) typically doubles every 48-72 hours during the early stages of pregnancy until levels are above 6000 mIU/mL. An increase of more than 60% after 48 hours is considered normal, but less than 53% is abnormal. Although slower growth alone does not indicate pregnancy loss, it is difficult to say about a decrease in hCG levels.

The concentration of this hormone in the blood is usually measured at intervals of 48-72 hours (2-3 days) to determine the development of pregnancy at the most early dates. Usually these tests are carried out at a time when ultrasound cannot yet determine the viability of the fetus.

The slow rate of increase or decrease in hCG levels during the first 8-10 weeks of pregnancy indicates the death of the trophoblast (cells in the outer layer of the embryo) and may indicate an ectopic or non-viable intrauterine pregnancy.

How accurate is the hCG level in determining a normal pregnancy?

The level of this hormone in the blood is a sufficient indicator to determine the viability of the fetus only until it exceeds 6000 mIU and / or until the period of 6-7 weeks of pregnancy. Later, it is already necessary to undergo an additional ultrasound examination to determine the presence. After that, there is no need to check the course of pregnancy with an analysis for hCG, as the famous American professor, MD, obstetrician-gynecologist Amos Grunebaum says.

One Canadian study in 2007 also showed that after hCG levels exceed 5000 mIU (or 5-6 weeks of pregnancy), this indicator should not be relied upon as a reliable determinant of the viability of pregnancy and in the first trimester.

Simply put, after 5-7 weeks of pregnancy, ultrasound becomes the best tool for getting information about how the pregnancy is progressing and is much more accurate than hCG numbers.

Slow rise in hCG

Unlike a drop in hCG levels (when the new test result is less than the previous one), a slow rise is not so obvious about the problem.

The doctor compares changes in hCG values ​​to established expected curves, which can help him determine how the pregnancy is progressing and if further action is needed. But to assess the growth rate of this hormone, there is a large number of restrictions, and by itself this indicator should never be used for conclusions - symptoms or signs of pregnancy should also be taken into account.

Reasons for the slow rise

slow rise hCG indicators may be related to:

• normal pregnancy;
• ectopic pregnancy;
• or his .

Only a doctor can determine which of these is more likely in each individual case.

What is the lowest acceptable rate of hCG rise?

A study in 2006 showed and in 2012 confirmed that an increase of at least 35% in 48 hours could be minimal growth indicator in normal uterine pregnancy at an early stage. Therefore, assumptions about the non-viability of the embryo, even if during the first month after conception, hCG increases at a rate of less than 53% within 48 hours, cannot always be correct.

How often does hCG rise slowly in a normal pregnancy?

Although a slow increase in the hCG doubling time may be a possible sign of a miscarriage or a symptom of an ectopic pregnancy, this is not always the case. According to the American Pregnancy Association, about 15% of viable pregnancies may have a slower hCG doubling time.

Decreased hCG levels

If there is not an increase, but a downward trend in the level of human chorionic gonadotropin in early pregnancy, it becomes clear that the embryo is not able to develop normally. In this case, intervention options or surveillance tactics may be considered. If the hCG level drops by less than 35-50% in 48 hours (see the table below), then this may indicate the presence of a trophoblast (the outer layer of the embryo - ed.) or development. In this case, examination and intervention are necessary for the final diagnosis.

Expected minimum percentage decrease in hCG in a non-viable pregnancy:

More about this table (click)

• The table above shows how hCG levels should decrease in a non-viable pregnancy. These are data from a study conducted in 2014. The previous similar analysis by scientists was carried out in 2004, and there the minimum level of hCG decrease was lower, although for a period of 7 days it practically leveled off. The reason for this difference is the use of updated statistical methods and a more diverse population in a newer study.
• The confidence interval here is 95%. That is, this means that only in 5% of women after the loss of pregnancy, the level of hCG will fall more slowly than shown in the table.
• A slower decrease in hCG than the threshold values ​​in the table may indicate the presence of a remaining trophoblast or an ectopic pregnancy.

The first weeks of pregnancy are especially exciting for women who planned conception and carefully prepared for it. Doubts that the long-awaited event has happened overcome even after the delay of menstruation and positive result express test. What other signs can confirm the fact of conception? This will help a blood test for chorionic gonadotropin. It is he who acts as the main marker of the birth of a new life.

What is hCG, what is the role of this hormone in the female body?

Human chorionic gonadotropin (hCG) is produced by the tissues of the chorion immediately after implantation of the embryo into the uterine cavity (about 12 days after conception). When there is no pregnancy, the level of this hormone is close to zero. After the onset of conception, it increases to tens of thousands of units, reaching the limit by the 10th week, and then decreases slightly.

The role of hCG in the early stages of gestation is very high. It supports the work of the corpus luteum - a temporary endocrine gland that produces progesterone, increases the number of chorionic villi, and provides them with nutrition. With its increase, there is a gradual adaptation to pregnancy, there is a restructuring of the hormonal background and important functions of the body.

Adaptation to pregnancy under the influence of hCG is an increase in the production of hormones of the adrenal cortex. They suppress the immune response to the embryo from the mother's body, because for him the fetus is to some extent alien. The production of hCG depends on how well the implantation process is going. If the fertilized egg is healthy, it produces the right amount of gonadotropin and gestation proceeds normally.

Diagnostic studies to determine the level of hCG

2-3 days after implantation, an increase in hCG is observed in the blood, after 3-5 days the hormone begins to be excreted along with the urine. With indirect signs of pregnancy (cycle delay, breast swelling, changes in taste habits), it is recommended to perform a rapid test. The probability of his error is 5%.

A blood test for hCG will give more accurate information. Biomaterial can be handed over in the direction of a doctor or independently in a paid clinic. To do this, take blood from a vein on an empty stomach in the morning. The answer will be ready on the same day or the next day. According to the results of the analysis, the fact of conception is judged.

How does the concentration of hCG change during pregnancy?

Deciphering the results of the analysis should be entrusted to the doctor. However, it is important to know that with a rate of less than 5 mU / ml, uterine pregnancy is excluded, and the reason for the cycle delay is different.

With an increase in hCG to values ​​​​above 5 mU / ml, you can prepare for motherhood. In any case, it is important to undergo an examination by a doctor who will confirm the fact of conception, register and monitor the performance of chorionic gonadotropin in the first weeks.

Which HCG result considered the norm? Indicators of acceptable hormone levels by week are shown in the table:

The indicators of the table are not an absolute dogma, after IVF they are always a little higher. Each expectant mother has her own optimal limits, therefore, to assess the dynamics of the increase in the hormone, the doctor evaluates the previous and new tests. When reporting from last day menses up to 4 weeks obstetric pregnancy gonadotropin levels double every two days.

You can calculate the doubling rate of the parameter using the formula “2.2+-0.8 days”. Hormone levels can increase faster, doubling every 1.5 days, or slower, doubling every 3 days. Having reached the limit values ​​​​by 9-11 weeks, it stops in growth, and then slows down. Subsequently, it slightly decreases to 6-7 weeks and remains so until childbirth. After the baby is born, the level of hCG gradually drops, and by the 4th week of the child's life does not exceed the norm of 5 mU / ml.

Reasons for the slow growth of hCG, its slowdown or decrease in the early stages

Deviations from normative indicators can be attributed to signs of pathology. It is important for the doctor to understand why this happened and urgently eliminate the anomaly. If hCG slowly grows in the blood of a pregnant woman in the early stages, a delay is likely physical development embryo. This happens because the formation of the placenta slows down and the blood flow between future mother and a child. The embryo does not receive enough oxygen and nutrients, which leads to intrauterine hypoxia.

Low hCG, a sudden drop in its level in the first weeks of gestation is a serious symptom that may indicate:

• placental insufficiency;
• ectopic implantation;
• fading pregnancy;
• slowing down the physical development of the embryo;
• the threat of failure;
• chromosomal abnormalities;
• rejection of the fetal egg before the delay of the cycle;
• detachment and non-engraftment of an embryo planted with IVF.

A low increase in gonadotropin may indicate placental insufficiency, fetal hypoxia, and its intrauterine death. Slowly rising rate later dates if the pregnancy is delayed, this situation is controlled by doctors.

Only a doctor can draw conclusions about what is attributed to the norm and pathology. Often, the analysis has to be retaken in order to eliminate the error of the laboratory. In the absence of suspicious signs, it is recommended to repeat the analysis in a week, and then conduct an ultrasound scan.

Of particular danger to women's health is an ectopic pregnancy after natural insemination or IVF. At first, a woman notes the same signs as with a normal conception. However, after a while, pathological symptoms join them - pain in the lower abdomen, bloody spotting. A blood test in this case does not show an increase in hCG, although there is a delay in menstruation. It is important to diagnose this condition in time and remove the embryo using laparoscopy. Otherwise, there may be a rupture of the fallopian tube (the place where the fetal egg usually begins to grow), peritonitis, sepsis.

Treatment tactics

In 15% of cases, a slow increase in the level of gonadotropin in the early stages is a natural phenomenon observed in the absence of pathology. In any case, having detected deviations in the growth of the pregnancy hormone, the doctor takes the patient under special control and prescribes additional examinations.

Bearing with an insufficient increase in hCG is complicated, since pregnancy is most often associated with certain pathologies and proceeds poorly. However, it is not uncommon to retain and endure healthy child Maybe. Much depends on the cause of the decrease in the level of hCG:

• if the drop in hCG is associated with an ectopic pregnancy, an emergency surgical intervention is indicated to save the patient's life (for more details, see the article:);
• in case of a frozen pregnancy, diagnostic curettage is carried out, then the cause of the pathology is found out, hormonal correction and careful preparation for a new pregnancy are carried out;
• when there is a threat of spontaneous abortion, preservation in a hospital is indicated, where important medical measures are carried out.

Treatment in the hospital involves monitoring the level of hCG in dynamics, as well as passing other tests that provide the doctor with additional information about the patient's health status. Special medications containing gonadotropin taken from the urine of pregnant women often help to increase the concentration of the pregnancy hormone (Pregnil, Horagon, Ecostimulin). Usually injections of drugs are made in dosages of 1500, 2000, 5000 IU. The dose is selected individually, while the patient's condition is monitored. If therapeutic measures are taken in a timely manner, the chances of bearing a baby increase.