Hello:

I am 29 years old and have been ttc for 21 months. My husband and I tried on our own for well over a year before we sought intervention. On my first cycle of Clomid, I acheived a pregnancy. I had a blood test that confirmed I was pregnant but my HCG levels were only around 8. Thereafter, my HCG levels rose but not appropriately. I experienced heavy bleeding with clotting which I thought was the miscarriage, but even after that, my levels continued to rise slowly. When my HCG levels were about 56, by OBGYN gave me methotextrate which ended up working and forcing my levels back to zero. After that, we sought the help of a specialist.

I had one cycle off because of the methotextrate and the following cycle we tried clomid again, with ovidrel and intercourse. I got pregnant again. I had a blood test which confirmed the pregnancy, but my HCG levels were only around 4. My HCG levels then rose to 8, then to 38 or so. I experienced heavy bleeding again with clots. I also had been taking Prometrium vaginally which my doctor switched to orally once the pregnancy was confirmed. I was taking two in the morning and two at night. I assumed that I had miscarried again, but my levels kept doubling up to about 240. I had a sonogram which slowed my uterine lining to be thin. The doctor said that it did not look good, but that they could not be sure. Today when I went back my levels had dropped to 45. So now I got back in two days to make sure they have dropped and then we start again. They said that I likely miscarried when I had all of the bleeding, but because my hormones were going crazy, my HCG levels continued to rise.

I have a few questions. First, I have had a full work up with no significant findings. Last week I requested auto-immune testing which I am now awaiting the results of. Are there any other tests that I should have?

Second, no one can tell me why this keeps happening. My OBGYN told me the first time that it probably had to do with a chromosomal abnormaility or there was also the possibility that it was ectopic. My tubes look good and are clear so I would think that would be the lesser of the two possibilities. This time, my fertility specialist said that it could be due to a weak implantation and that there are medicines that they can give me next time to try to help with this. What medications do you recommend in these types of situations?

Third, this cycle we are going to do IUI. I am wondering what the benefit of this really is if I have been able to conceive naturally with the clomid?

Mostly I am just confused and scared that the pregnancy will never work. Everyone, including my doctors, keep telling me that it will happen and to be positive. I just want to know if there is anything else that I can be doing to make a difference. I started acupuncture so I am hoping that that will help.

Thank you,

Dear Tristacase,
I’m sorry for your losses, this process can be so difficult.
From your description, it sounds as though it is not clear whether your pregnancies were biochemical pregnancies or ectopic pregnancies.  It is difficult to make recommendations on further work-up and treatment without reviewing all of your records and taking a complete history.  You may want to consider getting a second opinion.
It is so important to also be taking care of your emotional health as well, so acupuncture is a great idea. 
Best of Luck,
Keri L. Greenseid, MD
The Institute for Reproductive Medicine and Science at St. Barnabas
94 Old Short Hills Road, Suite 403E
Livingston, NJ 07039
973-322-8286

HELLO MY NAME IS JAQUALLA, I’M 25 YEARS OLD AND TRYING TO CONCEIVE MY 2ND CHILD BUT SINCE MY MISCARRIAGE A YEAR AND HALF AGO I HAVEN’T BEEN ABLE TO CONCEIVE. I RECENTLY STARTED TAKING CLOMID. I’M ON MY SECOND DOSAGE.  MY MENSTRUAL WAS LATE BY 4 DAYS AND ONLY ON 2DAYS WHICH IS VERY UNUSAL FOR MY CYCLE. DOES NAYONE HAVE AND SUGGESTION AND ANYTHING THING ELSE I CAN DO.

Dear Jaqualla,
I’m sorry for your loss.  This can be a difficult process.  Have you taken a pregnancy test yet this cycle?  If not, you should report your symptoms to your physician and take a pregnancy test.  Many women experience bleeding in early pregnancy that can be mistaken for their menses.  In terms of the next step, I think you should discuss this with your physician, as they are more familiar with your complete history. 
Best Regards,
Keri Greenseid