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Dr. Andrew Rynne

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Positive pregnancy test turned negative next day. Bleeding with back pain. Chemical pregnancy?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6011 Questions

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Posted on Tue, 5 Feb 2013 in Pregnancy
Question: Hi Dr. Lundi - i have a quick question re: fertility testing. I'm almost positive I just had a chemical pregnancy (faint positive pregnancy test at 16 days past ovulation). The next day i tested again and the result was negative, and I went on to have a fairly painful period that night. Still bleeding today with lots of cramping and back pain. Anyhow tomorrow I am due to take my day 3 fsh test but I am wondering if I should hold off due to the results possibly being inaccurate due to the chemical pregnancy? Or will this not make a difference? Thank-you for your assistance
doctor
Answered by Dr. Aarti Abraham 39 minutes later
Hello
Thanks for your query
As your history definitely suggests a chemical pregnancy, you should not go for the Day 3 FSH levels tomorrow.
Early chemical pregnancy as well as it's resolution both affect the pituitary gonadotropin secretion.
Hence, you should get it tested after one month on day 3 of your next cycle, when these changes have resolved, and your baseline values would be reflected.
Take care
Hope I have been of help
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 18 minutes later
Wow! Thank you for your prompt reply Dr. XXXXXXX so nice to hear from you. You have confirmed my suspicion that going for the 3-day fsh test tomorrow would not give me accurate results due to the circumstances and that I'm better off to wait until next cycle. I must say I am still a little upset right now about having a chemical pregnancy. Wondering why it happened and is there anything I can do to prevent one in the future and carry a pregnancy to term? Also wondering if you could tell me if it is safe to try to get pregnant again this cycle? Thank you,
doctor
Answered by Dr. Aarti Abraham 26 minutes later
Hi,
Nice to hear from you too again.
A chemical pregnancy is a failed one, where the embryo cannot grow to term.
There could be various reasons for this.
In your case, the primary one that comes to mind is age.
Beyond 40, the ovarian reserve of a woman declines ( ability to produce good quality and quantity of mature eggs ).
In fact, day 3 FSH is one of the tests that indicates your ovarian reserve.
With poor ovarian reserve, even if a woman conceives, the egg quality is not good enough to sustain the pregancy.
You might also have associated hormonal imbalances due to age or other conditions like polycystic ovaries, where adequate supportive hormones like LH, progesterone etc are not produced at the correct time, and in the critical amount necessary to support a pregnancy after fertilization.
Abnormal genetic make up of the embryo is a leading cause.
Latent thyroid or adrenal hormonal disturbances, increased prolactin levels, all could lead to such a phenomenon.
Often, some disease within the uterus that prevents successful implantation of the embryo could cause failed pregnancy - fibroids, adenomyosis, poor endometrial quality etc, which also are age related disorders.
To arrive at the exact cause of the mishap, you need to consult an Expert Infertility Specialist, who would thoroughly investigate you and your partner ( his semen analysis , if not normal, also could contribute to the failed pregnancy ), and suggest additional tests.
Apart from day 3 FSH, there are other more reliable and recommended tests for estimating the ovarian reserve - such as 1. AMH ( anti mullerian hormone ) and 2. AFC ( antral follicular count ) on transvaginal ultrasound.
I would suggest getting these done to know your ovarian reserve.
Also, you MIGHT need the aid of assisted reproductive technologies if your workup shows any such indication.
I would advice you to avoid conception for this cycle, to allow your hormonal milieu to stabilize, ideally one is advised not to conceive for 3 months after an abortion, but considering your age, a gap of one month is atleast advised.
Please do take folic acid prior to planning a pregnancy.
All the best and I would be happy to assist you anytime.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham 29 minutes later
Thank you again Dr. XXXXXXX for your very helpful and thorough response. Personally I feel that thin uterine lining is one of the issues as I have rather light periods. I am of course also quite concerned about my age. Although I am in very good health for my age and have never had any underlying fertility issues (like pcos, thyroid, endometriosis, ect.) I'd be lying if i said I wasn't feeling a little anxious about everything right now. Is there anything you would recommend to improve uterine lining and egg quality for an older woman trying to conceive? Thank you again for all of your help and assistance,
doctor
Answered by Dr. Aarti Abraham 22 minutes later
Hi again,
Its not about your health always.
Its about the natural physiological decline in the ovarian reserve with advancing age.
Of course, women DO conceive in this age group, so there is nothing to be disheartened about.
Also, only with proper tests, can the diagnosis of decreased endometrial thickness or poor ovarian reserve be made.
For the lining of the uterus, there are certain drugs like estrogen, sildanefil , aspirin etc which increase blood flow to the uterus during the follicular ( egg development ) phase, and which would be prescribed at appropriate timings by your Infertility consultant if she sees the need.
Unfortunately, there is no way to increase the ovarian reserve. A hormone - DHEA - is under investigation and has been found in initial studies to increase spontaneous conception rates in women with poor ovarian reserve. Because number of eggs in a female ovary is finite and fixed ( unlike male sperm genesis which is dynamic ), there is no way to reverse the poor ovarian reserve.
But cross those bridges when you come to them.
Stress and anxiety are also prime culprits in poor reproductive outcome.
Maintain a healthy lifestyle, consult a reputed Specialist, relax for the next cycle, and then aggressively pursue the suggested treatment regimen and investigations.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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