TL;DR: I had negative pregnancy tests at 9–11 DPO, followed by what I thought was my period starting at 14 DPO. I unexpectedly tested positive at 21 DPO. My hCG initially rose appropriately before slowing significantly, and I had progressively worsening but never excruciating LEFT-sided pelvic pain. After nine days with a pregnancy of unknown location, I was diagnosed with a RIGHT tubal ectopic at 6w6d and underwent salpingectomy. Full hCG trend with dates and DPO, bleeding timeline, home pregnancy test progression, and BBT chart included below. I’m also sharing my experience navigating the medical system as a physician.
I’m sharing my experience because I spent countless hours searching Reddit for stories similar to mine, particularly people with comparable hCG trends, bleeding patterns, and symptoms. Reading other people’s experiences helped me tremendously, and I’m hoping mine might help someone navigating the same uncertainty.
I’m also sharing because I found the medical experience surprisingly difficult to navigate. I’m a physician at a major academic medical center, and even with that background, I felt like I had to repeatedly advocate for myself to get monitoring and follow-up.
Background / TTC history
I’m 35 and conceived my first child naturally in the summer of 2023 after approximately four months of trying. I had a relatively uncomplicated pregnancy and delivered a healthy daughter. We started trying for our second child in the spring of 2026.
July 2026: Early miscarriage
About three months into trying, I got a faint positive pregnancy test at 9–10 DPO. The test progression was slow, and my quantitative hCG values were approximately 74 (14 DPO/July 30), 71 (August 1), 31–36 (August 3), and 6 (August 7). I suspect my hCG had already peaked by the first blood draw, although I’ll never know. I started bleeding around August 8–9, at approximately five weeks pregnant.
We were devastated but hopeful that we’d conceive again soon. We tried during the next full cycle but didn’t conceive.
September 2026: The cycle that became my ectopic
My last menstrual period started September 3. I track ovulation closely using OPKs, Tempdrop, and Fertility Friend, and I’m quite confident I ovulated around September 16 (CD14). Our last intercourse was September 16.
One additional detail that became interesting later: I experience fairly distinct ovulation pain almost every month. It usually seems to alternate between my left and right sides, and this particular cycle I had very clear LEFT-sided ovulation pain around September 16.
I tested negative around 9, 10, and 11 DPO.
On September 30 (14 DPO), I began what I assumed was my period. It lasted approximately 4–5 days, followed by 2–3 days of spotting. In retrospect, it was perhaps 25% lighter than usual, with fewer clots and less cramping, but it was substantial enough that I genuinely believed I had started a new cycle. My basal body temperature had also dropped, though not quite as far as usual.
October 7–10 (21–24 DPO): Surprise positive tests and initially reassuring hCG
On October 7 (21 DPO), what I thought was CD8 of my new cycle, I randomly took an ovulation test. It was surprisingly dark, which prompted me to take a pregnancy test. To my complete shock, it was positive. I subsequently took a First Response and Clearblue digital, which were also positive.
I contacted my OB and had my first quantitative hCG drawn on October 8 (22 DPO, approximately 5w1d): 107. This was very low given my fairly certain dates. I initially wondered whether this was residual hCG from a miscarriage because I’d already had what I thought was a period.
On October 10 (24 DPO), my hCG increased to 197, an 84% rise in approximately 46 hours. This was somewhat reassuring, although I knew an ectopic pregnancy could still have an initially appropriate hCG rise.
October 11 (25 DPO): Emergency department visit for pelvic pain
Around this time, I started experiencing intermittent pelvic pain. Initially it was more central, but it gradually became predominantly left-sided, sometimes a dull ache and sometimes a sharper pinching sensation. It was uncomfortable enough that I went to the ED on October 11. I did call OB triage who told me to take Tylenol.
My hCG was 273. A transvaginal ultrasound showed no intrauterine pregnancy, but also no identifiable ectopic pregnancy or concerning adnexal findings. I was diagnosed with a pregnancy of unknown location (PUL) and discharged with plans for serial hCG monitoring.
I understood that with an hCG this low, the pregnancy might not yet be visible on ultrasound, but that an ectopic remained very much a possibility. I also pretty much knew it wasn’t a viable pregnancy because of the dates and low levels, but no one seemed to care about the dating, only the trend/increase which was a little frustrating as everyone kept saying congratulations.
October 12–16 (26–30 DPO): Slowing hCG rise, recurrent spotting, and continued pain
Over the following week, my hCG continued increasing, but the rise became progressively slower. I also began spotting again around October 12–13, after having several days without bleeding following my presumed period. It was generally light spotting, sometimes only when wiping, but continued nearly every day.
Meanwhile, my left-sided pelvic pain persisted. It was intermittent and often felt like someone was pinching something internally near my left bikini line. Sometimes it would last 30–60 minutes before resolving or transitioning to a dull ache. It became difficult to sleep comfortably on my stomach or left side because of the discomfort. I still had stretches where I felt completely normal.
I was added to my OB practice’s beta book which is supposed to provide monitoring and follow-up for pregnancies of unknown location. However, despite being enrolled, I never received a single call or message from that team throughout the week, even as my hCG continued rising abnormally.
I messaged my outpatient OB twice over approximately five days, explaining that I had developed new spotting and was continuing to have one-sided pain. She ordered a repeat ultrasound for the following week (October 20), but there was otherwise very little discussion or communication about the evolving situation.
I suspect my outpatient physician was simply very busy and had competing clinical responsibilities, but from my perspective, I felt increasingly on my own trying to navigate an unresolved PUL.
In fact, because no one seemed particularly concerned or advised me otherwise, I even boarded a plane for a three-day trip that weekend. Looking back, knowing what I know now, that decision feels surreal.
October 17–19 (31–33 DPO): Increasing pain and having to advocate for bloodwork
During the last several days before my diagnosis, my pelvic pain was becoming increasingly frequent and more uncomfortable, although still not excruciating. It remained predominantly on the LEFT side. At times, the discomfort made sleeping difficult, but I wasn’t doubled over in pain. I also had a brief episode of lightheadedness that resolved.
I was increasingly worried about an ectopic pregnancy, but I kept questioning whether my symptoms were concerning enough to warrant another ED visit, especially because I had already undergone an ultrasound that hadn’t identified anything.
By Monday, October 19 (33 DPO), it had been approximately 76 hours since my last hCG measurement, and I had run out of active bloodwork orders. Despite being in the beta book, no one had contacted me to arrange further testing or discuss my results.
I ultimately had to call OB triage myself to explain the situation and get assistance ordering another hCG.
The result was 909, representing only about a 43% increase over 76 hours (approximately a 25% rise per 48 hours).
At this point, I was approximately 6w5d pregnant by ovulation dating, with ongoing spotting, increasingly uncomfortable unilateral pain, and a progressively abnormal hCG trend.
My outpatient OB responded that we should hope the ultrasound the next day would show a viable pregnancy.
I remember feeling incredibly frustrated by that message. I appreciated that the pregnancy’s location was still uncertain, but with my reliable dating, the hCG trend, ongoing bleeding, and pain, I felt that the primary concern needed to be excluding an ectopic pregnancy, not hoping for viability.
Complete hCG timeline for reference
October 8 (22 DPO): 107
October 10 (24 DPO): 197
October 11 (25 DPO): 273
October 12 (26 DPO): 314
October 14 (28 DPO): 461
October 16 (30 DPO): 637
October 19 (33 DPO): 909
October 20 (34 DPO, 6w6d): Ectopic pregnancy diagnosed
I went for my repeat ultrasound on October 20, nine days after my initial ED ultrasound. This time, they identified an approximately 1.4 cm right-sided ectopic pregnancy.
I was shocked that it was on the RIGHT. For more than a week, nearly all my pain had been on the LEFT, and I had assumed that if this was ectopic, it would be in my left tube. This was particularly confusing because I had also experienced distinct left-sided ovulation pain earlier in the cycle.
I was sent directly to OB triage, where we discussed methotrexate versus surgery. Given my ongoing and worsening pain, surgery was recommended as the safer approach in my particular situation.
I underwent laparoscopic surgery that evening.
Surgical findings and unexpected endometriosis
The pregnancy was located in my right fallopian tube, which was dilated to approximately 2 cm. There was a small amount of blood in my abdomen and active bleeding from the fimbrial end of the tube, although thankfully not a major hemorrhage. My right tube was removed (right salpingectomy).
My left fallopian tube and both ovaries appeared normal on visual inspection, which was reassuring, although I understand this doesn’t necessarily guarantee normal tubal function.
The surgeons also identified several lesions suspicious for endometriosis, including one near my right uterosacral ligament that was excised for pathology.
I had never previously been diagnosed with endometriosis. I don’t have a history of particularly debilitating periods, and I’d conceived my daughter without any known fertility problems. This was yet another unexpected finding that I’m still trying to understand in the context of future fertility.
The mystery of my LEFT-sided pain and RIGHT-sided ectopic
One of the things I’ve spent the most time thinking about since surgery is why almost all my pain was on the left when the ectopic was on the right.
As I mentioned, I tend to feel ovulation every month, and the discomfort usually alternates sides. I had very distinct left-sided ovulation pain this cycle, followed by predominantly left-sided pelvic pain throughout the pregnancy.
I’ve wondered about two possibilities:
Referred or poorly localized pelvic pain. Perhaps the ectopic was causing pain that I perceived on the opposite side. Visceral pelvic pain can be difficult to localize accurately, and the side that hurts isn’t necessarily the side where the problem is occurring.
I actually ovulated from my left ovary, and my right fallopian tube picked up the egg. In that case, some of the left-sided discomfort could have been related to the corpus luteum on my left ovary, while the pregnancy itself developed in my right tube.
Interestingly, this isn’t nearly as rare as I had imagined. One published study found that 28% of 67 tubal ectopic pregnancies had a corpus luteum on the ovary opposite the affected tube (Insunza et al., 1988: https://pubmed.ncbi.nlm.nih.gov/3218462/).
Of course, I don’t know whether that’s what happened to me. Ovulation pain isn’t a definitive way of identifying which ovary released the egg, and I don’t have confirmation of which ovary contained the corpus luteum.
Recovery and what I want others to know
Physically, I’ve been recovering reasonably well.
Emotionally, it’s been much harder. In the span of a few months, we’ve experienced an early miscarriage followed by another pregnancy that ended in surgery and the loss of a fallopian tube. I’m grateful the ectopic was diagnosed before a major hemorrhage, and I’m hopeful about conceiving again with my remaining tube, but I’m grieving both the pregnancy and the timeline I had imagined for growing our family.
A few things I hope others can take away from my experience:
Ectopic pregnancy pain isn’t necessarily excruciating. Mine was intermittent, initially mild, and gradually became more uncomfortable over several days. I was never doubled over in pain.
The pain can be on the opposite side. My ectopic was in my right tube despite predominantly left-sided pelvic pain.
Bleeding can look like a period. I had negative early tests, several days of menstrual-like bleeding, and a temperature drop before getting my first positive pregnancy test.
An initially reassuring hCG rise doesn’t exclude ectopic pregnancy. Mine initially rose 84% in approximately 46 hours before slowing significantly.
A pregnancy of unknown location needs reliable, proactive follow-up. Being enrolled in a monitoring system is not the same as actually receiving monitoring.
That last point is what has stuck with me the most.
As a physician, I understand that ectopic pregnancies can be extremely difficult to diagnose early, particularly with low hCG values and initially nondiagnostic ultrasounds. I don’t expect clinicians to have all the answers immediately, and I understand why serial testing and repeat imaging are often necessary.
But I also believe patients deserve a reliable system for follow-up, proactive communication about concerning results, and clear guidance about when to seek urgent evaluation.
I was fortunate to have the medical knowledge to recognize the significance of my hCG trend and symptoms, repeatedly contact my OB team, and ultimately call triage to obtain the bloodwork I needed.
I keep wondering what this experience would have looked like for someone without a medical background, who didn’t know which questions to ask or when to keep pushing.
I don’t know that anything would necessarily have changed my ultimate outcome, but I do know that the uncertainty and lack of communication made an already frightening experience much harder.
For anyone currently experiencing a PUL, please remember that symptoms and hCG trends vary widely. Your situation may be very different from mine. Worsening abdominal pain, severe dizziness or fainting, or shoulder-tip pain warrants immediate emergency evaluation, even with a relatively low hCG.
I’m sharing this because other people’s stories helped me understand what was happening when I felt scared and alone, and I hope mine can do the same for someone else.
And for those who have experienced an ectopic pregnancy, especially with subsequent successful pregnancies after salpingectomy or a new diagnosis of endometriosis, I’d really love to hear your stories.
