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Measuring and interpreting Blood hCG to Assess Pregnancy Viability Following ART Treatments

by Dr. Geoffrey Sher on December 23, 2015

I know of no medical announcement associated with the degree of emotional anticipation and anguish as that associated with a pending diagnosis/confirmation of pregnancy following infertility treatment. In fact, hardly a day goes by where I am not confronted by a patient anxiously seeking interpretation of a pregnancy test result.

Testing urine or blood for the presence of human chorionic gonadotropin (hCG) is the most effective and reliable way to confirm conception. The former, is far less expensive than the latter and is the most common method used. It is also more convenient because it can be performed in the convenience of the home setting. However, urine hCG testing for pregnancy is not nearly as reliable or as sensitive e as is blood hCG testing. Blood testing can detect implantation several days earlier than can a urine test. Modern pregnancy urine test kits can detect hCG about 16-18 days following ovulation (or 2-3 days after having missed a menstrual period), while blood tests can detect hCG, 12-13 days post-ovulation (i.e. even prior to menstruation).

The ability to detect hCG in the blood as early as possible and thereupon to track its increase, is particularly valuable in women undergoing controlled ovarian stimulation (COS) with or without intrauterine insemination (IUI) or after IVF. The earlier hCG can be detected in the blood and its concentration measured, the sooner levels can be tracked serially over time and so provide valuable information about the effectiveness of implantation, and the potential viability of the developing conceptus.

There are a few important points that should be considered when it comes to measuring interpreting blood hCG levels. These include the following:

  • All modern day blood (and urine) hCG tests are highly specific in that they measure exclusively for hCG. There is in fact no cross-reactivity with other hormones such as estrogen, progesterone or LH.
  • Post conception hCG levels, measured 10 days post ovulation or egg retrieval can vary widely (ranging from 5mIU/ml to above 400mIU/ml. The level will double every 48–72 hours up to the 6th week of gestation whereupon the doubling rate starts to slow down to about 96 hours. An hCG level of 13,000-290, 0000 mIU/ml is reached by the end of the 1st trimester (12 weeks) whereupon it slowly declines to approximately 26,000– 300,000 mIU/ml by full term. Below are the average hCG levels during the first trimester:
    • 3 weeks LMP: 5 – 50 mIU/ml
    • 4 weeks LMP: 5 – 426 mIU/ml
    • 5 weeks LMP: 18 – 7,340 mIU/ml
    • 6 weeks LMP: 1,080 – 56,500 mIU/ml
    • 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
    • 9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml
  • A single hCG blood level is not sufficient to assess the viability of an implanting embryo. Caution should be used in making too much of an initial hCG level. This is because a normal pregnancy can start with relatively low hCG blood levels. It is the rate of the rise of the blood hCG level that is relevant.
  • In some cases the initially hCG level is within the normal range, but then fails to double in the ensuing 48-72hours. In some cases it might even plateau or decline, only to start doubling appropriately thereafter. When this happens, it could be due to:
    • A recovering implantation, destined to develop into a clinical gestation
    • A failing implantation (a chemical pregnancy)
    • A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
    • An ectopic pregnancy which will either absorb spontaneously (a chemical-tubal gestation), or evolve into a full blown tubal pregnancy continue and declare itself through characteristic symptoms and signs of an intraperitoneal bleed.
  • The blood hCG test needs to be repeated at least once after 48h and in some cases it  will need to be repeated one or more times (at 48h intervals) thereafter, to confirm that implantation is progressing normally.
  • Ultimately the diagnosis of a viable pregnancy requires confirmation of the presence of an intrauterine gestational sac by ultrasound examination. The earliest that this can be achieved is when the beta hCG level exceeds 1,000mIU/ml (i.e., around 5-6 weeks).
  • Most physicians prefer to defer the performance of a routine US diagnosis of pregnancy until closer to the 7th week. This is because by that time, cardiac activity should be clearly detectable, allowing for more reliable assessment of pregnancy viability.
  • There are cases where the blood beta hCG level is extraordinarily high or the rate of rise is well above the normal doubling rate. The commonest explanation is that more than one pregnancy has implanted. However in some cases it can point to a molar pregnancy  
  • Finally, there on rare occasions, conditions unrelated to pregnancy can result in detectable hCG levels in blood and urine. They include ovarian tumors that produce hCG, such as certain types of cystic teratomas (dermoid cysts) and some ovarian cancers such as dysgerminomas.
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  • Lynne - October 13, 2017 reply

    Dear Dr. Sher, I was waiting to start my next icsi cycle when I got a surprise positive pregnancy test. My betas have been rising slowly and I’m worried about what an u/s will show when I go in 3 days time. My betas were at 4+3: 787, 4+5: 1303, 5+6: 7800, 6+6: 21500. Do you think this could be viable? Many thanks

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 13, 2017 reply

    Hi Lynne,

    This could well be a viable pregnancy!

    Good luck!

    Geoff Sher

    Lynne - October 16, 2017 reply

    Dear Dr Sher, thank you very much for your reply. I’m very happy to say that we’ve seen a heartbeat!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 16, 2017 reply

    Thought so!

    Good luck!

    Geoff Sher

    Lynne - July 6, 2018

    Just to report the safe arrival of my son in May! Many thanks Dr Sher for your insight at a stressful time.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 6, 2018

    You are very welcome Lynne!

    Congratulations!!

    Geoff Sher

    Rits 123 - October 17, 2017 reply

    Hi.
    I have my last periods on 10th September. And yesterday i.e. 16th October I take urine test and it is positive. Then I take blood Hcg test, it’s count is 650.80, my doctor suggested to re test blood hcg tomorrow.

    Is it confirm pregnancy or have some issues.
    How much hcg count it should have as per my dates.
    Can some one please suggest it.

    Thanks

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 17, 2017 reply

    A repeat test two days afte the 1st one and an US done in 10-14 days later should be definitive.

    Good luck!

    Geoff Sher

  • Yogita - October 12, 2017 reply

    Hi Doc,

    We did 1 frozen embryo(6AA) transfer on Sep 22. my HCG level on 5 days after was Sep 27 was 495 and on Oct 2 (10 days after) was 3000. I am really worried because hcg level is quite high(abnormally high?) for single embryo . Do you see any problems or issues? I have ultrasound scheduled on Oct 17.
    Thanks
    Yogita

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 12, 2017 reply

    No this looks an like an appropriate rise for 5-6 days to me.

    Geoff Sher

  • Christina - October 11, 2017 reply

    I had two 5 day frozen embryos transferred on March 27. On 10/6 my blood test showed 114. Then on 10/9 the number was 173. Is it possible both embryos took initially and now just one is continuing to produce HCG? I am testing again 10/11 and I am hoping to see double of 173.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 11, 2017 reply

    It is indeed possible.

    Good luck!

    Geoff Sher

    Christina - October 14, 2017 reply

    Blood test on 10/11 was 165 – the Dr wants me to test again on Monday 10/16 so maybe there is still hope by some chance.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 14, 2017 reply

    Hope so!

    Good luck!

    Geoff Sher

    Christina - October 17, 2017

    My blood test results came back at 340 today 10/16 so really great news. Hopefully the final test on 10/19 will be even higher numbers.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 17, 2017

    Good luck Christina!

    Geoff Sher

  • Yogita - October 10, 2017 reply

    Hello Dr,

    We did 1 frozen embryo(6AA) transfer on Sep 22. my HCG level on 5 days after was Sep 27 was 495 and on Oct 2 (10 days after) was 3000. I am really worried because hcg level is quite high(abnormally high?) for single embryo . Do you see any problems or issues? I have ultrasound scheduled on Oct 17.
    Thanks
    Yogita

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 10, 2017 reply

    I do not see problems!

    Good luck!

    Geoff Sher

    Yogita - October 12, 2017 reply

    Thank you Dr. Appreciate much.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 12, 2017 reply

    You are welcome!

    Geoff Sher

  • Kate - September 20, 2017 reply

    Hello Dr Sher. I had a pgs tested transfer on august 24th. My betas have been doubling normally. Yesterday we saw a heart beat and I am 6 weeks. My beta HCG was rechecked and its only 7600 from 3600 5 days ago. Should I be concerned?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 20, 2017 reply

    The beta levels rise more slowly at this stage. Sounds as if all could be fine here.

    Good luck!

    Geoff Sher

    Kate - September 21, 2017 reply

    Thank you Dr Sher. I really appreciate you answering back. I am worried because the doubling time is about 110 hrs, which seems a lot. My RE does not want to retest hcg now but wait for a repeat ultrasound in a week.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 21, 2017 reply

    For reasons I gave, I concur with your RE.

    Geoff Sher

  • Concerned - September 14, 2017 reply

    My husband and I have been trying to conceive for a long time. I am probably about 10 days past ovulation. My Dr sent me for blood work. 2 days ago my hcg was at 4.5. 2days later it is at 5.8. She is sending me for more bloodwork to be done in a few days. I am hoping that these low levels mean that I am very early on but I’m afraid I am getting my hopes up. From what I have read it says anything over a 5 is pregnant. But if I am shouldn’t my levels have increased more than that over 2 days?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 15, 2017 reply

    Sadly, these results are not encouraging!

    Sorry,

    Geoff Sher

    Concerned - September 15, 2017 reply

    Thanks for your reply. I suspected as much. Is it at all possible that the outcome will be positive?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 15, 2017 reply

    possible but very unlikely.

    Geoff Sher

  • jaishree - September 10, 2017 reply

    I’m of 44yrs and had done day 5 blastocyst transfer on 23 Aug. My first hcg is 228 on 10 th day I.e on 1 Sep. On 13 th day I.e on 4 Sep it is 1558. 2 blastocyst were transferred. Does this super rise in count indicates possibility of twins? Pl reply.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 11, 2017 reply

    I do not think it will be twins, but so far so good!

    Good luck!

    Geoff Sher

  • Andrea - August 22, 2017 reply

    Hi Dr. Sher,
    I did a 5 day transfer on July 31st. My beta values were 17 on 08/11, then 47 on 08/15, then 56 on 08/17, and finally 187.8 on 08/21.
    My RE is concerned about the slow rise and has discussed chemical and ectopic with me. Is there any chance that this could be a viable pregnancy?
    Thank you so much for your time.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - August 22, 2017 reply

    I have to concur with the opinion by your RE.

    But…only time will tell!

    Geoff Sher

    Andrea - August 22, 2017 reply

    Thank you

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - August 22, 2017 reply

    You are very welcome!

    Geoff Sher

    Andrea - August 22, 2017

    I was told to stop my progesterone after my third beta. I checked back in after my fourth beta and was told I should still not be taking it. Do you agree with this?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - August 22, 2017

    If your pregnancy is a chemical gestation, there would be no purpose continuing the progesterone therapy.

    Geoff Sher

    Andrea - August 23, 2017

    My fifth beta is 445 …that’s 48 hours after my last beta of 187.8. My clinic is still not hopeful at all. Am I wrong to think that there is a chance for this pregnancy?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - August 23, 2017

    I have not given up on you. This could still be OK. Have an ultrasound done in about 10 days.

    Good luck!

    Geoff Sher

  • Jenny - August 21, 2017 reply

    Dear Dr,
    – 14 dpo hcg level 150 @ 9.00 a.m.
    – 19 dpo hcg level 860 @ 8.30 a.m.
    Here are my numbers after transferring 2 embryo’s 2 days after egg collection. I am so nervous after years of fertility treatment and several early losses that I am anxious to be hopeful. Bust just based on these numbers, would you agree it looks positive? Thank you.
    Jenny

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - August 21, 2017 reply

    Absolutely ..it does look positive!

    Good luck!

    Geoff Sher

  • Aparna - July 27, 2017 reply

    Dear Dr Sher, I am 42 years old, this was my third fresh IVF after repeat failed IVFs and FETs. This time I got PGS normal embryos and Endometrial receptivity test done to locate the window of implantation. 13 days since transfer, my B-hcg levels came out at 41. The doctor rules this as a chemical conception that failed to develop further. I am go back for a second blood test on 7/28/2017. Do you think this cycle has any future? Should I check for immunological issues now? I did develop a sore throat and cold 8-9 after transfer. Please let me know your thoughts. Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 27, 2017 reply

    It does not look encouraging, I am afraid!

    Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
    It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
    1. Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
    2. Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
    We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
    3. The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
    4. Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
    a. A“ thin uterine lining”
    b. A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
    c. Immunologic implantation dysfunction (IID)
    d. Endocrine/molecular endometrial receptivity issues
    Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
    I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.

    • The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
    • Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
    • IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation (COS)
    • The Fundamental Requirements for Achieving Optimal IVF Success
    • Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
    • Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
    • Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
    • Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
    • The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
    • Blastocyst Embryo Transfers should be the Standard of Care in IVF
    • IVF: How Many Attempts should be considered before Stopping?
    • “Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
    • IVF Failure and Implantation Dysfunction:
    • The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 1-Background
    • Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 2- Making a Diagnosis
    • Immunologic Dysfunction (IID) & Infertility (IID): PART 3-Treatment
    • Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
    • Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management 🙁 Case Report)
    • Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
    • Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
    • Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
    • Endometrial Thickness, Uterine Pathology and Immunologic Factors
    • Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
    • Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
    • A personalized, stepwise approach to IVF
    • How Many Embryos should be transferred: A Critical Decision in IVF?
    • The Role of Nutritional Supplements in Preparing for IVF

    If you are interested in seeking my advice or services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com You can also apply online at http://www.SherIVF.com .

    *FYI
    The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

    Geoffrey Sher MD

  • Siobhan - June 23, 2017 reply

    Dear Dr Sher,

    With regards to the FET, my clinic said they would thaw the embryo in the morning of the day of transfer, but said the transfer could take place anytime between 10-3.
    Would it be better to have the transfer done on the earlier side if its thawed in the morning, or better to be done in the afternoon?
    I am also planning on 48hours of bed rest (ish) after it’s been done, is this a good idea?

    Thank you

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 23, 2017 reply

    I personally do not advocate absolute bed rest. As to the timing of the FET…it should not matter. I concur with the propsed timing of the FET.

    Geoff Sher

  • Susan - June 22, 2017 reply

    Dear Dr. Sher,

    I did IVF and Frozen embryo transfer day-5 blastocyst was done on 06/05 and on 06/19 hcg level was 39. On 06/21 hcg level was 184. My doctor has asked to come for a US one week later. I asked him whether I should repeat the hcg test again and his answer was no. I am worried whether this a sign of positive pregnancy? Do I need to repeat the hcg test?

    Thanks

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 22, 2017 reply

    I agree with your doctor! Just do an US in a week. Things are actually looking quite promising for you!

    Good luck!

    Geoff Sher

  • Hannah - June 20, 2017 reply

    Many thanks for your swift reply. Sorry to start a new comment but I can’t seem to reply to your post. The want to measure hcg again to see if it has doubled, am I right in thinking though that hcg this high wouldn’t necessarily double in 48 hours? This has caused a lot of worry after years of trying to conceive and I don’t want to be worried without due cause.
    Thanks again

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 20, 2017 reply

    At this stage it often wont double every 2 days.

    Geoff Sher

    Hannah - June 20, 2017 reply

    Many thanks, this has reassured me.
    Hannah

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 20, 2017 reply

    G-d bless!

    Geoff Sher

  • LaDawn - June 6, 2017 reply

    Dr. Sher,

    I’m feeling a bit defeated!
    9dp5dt HCG 17
    11dp5dt HCG 35
    13dp5dt HCG 104

    To me, they are doubling which is what I’ve understood to be the most important factor. However, my doc said 17% chance of this being a viable pregnancy and seems to be convinced it is ectopic. I’ve been through this nine times over, accusing pregnancy twice. The first I miscarried at 6.5 weeks, and this pregnancy.

    Are these levels really so low to be concerned? Do you agree with the assessment of only 17% viability?

    Thank you!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 6, 2017 reply

    I do not see a problem. I think the hCG levels are rising adequately.

    Geoff Sher

    LaDawn - June 7, 2017 reply

    Thank you for your response! So, your opinion is that a low initial beta does not necessarily mean a poor prognosis?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 7, 2017 reply

    Correct!

    Geoff Sher

    Hannah - June 20, 2017

    Dear Dr Sher,
    I am wondering if you can help me. My beta hcg was measuring 18,000 at 6 weeks pregnant. 48 hours later it had risen to 22,015. A live foetus with a heartbeat was also seen on scan. My doctor said as hcg has not doubled in 48 hours that this indicates a miscarriage but I was under the impression that doubling slows down once levels are this high. Can you shed any light?
    Many thanks

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 20, 2017

    I do not necessarily agree. However, I would repeat the US in 1 week and asceratain whether alll is OK.

    Good Luck!

    Geoff Sher

    LaDawn - June 12, 2017 reply

    Hello,

    Hoping you might ease my mind. My follow up HCG Levels were as follows, in addition to the three previous levels provided:

    16dp5dt HCG 367
    20dp5dt HCG 1157
    I am now 5w 4d pregnant. My major concern is now that my doubling time is increasing and my HCG is still at such a low level.

    Do you consider this to be an appropriate increase?

    Is it of concern that my doubling time is slowing at such a low level?

    Do you think this level is suggestive of a viable pregnancy given that I have (combined) a lower HCG that seems to be slowing in its rise?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 12, 2017

    At this point, I would not be over-concerned. Wait a week and do an ultrasound for a definitive answer.

    Geoff Sher

    LaDawn - June 6, 2017 reply

    Thank you for some reassurance:). So, in your opinion, having a low initial beta doesn’t indicate a poor prognosis for this pregnancy?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 7, 2017 reply

    It is of course more reassuring when it starts off higher. However a doubling effect (every 2 days) bis equally encouraging in my opinion.

    Geoff Sher

  • KAR - June 5, 2017 reply

    I did IVF and embryo transfer was on 05/25 and on 3rd of Jun hcg level is zero what des its mean

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 5, 2017 reply

    I am afraid this does not bode well. The cycle has probably not worked.

    Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
    It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
    1. Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
    2. Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
    We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
    3. The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
    4. Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
    a. A“ thin uterine lining”
    b. A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
    c. Immunologic implantation dysfunction (IID)
    d. Endocrine/molecular endometrial receptivity issues
    Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
    My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.

    Geoff Sher

  • MARIA ROHAZE Te - June 3, 2017 reply

    i had a scan done at 6weeks and 3days but no heartbeat yet. a day later i bled and i thought i miscarried. the scan showed a sac w a yolk and my hcg was 25000. my cervix was also closed. 2 days later my hcg came up to 48000. is there hope for a viable pregnancy still? no more bleeding since that night.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 3, 2017 reply

    I would definitely repeat the US after the weekend!

    Geoff Sher

    Rachel - June 21, 2017 reply

    I had a HCG test at 14 dpo which was 50.7 and repeated on 19dpo with a result of 97. The levels aren’t increasing will this pregnancy fail or is it an indicator it’s ectopic?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 21, 2017 reply

    I am afraid this does not look very promising. Repeat the hCG test in 2 daily intervals . It should double each time .

    Geoff Sher

  • Destiny - April 25, 2017 reply

    My obgyn called last Thursday said my HCG was 9000 I haven’t had a period since March 10 and she doesn’t know how far along I am. Everything I read says 6-8 weeks could this be true?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 25, 2017 reply

    Possibly!

    Geoff Sher

  • Kate - April 22, 2017 reply

    Dear Dr Sher,
    My hcg at 16po was only 24, and I have been spotting since 14 dpo, with a brief period of light/moderate bleeding and cramping yesterday at 18dpo. I was figuring I was probably starting to miscarry, but just found out my betas more than doubled in 44 hours (hcg 63 at 18dpo), and now the bleeding has slowed to light spotting again. Does the doubling of hcg mean there is hope for this pregnancy? Can a pregnancy start with low hcg and 5 days of spotting/light bleeding and still be viable?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 22, 2017 reply

    It is a most encouraging development.

    Good luck!

    Geoff Sher

  • Naty - March 23, 2017 reply

    Dear dr. Sher,
    I have had a transfer of 2 frozen blastocysts on 8 March 2017. On day 15 after transfer (23 Mar.), my HCG was 7000. Do this numbers mean that I have twins? thank you in advance for the answer!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 23, 2017 reply

    Could be.

    Geoff sher

  • Mariam - January 15, 2017 reply

    Dear dr. Sher,
    I have had a test of the natural killer cells of my endometrium before I started IVF. This test show no significant immunological alterations. I have had 2 miscarriages and I am going for my third IVF attempt. After my first miscarriage I have had Methylprednisolone 4 mg per day. My doctor suggests Intralipids (and Methylprednisolone 4 mg and Clexane 40 mg) for my third attempt. If I had elevated NK cells I would understand this suggestion. I am in doubt. Would Intralipids improve the chance?

    Kind Regards, Mariam

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 15, 2017 reply

    Uterine cytokine analysis is in my opinion often wrong and the NK cell concentration is irrelevant. You need to be tested for uterine NK cell activation, using the K-562 target cell test.

    Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
    It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
    1. Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
    2. Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
    We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
    3. The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
    4. Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
    a. A“ thin uterine lining”
    b. A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
    c. Immunologic implantation dysfunction (IID)
    d. Endocrine/molecular endometrial receptivity issues
    Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
    I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
    • The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
    • Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
    • IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
    • The Fundamental Requirements For Achieving Optimal IVF Success
    • Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
    • Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
    • Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
    • Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
    • The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
    • Blastocyst Embryo Transfers Should be the Standard of Care in IVF
    • IVF: How Many Attempts should be considered before Stopping?
    • “Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
    • IVF Failure and Implantation Dysfunction:
    • The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
    • Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
    • Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
    • Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
    • Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
    • Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
    • Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
    • Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
    • Endometrial Thickness, Uterine Pathology and Immunologic Factors
    • Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
    • Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
    • A personalized, stepwise approach to IVF
    • How Many Embryos should be transferred: A Critical Decision in IVF.
    • The Role of Nutritional Supplements in Preparing for IVF

    Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
    Julie Dahan
    • Email: Julied@sherivf.com
    • Phone: 702-533-2691
     800-780-7437

    Geoff Sher

    I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

  • Amanda - January 11, 2017 reply

    Transfered 2 5 day blasts
    8dp5dt 15
    10dp5dt 36
    15dp5dt 293
    US & beta in 1 week
    Thoughts on this being a viable pregnancy please!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 11, 2017 reply

    Looks encouraging to mew\!

    Good luck!

    Geoff Sher

    Brigitte Adams - March 8, 2017 reply

    I had FET of 1 PGS normal (day. 6 5bb) embryo . My 1st beta was 90…then 48 hours later 86 and 72 hours later 78. Is there any hope at all? This was my only surviving embryo from eggs I froze 5 years ago at well known clinic in CO. Not getting any feedback from my Doctor. I had a myomectomy 5 months ago so should be no issues with there and my lining was 10 triple. Any feedback you have would be great… I am a wreck.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 8, 2017 reply

    I am afraid that on the face of it, this does not look good.

    Good luck!

    Geoff Sher

    Amanda - January 14, 2017 reply

    Ty for the fast response! My last transfer of 2 embryos ended in a cp due to possible chromosome abnormalities. (testing wasn’t available when retrieval was done.) With my successful cycle at 15dp5dt my hcg was 1,000. Why so low this time around? Do you think this is a low start? All embryos were 5d, frozen, and from same retrieval.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 15, 2017 reply

    I do not consider this number to be low!

    Good luck!

    Geoff Sher

    Amanda - January 18, 2017 reply

    Results are in!

    8dp5dt 15
    10dp5dt 36
    15dp5dt 293
    22dpd5t (5w6d) 4,366
    Ultrasound showed a gestational sac & yolk sac measuring on the small side, 5w2d (4 days behind.)
    Any concerns? us & beta again in a week.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 18, 2017

    Looks promising!

    Good luck!

    Geoff Sher

    Amanda - January 24, 2017

    Ty. Isn’t being behind in size alarming since the exact conception is known with IVF. Also loss of preg symptoms for 3 or 4 days now. Going crazy from all the worrying.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 24, 2017

    Just hang in there Amanda. there is nothing you can do except wait it out.

    Good luck and G-d bless!

    Geoff Sher

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 25, 2017

    Hang in there.

    Geoff Sher

    Amanda - January 26, 2017

    I can finally relax as yest we not only saw, but heard a strong heartbeat! Just want to say thank you for creating this site & taking time to answer people’s questions. For anyone starting out on the slow side with hcg levels keep the faith and stay off the internet!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 26, 2017

    So happy for you Amanda!

    Good luck and G-d bless!!

    Geoff Sher

  • shailey - January 9, 2017 reply

    Hi Dr,
    I am trying to conceive through natural way. This is my 8 DPO and my beta hcg is only 8.37 mIU/ml. Is it a pregnancy or not because I have learned that any level below 10 mIU/ml is considered non pregnant?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 9, 2017 reply

    It is too early to reach any definitive conclusions. Wait 7 days and repeat the beta.

    Good luck!

    Geoff Sher

    shailey - January 10, 2017 reply

    Thanks Doctor. But is it true that anything below 10 mIU/ml is considered non-pregnant?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 10, 2017 reply

    Not true! What is more important is to see a (roughly) doubling every 2 days nis early pregnancy and ultimately a few weeks later, ultrasound confirmation of a potentially viable pregnancy.

    Geoff Sher

  • Elisa - January 5, 2017 reply

    Dear Dr.
    I had two three day embryos transfered 19/12/16, my first beta 12/30/16 was 83 and the second 01/05/17 has been 749. Do you think the value is increasing correctly?

    Thank you very much for your answer.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 5, 2017 reply

    Yes I do!

    Good luck!

    Geoff Sher

    Rohan - January 7, 2017 reply

    Dear Doc, we conducted iui on 14th Dec. Our last lmp was on 28th nov. Hcg level on 30th dec was 67, on 2nd Jan was 161 & on 6th Jan was 858. We would like to request your opinion about how do you think it is growing & any insights that you can help us with. Regards, Rohan Dodal

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 7, 2017 reply

    It looks quite promising to me.

    Good luck!

    Geoff Sher

    Rohan - January 7, 2017

    Dear Doc, are there any concerns due to low hcg values. Also, my wife had vomiting & pain below today in morning.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 7, 2017

    I cannot answer that question authoritatively without MUCH more specific information. …Sorry!

    Geoff Sher

  • Mariam - December 5, 2016 reply

    Dear dr. Sher,
    My third frozen transfer failed. I have a question. I have had a test about endometrial receptivity in a mock cycle on day 22. The test advises to do the transfer in the same conditions: day 22 and P+5.5 (five and a half day of progesterone). My hospital has done the transfers (frozen transfer on which assisted hatching was performed) on day 22 and P+4 or P+4.5 (four and a half or four days of progesterone). How important for my window of receptivity is this one day less or more of progesterone. What would you advice?
    Kind regards, Mariam

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - December 5, 2016 reply

    It could be significant!

    Geoff Sher

    hannah - December 21, 2016 reply

    mybeta hcg 14dpo was 37 then 16dpo beta was 120 is that good? ive had backcramps no bleeding i have ultrasound on 28th is there a goodchance normal pregnancy pregnant through ivf

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - December 22, 2016 reply

    Looks very promising Hannah!

    Good luck!

    Geoff Sher

  • Maria - November 28, 2016 reply

    Dear dr. Sher,
    I have had a transfer of 3 frozen blastocysts on 10 November. On day 15 after transfer (25 Nov.), my HCG was 209. I have had morning sickness from 15 till 22 Nov., but the nausea is totally gone from 23 Nov. I don’t have a positive feeling about this. What is your opinion?
    Kindest regards, Maria

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 28, 2016 reply

    Symptoms are subjective….Repeat the beta hCG and if it is >1,00MIU/ml, get an ultrasound done.

    Geoff Sher

    Maria - November 30, 2016 reply

    Dear dr. Sher, thank you for your reaction. I requested a second Beta yesterday 29 November. The HCG was 359. The HCG has risen 72% in 96 hours. This will be a miscarriage? Kind regards, Maria

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 30, 2016 reply

    So sorry!

    Geoff Sher

    Nadie - November 28, 2016 reply

    Dear Dr. Sher,
    I just did an FET on 11/11 and my first beta was 11/23 at 158. The repeat was two days later and came back at 415. I asked for a third, which was scheduled for 3 days after the second and it is 1046. Should I be concerned that my doubling times have slowed down?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 29, 2016 reply

    No! this looks fine to me.

    Good luck!

    Geoff Sher

    Nadie - November 29, 2016 reply

    Thank you so much! You’ve put my mind at ease, so I can relax and wait for my ultrasound.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 29, 2016

    Good luck Nadie!

    Geoff Sher

  • Vik - November 14, 2016 reply

    Dear Dr. Sher, We’re a couple of Indian descent (wife: 39, me: 41) and have been trying to conceive via IVF for a year or so. On Oct 31 we transfered 2 frozen 3 day embryo’s (8 cells, between the “best and second best grade”)

    On Nov 11 we did our first HCG and it was 485
    On Nov 13 HCG was 1735
    We’re scheduled for a 3rd HCG and doctor’s appointment on Nov 15th.

    While we’re excited about good HCG numbers and a great increase rate, we’re worried that it might be too fast growing. Does this bring us within the potential of Molar Pregnancy possibilties?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 14, 2016 reply

    Not really! However, it could be a multiple pregnancy.

    Geoff Sher

  • Judy - November 10, 2016 reply

    Dear Dr. I had an iui with trigger shot. Having hcg test every 48 to 72 hours. My levels are as follow: 13dpo 15, 16dpo 88, 18dpo 150 does this seem like a viable pregnancy? Is there any hope with low hcg numbers?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 10, 2016 reply

    Looks very promising Judy!

    Good luck!

    Geoff Sher

  • Sherelle - October 26, 2016 reply

    Hi Dr. Sher,
    I had a frozen embryo transfer 14 days ago. My first bhcg test was done 10dpt and my level was a 4. The nurse said that she was sorry but it probably wasn’t a viable pregnancy but come on 10/22 and do another hcg level. I went back on 10/24 and my level was 11 so the nurse said to come back on 10/26 to do another hcg level. Now I have seen the hcg blood level chart that you posted in an earlier comment and that some pregnancies start off with low bhcg levels. I am encouraged by that and I believe God has the last say in this situation but would like to get your thoughts on this being a viable pregnancy.

    Sherelle - October 26, 2016 reply

    I forgot to mention that it was a 5day blastocyst. Thanks again for your time.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 26, 2016 reply

    Copy!

    Geoff Sher

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 26, 2016 reply

    It is not very promising but possible that this might viable.

    Geoff Sher

  • Alexandra Harvey - October 24, 2016 reply

    Hi Dr. Sher –
    I transferred a single five day embryo on October 11th. 6 days after transfer my HCG levels were 35. At 9dpt, rose to 190. At 11dpt, rose again to 487. At 7 days after transfer I started experiencing some spotting that continued to the 11th day that turned into light to moderate bleeding. I had my HCG drawn again this morning at 13dpt and my HCG had plateaued at 486.
    Is this a chemical pregnancy? Is there a reason why my numbers continued to rise so well despite experiencing spotting early on? Is there any chance this pregnancy is viable?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 24, 2016 reply

    Repeat the beta in 48H to see if it doubles. If so, arrange for US confirmation in 2 weeks or so. If not, it could be a chemical pregnancy or a tubal pregnancy.

    Good luck!

    Geoff Sher

  • Kelsey - September 27, 2016 reply

    Hi! I just went through my 4th IVF cycle but it was the first FET we have ever done. Yesterday (13 days past 3 day transfer of 2 embryos) I did an HCG blood test (it didn’t indicate it was a beta, just said HCG) the result was 40.9 U/L, and at the bottom of the paper it says anything over 30 means positive pregnancy test. We were over the moon yesterday and so excited to finally be pregnant first time in our lives. But I called my doctor this morning and he said the number is low and to go into the clinic and do a beta HCG test to see what’s up tomorrow. He also said that lab might have different range of what is a positive HCG level. I don’t understand, what is the difference between plain HCG and beta HCG? Is that number really low of 13dp3dt? Is there still hope? We are hoping it will double by tomorrow. Thank you for your help!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 28, 2016 reply

    I think guardedly that this is good news. The hCG test and beta hCG test is one and the same thing. Repeat the test in 48H. It should double. Good luck!

    Geoff sher

  • Tsitsi Chitiza - September 22, 2016 reply

    I did IVF and embryo transfer was on 11 Sept 2016. My first beta on 21 sept 2016 was 17. Whats your opinion.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - September 22, 2016 reply

    You need to repeat it in 2 days. It should more or less double every 48H .

    Geoff Sher

  • Tiffany Langford - July 23, 2016 reply

    Hello. I’m a hopeful gestational carrier for my friends and am 5w1d pregnant. We had our 5 day blastocyst transferred on July 5th followed by a positive test on the 14 and my first hCG beta at 135. The next was 48 hours later at 173. Not a good rise. The next two were 351, then 613. Appropriate rises. They are still very concerned about that initial rise and said ectopic is a possibility. Today my 5th beta at 17dp5dt was 1224-finally doubled. I’m scheduled for an ultrasound next week right at 6wks. What would you suggest might be going on here?
    Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 23, 2016 reply

    Hi Tiffany,

    Yes this is an abnormal rise in beta hCG and indeed a failing uterine implantation or an ectopic needs to be ruled out. However, it could still be OK… so until the US examination it is not possible to tell will any degree of confidence.

    Sorry!

    Good luck.

    Geoff Sher

    Tiffany Langford - July 23, 2016 reply

    Thank you for your response. Could you explain what “A recovering implantation, destined to develop into a clinical gestation” means?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 23, 2016 reply

    That it might be a chemical pregnancy.

    Geoff Sher

    Tiffany Langford - July 24, 2016 reply

    I found a different explaination in your reply to someone on April 28. I hadn’t considered a chemical pregnancy since my numbers are still rising. Thanks.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 24, 2016

    Copy!

    Geoff Sher

  • James Kemp - July 22, 2016 reply

    My business partner acquired a sample a form form using this http://goo.gl/qhoxAJ

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 22, 2016 reply

    Copyu!

    Geoff Sher

  • tracy bullis - July 21, 2016 reply

    Great Article. comments ! I loved the facts , Does anyone know where my assistant can access a template a form version to use ?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 21, 2016 reply

    Not sure I understand precisely what you are looking for.

    Geoff Sher

  • Gloria - July 18, 2016 reply

    Hi! I had an IVF with 2 day 5 blastocysts transferred on June 27,2016. My first hcg value 14 days after transfer was 1,046 (July 11, 2016) with repeated test (July 13, 2016) at 2,241. Did ultrasound at 5 weeks 2 days with only one gestational sac identified. Is it still possible to be a twin pregnancy with another sac still not showing? I was really hoping for twins as crazy as it may sound.
    Thanks!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 18, 2016 reply

    Unlikely Gloria! It might have started oof with >1 but with all but one absorbing.

    Good luck!

    Geoff Sher

  • Lauren W - July 13, 2016 reply

    Dr. Sher,
    My beta at 13dp5dt was 257. Beta #2 scheduled for 15dp5dt. Do you think 257 is low for 13dp5dt?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 13, 2016 reply

    No I think it could be OK provided the next beta shows a doubling over 2 days.

    Geoff Sher

    Lauren W - July 22, 2016 reply

    Update:
    13dp5dt: 257
    15dp5dt: 258
    17dpt5dt: 316
    19dp5dt: 624
    21dp5dt: 1,012
    Crazy numbers. Ultrasound scheduled for Monday (26dpt5dt). We’re told to be cautiously optimistic and possibly both embryos took and one did not make it. Realistically – any hope?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 22, 2016 reply

    I concur!

    Good luck!

    Geoff Sher

  • Courtney - July 8, 2016 reply

    Good Evening,
    At 5 weeks ish- I was at 4012 and 51 hours later I was at 6221. It didn’t double but I heard after a certain value it can slow down. Should I be concerned with this level?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 8, 2016 reply

    Probably not! Wait a wek and do an ultrasound!

    Geoff Sher

  • Y&D - June 26, 2016 reply

    I just completed my first IVF CYCLE. Ive never been on any fertility meds before until this cycle. We transferred 1 frozen embryo (grade 4ab) 5day blastocyst . My first beta was on 10dp5dfet and my hcg is at 5.8. Is there still hope for a positive pregnancy?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - June 27, 2016 reply

    Yes! There is hope but it the chances are not good.

    Geoff Sher

  • Rebecca - May 3, 2016 reply

    After a miscarriage at 9 weeks a years ago, I had a positive home pregnancy test on a natural cycle. My first beta at 14 dpo was 452 and my second 73 hours later was 2070. While I am happy about these high numbers I am now concerned they are too high. Do you think these are signs of a Molar pregnancy or Downs Syndrome?

    Thank you,

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - May 3, 2016 reply

    No I do not think there is reason for concern…..

    Good luck!

    Geoff Sher

  • EYA - April 27, 2016 reply

    Dear Dr

    i have nk cells at 19% and slight sticky blood. upon BFP i started duphaston and 10mg prednisone.
    my 1st hcg was 982.
    96 hours later it was 3296.
    96 hours later it was 5445. Upped to 20mg prednisone. Cervical scan three days later showed a gestational sac and yolk sac that measured ard 5 weeks gestation. by LMP i should be 6 weeks. I started my clexane.

    Could be it recovering implantation? I am due to see my dr in 3 days time.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 27, 2016 reply

    Only time will tell Aya! I certainly hope so for you!

    Geoff Sher

    EYA - April 28, 2016 reply

    why i said its recovering implantation is cos the first scan, my dr cant even make out if thats a sac. But 3 days later we saw a gest sac and yolk sac..
    Could it be possible?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 28, 2016 reply

    Hopefully this is on target.

    Geoff Sher

    EYA - April 28, 2016 reply

    What is recovering implantation? I cant seem to google the term.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 28, 2016 reply

    Please give me the entire statement where this was mentioned so I can see what you are referring to.

    Geoff Sher

    EYA - April 28, 2016

    In some cases the initially hCG level is within the normal range, but then fails to double in the ensuing 48-72hours. In some cases it might even plateau or decline, only to start doubling appropriately thereafter. When this happens, it could be due to:
    A recovering implantation, destined to develop into a clinical gestation
    A failing implantation (a chemical pregnancy)
    A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
    An ectopic pregnancy which will either absorb spontaneously (a chemical-tubal gestation), or evolve into a full blown tubal pregnancy continue and declare itself through characteristic symptoms and signs of an intraperitoneal bleed.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 28, 2016

    Thank you. What was implied is that it could be possible for an embryo to get off to a slow start or go through a regression with regard to its implantation status and thereafter recover and improve its implantation performance. Of course this is a theoretical possibility only, but logically it is a potential scenario.

    Geoff Sher

  • Maja - April 24, 2016 reply

    Hello,
    I am currently 6w3d pregnant. I had a m/c two years ago and am really worried about this pregnancy as well: my bhcg levels at 5w were 966, then at 5w4d just 1.151. I had an US on the same day and there were a GS (0.52 cm) and a YS (0.25 cm) clearly visible. I have another US tomorrow. My doctor told me everything does llok pretty normal and that a heartbeat should be visible tomorrow but if not I shouldn’t worry, it can happen a few days later. The bhcg levels still worry me. I did not go for another blood test because my doctor advised me not to – she said it would only confuse me. But I am extremely nervous about the US tomorrow.
    What do you think about these bhcg levels? Is there hope that everything will be ok tomorrow? I do still have all the symptoms as before – tender breasts, bloating, fatigue and food cravings (no nausea so far).
    Thank you so much for your help and I do apologize for my English – I am not a native speaker.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 25, 2016 reply

    You are correct, this is slowish rise in the beta and yes…it could go either way. The ideal time to do an US is closer to 7 weeks.

    Good luck!

    Geoff Sher

    Maja - April 25, 2016 reply

    I just had the US and there was a heart beat of 107 and the measured age is 6w not 6w4d. the size is 0.36 cm. The doctor said everything looks fine although the heart beat is a bit slow. Do you think it’s too slow?
    Thank you so much!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 25, 2016 reply

    It s on the slow side Maja. Repeat the US in 1 week and reassess.

    I wish you well!

    Geoff Sher

  • Natalie - April 22, 2016 reply

    Hello Dr.Sher,

    I’m about 5 weeks and I had my first hcg taken 72hrs ago measuring at 550. I had another one done at the 48hr mark which came back 883 – a 60% rise. One Doctor said I’m between the normal range but just on the low end. Another Doctor said I’m not rising fast enough. Could you shed some light on the accuracy of hcg levels and a viable pregnancy. Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 22, 2016 reply

    This is a slow rise and it could go either way with regard to this pregnancy. Wait 1week and then do an ultrasound examination to determine.

    Geoff Sher

  • Brittney Ferguson - April 21, 2016 reply

    My last period was somewhere between March 17- 23ish. I noted myself bleeding on April 19 around 12am thought it was my period and put in a tampon. When I woke up it was completely dry. On April 19 I took a pregnancy test with my first morning urine and got a very fast faint positive. I went to the Dr later and the urine test I took there was negative. I insisted they gave me a blood test which the did my levels were 5.1 Today April 20 I’ve started bleeding. Is this my period?
    I just don’t know what’s going on. I have another blood draw today.

    Brittney Ferguson - April 21, 2016 reply

    Wanted to add I’ve been consistently bleeding

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 21, 2016 reply

    Copy!

    Geoff Sher

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 21, 2016 reply

    It looks like the cycle failed. Please consider calling or emailing Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me so we can discuss your case. You can reach Julie at on her cell phone or via email at any time:
    Julie Dahan
    • Email: Julied@sherivf.com
    • Phone: 702-533-2691

    I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

    Geoff Sher

  • Erin - April 5, 2016 reply

    I had an iui and a positive blood test on 3/25. I’ve had 4 hcg draws. 150, after 2 days 385, after 6 days 2520, after 2 days only 3075. They said it could go either way, but they don’t have me coming back until 4/12. Is there really any hope?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 5, 2016 reply

    Yes there certainly is some hope but only time will tell.You need an US to see if there is an intrauterine gestation. and it could be done now.

    Geoff Sher

    Erin - April 5, 2016 reply

    I forgot to mention this. There was a gestational and yolk sac on the day of the 3075 draw.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 5, 2016 reply

    That is positive.
    Hang in there!

    Geoff Sher

  • Niki - March 10, 2016 reply

    Hello!

    I had a FET on Feb. 26 – 2 great looking embryos
    On March 7 (10dp5dt) my first HCG Beta number was 109,
    On March 10 (12dp5dt) my second HCG Beta number was 169- So it did not double.
    I go in tomorrow for a 3rd blood draw- March 11
    Still on Progestrone, and estrogen, baby aspirin but no pregnancy symptoms.
    Online beta hcg calculators confuse me more(can you help here too?)
    , but the IVF due date calculator has me at 4 weeks and 4 days.
    Do you think we still have Hope?

    Thank you so much for all that you do!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 10, 2016 reply

    Yes indeed there is hope. However, you will know much more after the next beta hCG test.

    Geoff Sher

  • Sarah - February 28, 2016 reply

    First I’d like to say thank you for providing this service. We hcg tested 9 days after transfer. My levels rose slowly and then suddenly shot up 90%. The numbers were 147,201,298 and finally 574. We go in for our 6w5d u/s in a few days. Could the slow rate of initial increase be a sign of chemical pregnancy or ectopic? Have you seen viable pregnancies with similar numbers?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 28, 2016 reply

    I suspect all will be well but honestly, while I wish I could say for sure…..I cannot. You will have to endure the anguish and wait it out until the ultrasound.

    Testing urine or blood for the presence of human chorionic gonadotropin (hCG) is the most effective and reliable way to confirm conception. The former, is far less expensive than the latter and is the most common method used. It is also more convenient because it can be performed in the convenience of the home setting. However, urine hCG testing for pregnancy is not nearly as reliable or as sensitive e as is blood hCG testing. Blood testing can detect implantation several days earlier than can a urine test. Modern pregnancy urine test kits can detect hCG about 16-18 days following ovulation (or 2-3 days after having missed a menstrual period), while blood tests can detect hCG, 12-13 days post-ovulation (i.e. even prior to menstruation).
    The ability to detect hCG in the blood as early as possible and thereupon to track its increase, is particularly valuable in women undergoing controlled ovarian stimulation (COS) with or without intrauterine insemination (IUI) or after IVF. The earlier hCG can be detected in the blood and its concentration measured, the sooner levels can be tracked serially over time and so provide valuable information about the effectiveness of implantation, and the potential viability of the developing conceptus.
    There are a few important points that should be considered when it comes to measuring interpreting blood hCG levels. These include the following:
    • All modern day blood (and urine) hCG tests are highly specific in that they measure exclusively for hCG. There is in fact no cross-reactivity with other hormones such as estrogen, progesterone or LH.
    • Post conception hCG levels, measured 10 days post ovulation or egg retrieval can vary widely (ranging from 5mIU/ml to above 400mIU/ml. The level will double every 48–72 hours up to the 6th week of gestation whereupon the doubling rate starts to slow down to about 96 hours. An hCG level of 13,000-290, 0000 mIU/ml is reached by the end of the 1st trimester (12 weeks) whereupon it slowly declines to approximately 26,000– 300,000 mIU/ml by full term. Below are the average hCG levels during the first trimester:
    o 3 weeks LMP: 5 – 50 mIU/ml
    o 4 weeks LMP: 5 – 426 mIU/ml
    o 5 weeks LMP: 18 – 7,340 mIU/ml
    o 6 weeks LMP: 1,080 – 56,500 mIU/ml
    o 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
    o 9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml
    • A single hCG blood level is not sufficient to assess the viability of an implanting embryo. Caution should be used in making too much of an initial hCG level. This is because a normal pregnancy can start with relatively low hCG blood levels. It is the rate of the rise of the blood hCG level that is relevant.
    • In some cases the initially hCG level is within the normal range, but then fails to double in the ensuing 48-72hours. In some cases it might even plateau or decline, only to start doubling appropriately thereafter. When this happens, it could be due to:
    o A recovering implantation, destined to develop into a clinical gestation
    o A failing implantation (a chemical pregnancy)
    o A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
    o An ectopic pregnancy which will either absorb spontaneously (a chemical-tubal gestation), or evolve into a full blown tubal pregnancy continue and declare itself through characteristic symptoms and signs of an intraperitoneal bleed.
    • The blood hCG test needs to be repeated at least once after 48h and in some cases it will need to be repeated one or more times (at 48h intervals) thereafter, to confirm that implantation is progressing normally.
    • Ultimately the diagnosis of a viable pregnancy requires confirmation of the presence of an intrauterine gestational sac by ultrasound examination. The earliest that this can be achieved is when the beta hCG level exceeds 1,000mIU/ml (i.e., around 5-6 weeks).
    • Most physicians prefer to defer the performance of a routine US diagnosis of pregnancy until closer to the 7th week. This is because by that time, cardiac activity should be clearly detectable, allowing for more reliable assessment of pregnancy viability.
    • There are cases where the blood beta hCG level is extraordinarily high or the rate of rise is well above the normal doubling rate. The commonest explanation is that more than one pregnancy has implanted. However in some cases it can point to a molar pregnancy
    • Finally, there on rare occasions, conditions unrelated to pregnancy can result in detectable hCG levels in blood and urine. They include ovarian tumors that produce hCG, such as certain types of cystic teratomas (dermoid cysts) and some ovarian cancers such as dysgerminomas.

    Hope this helps!

    Good luck!

    Geoff Sher

  • Ann - February 27, 2016 reply

    Hi Dr Sher,

    My first HCG came back at around the 7000 mark for 5 and a half weeks, 2 days later it had only progressed to 9000. An ultrasound was performed at 6 weeks 2 days and heartbeat found (but low at 90 beats per minute). Waiting next blood results. Does the initial rise suggest this is not viable? Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 27, 2016 reply

    No! I dont think you can go that far in your deductions. The beta hCG slows down in its rise after about the 5th-6th week. The next US will however probably be definitive,.

    Good luck and G-d bless!

    Geoff Sher

  • Jag - February 27, 2016 reply

    Hi Dr

    My wife and I recently transferred a frozen embryo and we are having a hard time figuring out what is going on. We transferred a frozen day 6 blast on feb 3. We got tested on the 12 and the hcg level was only 15. It went up to 23 on the 15th and we were told to stop all meds. My wife took an at home test on the 17 and noticed the line got brighter. We asked for another blood test and on the 19th hcg was 172. We were told to start all medication again and go test again on the 22nd. Tested again on the 22nd and it was 440. It then went up to 690 on the 24th and and its 980 on the 26th. Is there an explanation for this? We fear this can be ectopic and the whole thing has been a less than ideal situation. We accepted it probably isn’t viable at this point but we aren’t sure how long this can drag on.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 27, 2016 reply

    Yes, it could be an ectopic but it could also be an intrauterine pregnancy. An US done in 10-14 days will be definitive.

    Good luck!

    Geoff Sher

    Jag - February 27, 2016 reply

    Thanks for your response. Given that it was a day 6 blast and the numbers being low and not doubling, we kind of ruled out this being a normal pregnancy. It’s reassuring to know we may still have a chance.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 27, 2016 reply

    Good luc Jag, and please keep me updated.

    Geoff Sher

    Jag - March 1, 2016

    We had our ultra sound today and it’s not ectopic so that’s a good thing. They did see a small sac however we were told it’s too small ( measuring in at only 6 weeks). We were told to stop the meds and just wait for the miscarriage. I guess it wasn’t meant to be.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 1, 2016

    So sorry Jag,

    I suggest that you call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.

    I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

    Geoff Sher

  • Kat - February 18, 2016 reply

    Hi Dr Sher,

    I had an IUI 13 days ago.
    I received a positive hcg result at 11dpo of 25, and then another result of either 32 or 34 (my memory is hazy as I’m upset) today at 13dpo.
    I had a trigger shot of ovidrel 250, two days before ovulation.
    Is there any hope that this pregnancy will progress, given the slow hcg rise?
    Thanks

    Kat

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 18, 2016 reply

    I know of no medical announcement associated with the degree of emotional anticipation and anguish as that associated with a pending diagnosis/confirmation of pregnancy following infertility treatment. In fact, hardly a day goes by where I am not confronted by a patient anxiously seeking interpretation of a pregnancy test result.
    Testing urine or blood for the presence of human chorionic gonadotropin (hCG) is the most effective and reliable way to confirm conception. The former, is far less expensive than the latter and is the most common method used. It is also more convenient because it can be performed in the convenience of the home setting. However, urine hCG testing for pregnancy is not nearly as reliable or as sensitive e as is blood hCG testing. Blood testing can detect implantation several days earlier than can a urine test. Modern pregnancy urine test kits can detect hCG about 16-18 days following ovulation (or 2-3 days after having missed a menstrual period), while blood tests can detect hCG, 12-13 days post-ovulation (i.e. even prior to menstruation).
    The ability to detect hCG in the blood as early as possible and thereupon to track its increase, is particularly valuable in women undergoing controlled ovarian stimulation (COS) with or without intrauterine insemination (IUI) or after IVF. The earlier hCG can be detected in the blood and its concentration measured, the sooner levels can be tracked serially over time and so provide valuable information about the effectiveness of implantation, and the potential viability of the developing conceptus.
    There are a few important points that should be considered when it comes to measuring interpreting blood hCG levels. These include the following:
    • All modern day blood (and urine) hCG tests are highly specific in that they measure exclusively for hCG. There is in fact no cross-reactivity with other hormones such as estrogen, progesterone or LH.
    • Post conception hCG levels, measured 10 days post ovulation or egg retrieval can vary widely (ranging from 5mIU/ml to above 400mIU/ml. The level will double every 48–72 hours up to the 6th week of gestation whereupon the doubling rate starts to slow down to about 96 hours. An hCG level of 13,000-290, 0000 mIU/ml is reached by the end of the 1st trimester (12 weeks) whereupon it slowly declines to approximately 26,000– 300,000 mIU/ml by full term. Below are the average hCG levels during the first trimester:
    o 3 weeks LMP: 5 – 50 mIU/ml
    o 4 weeks LMP: 5 – 426 mIU/ml
    o 5 weeks LMP: 18 – 7,340 mIU/ml
    o 6 weeks LMP: 1,080 – 56,500 mIU/ml
    o 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
    o 9 – 12 weeks LMP: 25,700 – 288,000 mIU/ml
    • A single hCG blood level is not sufficient to assess the viability of an implanting embryo. Caution should be used in making too much of an initial hCG level. This is because a normal pregnancy can start with relatively low hCG blood levels. It is the rate of the rise of the blood hCG level that is relevant.
    • In some cases the initially hCG level is within the normal range, but then fails to double in the ensuing 48-72hours. In some cases it might even plateau or decline, only to start doubling appropriately thereafter. When this happens, it could be due to:
    o A recovering implantation, destined to develop into a clinical gestation
    o A failing implantation (a chemical pregnancy)
    o A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
    o An ectopic pregnancy which will either absorb spontaneously (a chemical-tubal gestation), or evolve into a full blown tubal pregnancy continue and declare itself through characteristic symptoms and signs of an intraperitoneal bleed.
    • The blood hCG test needs to be repeated at least once after 48h and in some cases it will need to be repeated one or more times (at 48h intervals) thereafter, to confirm that implantation is progressing normally.
    • Ultimately the diagnosis of a viable pregnancy requires confirmation of the presence of an intrauterine gestational sac by ultrasound examination. The earliest that this can be achieved is when the beta hCG level exceeds 1,000mIU/ml (i.e., around 5-6 weeks).
    • Most physicians prefer to defer the performance of a routine US diagnosis of pregnancy until closer to the 7th week. This is because by that time, cardiac activity should be clearly detectable, allowing for more reliable assessment of pregnancy viability.
    • There are cases where the blood beta hCG level is extraordinarily high or the rate of rise is well above the normal doubling rate. The commonest explanation is that more than one pregnancy has implanted. However in some cases it can point to a molar pregnancy
    • Finally, there on rare occasions, conditions unrelated to pregnancy can result in detectable hCG levels in blood and urine. They include ovarian tumors that produce hCG, such as certain types of cystic teratomas (dermoid cysts) and some ovarian cancers such as dysgerminomas.

    I hope this helps.

    Geoff Sher

  • Maya - February 17, 2016 reply

    Dear Dr.
    First of all sorry for my pour English since it’s not my native language.
    I did IVF and embryo transfer was on 1/28/2016. My first beta was on 2/8/2016 59.9; 2nd 2/10/2016 103.1; 2/12/2016 159.9 and 2/15/2016 275.8
    What is your opinion since values are small and not doubling as it should?
    Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 17, 2016 reply

    This is a very slow rise. It could be a failing intrauterine implantation or a tubal (ectopic) pregnancy. I suggest you discuss this with your RE and be sure that he/she follows up with you.

    Geoff Sher

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