IVF Pregnancy with a “Vanishing Twin”

Today, in first world environments where there is ready access to advanced medical technology, many women undergo ultrasound diagnosis of pregnancy as early as 5-6 weeks after their last menstrual period. As a result, multiple pregnancies are often recognized very early on. Serial ultrasound follow-up examinations performed in such cases have shown that often times one of the developing babies subsequently “mysteriously” vanishes while the remaining, surviving conceptus (baby) proceeds to a healthy birth. Since most multiple gestations comprise of twin pregnancies, the term “vanishing twin” has emerged as the term to describe this situation. While in most cases the vanishing of a twin is associated with an innocuous small bleed, this is not invariably the case.In fact, in many cases the disappearance of the conceptus goes undetected without there being any bleeding or other symptoms at all.

The incidence of spontaneous pregnancies resulting in twin births is about 1:80. But what many fail to appreciate is that about one in 10 spontaneous pregnancies start off as twins but as the pregnancy advances into the 1st trimester and beyond, one twin will “vanish” (absorb) while the other will continue as a healthy, unaffected singleton. The incidence of multiple pregnancies increases in women with absent or dysfunctional ovulation, who takes fertility drugs. In fact the incidence of multiple pregnancies in such women under 35 years of age who are treated, treated with Clomiphene and Femara is about 1:20. In similar women using injectible gonadotropin fertility medications the incidence is about 1:4-5, while women (regardless of their ovulatory status) who receive fertility drugs in preparation for IVF (where multiple embryos are usually transferred), the current incidence is about 1:3 to 1:4.

When with a multiple pregnancy, the occurrence of painless mild bleeding is followed by ultrasound evidence that one is “absorbing” or “vanishing” often evokes understandable alarm raising several concerns and questions:

Q : Am I destined to lose both concepti and miscarry?

A: The bleeding results from the absorption of one of the pregnancies and since the vast majority of twin pregnancies have separate and independent placentas; the loss of one will accordingly usually not affect the remaining twin. As long as the bleeding remains mild and she does not experience an increase in cramping and pain over a period of a few days, the pregnancy will probably not be lost. In fact, in the majority of such cases, this is precisely what happens!

Q: How long will I continue to bleed?

A:In most cases unless the remaining conceptus is also abnormal and thus destined to miscarry, the bleeding will remain slight, painless, and will usually stop within a week or so. However, this will depend on when the one twin succumbed. If it occurred late in the first trimester the bleeding could last longer (even for a few weeks) than when the pregnancy is lost earlier. It should be borne in mind however, that the loss of one conceptus (the “vanishing twin”) might not be accompanied by any bleeding at all In effect they might absorbs the one twin without symptoms and with no outward indication of the loss.

Q. How will the loss of one twin affect the surviving one?

Answ: In the majority of cases, the other conceptus usually progresses, unaffected, onto a healthy birth.

Q: Will there be any residual evidence of the “vanished twin” detected at birth?

A: Usually not! Sometimes a small area of scarring or “thickening” of part of the placenta will be seen. However, this will usually only occur in cases where the one conceptus succumbed late in the first trimester (10-12 weeks) or in the 2nd trimester. In rare cases where a baby is lost later in pregnancy. It might not absorb completely and be expelled with birth of the surviving baby (“fetus papyraceus”).

Q: Could the “vanishing” of one twin have been prevented — Did I do something wrong?

Answ: The vanishing twin is neither parents fault. In most cases the conceptus twin is lost because it is chromosomally or genetically abnormal. Since many “vanishing twins” are lost very early in pregnancy, before most women would have undergone a diagnostic ultrasound, most cases go undetected and the woman would have no knowledge that she had been carrying more than one conceptus. In fact as stated above, many more of us begin life as twins than was previously thought.

“Vanishing” concepti can also occur in high order multiple pregnancies (triplets or greater). In such cases the pregnancy could reduce from triplets to twins or even a singleton or even from a higher number downward. Since the incidence of multiple pregnancy as well as high order multiples are most common after IVF where several embryos are often deliberately transferred to the uterus, the incidence of a conceptus “vanishing” is greatest with IVF.

Regardless of the genesis of multiple gestations, individuals and families who experience the “vanishing” of a conceptus will often experience anxiety and even panic when bleeding starts and a sense of relief when it finally and  they learn that the remaining conceptus and the pregnancy have survived. However, in most cases there will inevitably be an accompanying sense of profound loss, sadness and even grief, especially in cases where prior ultrasound examination had spelled the “promise” of a multiple birth.

63 Comments

Radhiya Minty

Hi!! I’m 29 years old and pregnant. At 4 weeks my hcg was 4666 and then 8668,not quite doubled. So my obgyn called me in for a scan where we saw 2 gestational sacs, one larger than the other and she diagnosed vanishing twin. Hcgs in week 5 were 14053 and 19998 48hours apart, still not doubling. She decided we wait till 7 weeks to do 2 more Hcgs and a repeat ultrasound. The Hcgs were now 68000 and then 54000, so actually declining. In the ultrasound we saw one sac with a Fetal pole and a heartbeat of 140bpm. We saw another tiny sac with a pole and no heartbeat. She said she felt reassured and doesn’t feel the need to do more hcgs. I keep wondering why it dropped and what if it’s currently dropping. Do you think there is reason to worry?

reply
Dr. Geoffrey Sher

once hCG levels rise above 5,000, they often stop doubling every 48h.

No! I think things will work out fine!

Good luck!

Geoff Sher

reply
todd

Could my wife have vanishing twin syndrom with her first hcg being 400 at 4 weeks and 3 days or is that to low to be a multiple?

reply
todd

My wife has done 3 ivf transfers, one fresh two frozen. The first fresh cycle didnt work, the second resulted in a miscarriage at week 6. The second transfer had an initial hcg of 57, our current frozen embryo was transfered on the 11th of June and after 13 days our first hcg reading was 400, our second hcg was 600, we go back tomorrow for our 3rd hcg reading, is this pointing towards another miscarriage?

reply
Dr. Geoffrey Sher

My thoughts are with you!

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 15y 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
e. Ureaplasma Urealyticum (UU) Infection of cervical mucous and the endometrial lining of the uterus, can sometimes present as unexplained early pregnancy loss or unexplained failure following intrauterine insemination or IVF. The infection can also occur in the man, (prostatitis) and thus can go back and forth between partners, with sexual intercourse. This is the reason why both partners must be tested and if positive, should be treated contemporaneously.
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?
______________________________________________________
ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Founded in April 2019, Sher Fertility Solutions (SFS) offers online (Skype/FaceTime) consultations to patients from > 40 different countries. All consultations are followed by a detailed written report presenting my personal recommendations for treatment of what often constitute complex Reproductive Issues.

If you wish to schedule an online consultation with me, please contact my assistant (Patti Converse) by phone (800-780-7437/702-533-2691), email (concierge@SherIVF.com) or, enroll online on then home-page of my website (www.SherIVF.com).

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Geoff Sher

reply
Todd

This is our second round of ivf, first one resulted in miscarriage, my wife had her first hcg check and it was 400, 48 hours later it was 600, we go back 2 days for another hcg check, she is having nausea, breast tenderness, light cramps every now and then, back ache, spotting here and there, she is 4 weeks 6 days. Since her first two numbers didn’t double does this point to another miscarriage?

reply
Dr. Geoffrey Sher

The next hCG test will provide more information. The level, 48h after the last test should be >1200.

Ultimately, an US done at 7 weeks will be definitive.

Good luck!

Geoff Sher

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Anna

At 3 weeks 2 days I had a hcg of 211 which is so high! 48 hours later hcg is up but not doubled (282). Possible vanishing twin?

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Dr. Geoffrey Sher

Could be…but it will take an US at 6-7 weeks to tell!

Good luck!

Geoff Sher

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Koshiga

Hello!

My hcg levels started off 59,195,613,1180 every 72 hours. I went to ER for some cramping and brown spotting where hcg was 1280. U/s was done and 2 avascular fluid filled areas were seen (1.4×1.3×0.4cm and 1.9×1.2×0.9cm) however no definitive gestation sac. Then it rose to 1400 3 days later and dropped to 1290 an hour later (at different labs). Again ultrasound was done and they saw a gestation sac measuring 5.8 weeks with probably yolk sac along with a subchorionic hemorrhage. Does this sound like a vanishing twin? I am so confused and don’t know what to think. Can a sac show up 3 days later with fluctuating hcg?

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Dr. Geoffrey Sher

This could be a vanishing twin or a “compromised” implantation. A repeat US in 1 week should be definitive.

Good luck!

Geoff Sher

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Shannon Smith

Hello,

We had a great rising HCG < 48 hours up until this weekend where it slowed considerably at about 6 weeks. I'm wondering if this means impending miscarriage or if it could be due to a vanishing twin:

DPO14 141
DPO17 541 Doubling of 37.1 hours
DPO18 764 Doubling of 48.2 hours
DPO20 1,714 Doubling of 41.2 hours
DPO25 11,876 Doubling of 43.0 hours
DPO28 17,869 Doubling of 122.2 hours

reply
Dr. Geoffrey Sher

It looks promising to me. Remember, the rate of the rise in hCG level slows down after goes above 6,000.

Good luck!

Geoff Sher

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Yasmin

Hello,
My hcg at 5w0d was 6,914 then 11,293 at 5w2d then 12,300 at 5w5d. I was told these levels were high for how far along I am, but now i’m super concerned because they’re nowhere close to doubling. Please Advise!!!

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Sophie Croutear

Hello,

I have been having regular early ultra sounds which have shown 2 sacs but only one has ever been seen with an embryo/ Fetus).

Baby one is showing on track and normal for 10 weeks the other is confirmed blighted ovum.

Does this constitute as vanishing twin?

Is there an increased risk of birth defects for the baby?

Thank you

reply
Dr. Geoffrey Sher

The blighted sac should absorb without consequence and NO…there should not be an incease in the risk of a birth defect. whether to do prenatal genetic testing should be based on age, family genetic history and other unrelated criteria.

Good luck!

Geoff Sher

reply
Dr. Geoffrey Sher

After hCG levels reach 4,000-5,000 the rise slows down. I suggest you have an US done for confirmation of viability.

Geoff Sher

reply
Ashley

Hello, I had an ultrasound yesterday (5w4d) showing one well formed gestational sac with yolk sac (no fetal pole) and one that was irregular ( looked collapsed) with no yolk. I assume this is a vanishing twin and my main concern is that my hcg at 21dpo was 9565 and at 23dpo only 12661. I have been more than doubling all the way till now. I also had one day of bleeding day 22dpo which has since stopped.

Do you think the entire pregnancy is compromised or could this slow and increase be from the vanishing twin and the levels are leveling out now?

reply
Dr. Geoffrey Sher

I would do a repeat US in 10 days for a definitive answer.

Good luck!

Geoff Sher

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Lisa

I am 5.5 weeks with 2 gestational sacs (one contained a YS at 5 weeks The other was smaller and nothing inside). My HCG was 5900 at 24 hours after my ultrasound, Doubling every 1.5 -2 days up until then.
3.5 days later my hcg only goes to 9900, moderate increase but not doubling. Does this look like a potential vanishing twin or would there be more likelihood of both pregnancies ending?

reply
Dr. Geoffrey Sher

It could be such. However, 5.5 weeks is really too early to make a confident US assessment. Repeat in 7-10 days.

Good luck!

Geoff Sher

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Shaina

I had my et on 11 th September with 2 blasts..! 14 days post et upt was positive and hcg was 840.. 2 days later hcg was 1240( not a good rise..) then again 2 days later it was 1500( again not a good rise) . I am experiencing all symptoms of pregnancy..and there is no cramping no spotting..! But my hcg levels are not doubling and are weird.. Can it be a vanishing twin thing.,? Please help..!

reply
Dr. Geoffrey Sher

It could be a vanishing twin. I would have an ultrasound examination done.

Geoff Sher

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Shaina

Thanks..! I got my 1st usg done.! It shows intrauterine gestational sac and yolk sac at 5 1/2 weeks of pregnancy..!

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Shaina

Thanks..! Is there still any hope..? Bcoz my doc was saying chances are only 1percent..!

Dr. Geoffrey Sher

Sorry Shaina, I lost the thread! You would need to re-post the original question along with this one.

Geoff Sher

Shaina

I had my et on 11 th September with 2 blasts..! 14 days post et upt was positive and hcg was 840.. 2 days later hcg was 1240( not a good rise..) then again 2 days later it was 1500( again not a good rise) . I am experiencing all symptoms of pregnancy..and there is no cramping no spotting..! But my hcg levels are not doubling and are weird.. Can it be a vanishing twin thing.,? Please help..!
U replied
Get an usg done
My usg is showing gestational sac and yolk sac at 5 1/2 weeks..of pregnancy..!
U replied
Gud luck..! Get a scan done in 1-2 weeks
Now my question is :- is there any hope, as my doc was saying chances are less..!
Thanks ..!

Dr. Geoffrey Sher

The chances are guarded but it is possible that it is a viable pregnancy.

Geoff Sher

Shaina

Hi i got my ET done on 11thsep day 5 blast transfer . My first hcg value was 843 on 25th sep , subsequent values were 1230 on 27/9 , 1543 on 29/9 , 2343 on 4/10 . So the hcg is not doubling and rising as it should be . So i got a scan done on 5/10 which showed a gestational sac with a yolk sac on roughly 5 and a half week . My doc has asked me to repeat a scan after 10 days but she says chances are very less as hcg is not rising appropriately. So can you pls tell that is everything ok or is there anything to be worried ?

Dr. Geoffrey Sher

Thew prognosis is guarded based on this attenuated rise in hCG. However, only an ultrasound in about 10 days from now can offer definitive information.

Sorry!

Geoff Sher

Shaina

Hello doctor.. usg at 6 weeks 5 days shows fetal pole, fetus with crl 7 mm, and a heart beat which was 95 initially but in fraction of seconds it increased to 115.. Doc was saying heart beat is too feeble and flickering.. Is there any hope..?
Thanks..!

Dr. Geoffrey Sher

Shaina,

Unfortunately only time will tell. If the HB is normal in a week from now, it could be fine.

Geoff Sher

Dr. Geoffrey Sher

It could be a vanishing twin, bur if so, your next beta hCG …2 days from the last one, should be around 2,000.

Please keep me in the loop!

Geoff Sher

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Ramy

I had a hcg level of 333 at first which on 48 hours increased to 442 which is less than 35% and then 442 reduced to 249 in next 48 hours. Could you tell me ifthis us a miscarriage?..Not yet experienced any vaginal bleeding except for mild cramps in abdomen

reply
Dr. Geoffrey Sher

Unfortunately, this sounds like a failing implantation. I hope I am wrong but I do not think I am.

G-d bless!

Geoff Sher

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Ethan

Dr. Sher we transfered a single embryo and at our 6week ultrasound we found one sac with a healthy heart beat and a second sac that was empty! Is this considered a VT? And if so does that mean a grim prognoses for the sac with the baby that has a heart beat?

reply
Dr. Geoffrey Sher

If the one baby is healthy and viable, it should not be lost due to the other being a blighted ovum. BUT only time will tell!

Good luck!

Geoff Sher

reply
Stephanie

Hello I am 5 weeks and 6 days today according to my calculations. I had hcg levels 127 then 636 then 1276 then 3500 then they dropped to 3400. Had an ultrasound today that showed two sacs. Neither had a fetal pole. They said twin pregnancy vs possible bleeds. I’m have my levels checked in a couple days again to see how they are trending. Is it possible for both sacs to be blighted ovum?

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Eve

my first ultrasound at 5 weeks showed one sac, my second ultrasound at 5 weeks 6 days showed a second sac but MD stated its empty and called the sac a vanishing twin. Is there a possibility medically for the second sac to still grow and i have twins?

reply
Dr. Geoffrey Sher

5-6 weeks is a little early. I would advise repeating the US at 7 weeks.

Geoff Sher

reply
dan

We did IVF & are 10weeks pregant. There was vanishing twin. What are our options for testing for genetic disorders for the fetus that is progressing normally? I’ve read the blood work that would normally be done to test for genetic disorders can give a false positive result due to the vanishing twin. Thank you for any info you can provide.

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Dr. Geoffrey Sher

Blood work is quite good but in my opinion, CVS now or amniocentesis in a month or so is the way to go!

Good luck and G-d bless!

Geoff Sher

reply
Nana22

We had 3 embryo transferred Via IVF. hCG level was 276 then 1930 then 4216 then 5809 however 4 days after the last hcg of 5809 my hcg dropped to 4400. 2 days before the hcg drop.. we had a scan with one sac found… a fetal crl 2.1mm with cardiac activity gestational sac 9mm and i was measured at 5 weeks 5 days… im worried that my hcg fell… however is this because of vanishing twin… please advise…

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Dr. Geoffrey Sher

You possibly started with >1 baby and have reduced down to one. This could explain the slight drop in hCG.

Good luck and be safe!

Geoff Sher

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Betsy palmer

Hello
I wonder if you can help me. It’s been confirmed that although I started with a twin pregnancy only one of the fetus had a heart beat ( the other one has a fetal pole and appears to have grown from 8mm to 12mm in the last week). The healthy fetus is the right size of 8 weeks 2 days. Is it more likely that the fetus will be absorbed by the body or that I will miscarry? Thank you

reply
Dr. Geoffrey Sher

It is more likely that the healthy one will survive and develop appropriately.

Geoff Sher

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Tracie Futterman-Alvarez

Two things-Is it true that eggs go through a 3-4 month cycle so anything you change (Adding CoQ10, change in diet-more protein to gain weight, change in exercise, acupuncture, etc) will not affect egg quality if you are doing an IVF cycle that next month or two?
I am 33, with normal AMH and FSH but had one IVF with only One normal blast and it didn’t implant, second IVF, high responder with 14 fertilized but no genetically normal blasts out of 5, and now doing a third IVF with 16 fertilized awaiting day 5 results then PGS results.
How would you explain poor quality for my age and normal reserve/levels?
Protocol for IVF 1 was a study, so only stimmed with menopur, then ganerlix, then HCG trigger
Protocol for ivf 2 and 3 was gonal F/follistim with low dose HCG to stim then ganirelix, then lupron. trigger. This protocol for 2nd and 3rd time got me 17 mature eggs retrieved, then 20 mature retrieved.
Thanks!!
Tracie

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Dr. Geoffrey Sher

I cannot be sure, but one of the common reasons relates to the protocol used for ovarian stimulation (see below). I would need a great deal more information to comment authoritatively.

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.
• 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 Aproach
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
• Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
• Optimizing Response to Ovarian Stimulation in Women who Have Compromised Ovarian Response to Ovarian Stimulation in Women who Have Compromised Ovarian Reserve: A Personal Approach.
• 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
• Why did my IVF Fail
• Preimplantation Genetic Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
• Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
• PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
• PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
• 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:
• Traveling for IVF from Out of State/Country–
• 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

reply
Christine

Vanishing twin
I can’t understand why I have lost one of my twins they said it wasn’t growing but never told me there wasn’t a heart beat I am having another scan in 3 weeks time but I am scared there going to say both have gone

reply
Mika Lowry

Hi Dr. Sher:
I transferred two embryos & found out at 6 weeks that I was pregnant with twins. At 7 weeks, we only heard Baby A’s heartbeat. We could see that Baby B had a flickering heart, but when we would zoom in to listen to it, it sounded static. Still, they both measured the same size and were growing. Beta on this day was over 18,000+. Would seeing a flickering heartbeat and hearing it both be a good sign in your opinion? Or does this most likely mean a VT? Next ultrasound is not for another 10 days and I’m worried every day. I’ve heard one twin may not be heard until the following week, crossing my fingers that’s true in my case.

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Mila

I meant would seeing a flickering heartbeat but not hearing it* still be a good sign..

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Mika Lowry

Thank you so much! Is it common with twins that we hear one sooner than the other?

Dr. Geoffrey Sher

I would regard the flickering HB as a “promising sign”!

Geoff Sher

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Aydde Hurtado

I has 2 5d frozen embryo transer done on 7/12/16 on 7/21 had my first beta hcg level of 11. On 7/33 my hcg level dropped to 4. My re and staff can only say it’s not a negative and we’ll see you on monday. Can you please explain what’s happening?

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Dr. Geoffrey Sher

Respectfully, this does not look promising Aydde,

So sorry!

Geoff Sher

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