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

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.

2,823 Comments

Carla Langley

Hi Dr.
I had a miscarriage on the 14th December 2020 my last blood test was when I was having the miscarriage was 62 hcg. On the 4th January 2021 just had a feeling something was wrong g did a pregnancy test clearblue can out with 1 to 2 week. Did another one on the 5th January 2021 and it went up to 2 to 3 weeks so I thought I was pregnant again. Did another test over a week later still came out 2 to 3 weeks so was a little worried. Did another one couple of days later came out 1 to 2 weeks so was really worried booking in for blood test did do another for a few days after still was 1 to 2 weeks. I tested the morning of my blood test came out 2 to 3 week again so really confused my bloods come back 146 hcg booked in to have more done just wondering what your thoughts was.
Many thanks

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Samantha

i tested positive on jan 5th and got blood test jan 7th and hcg is at 45. the date of my last period was dec 8th but im not sure when i ovulated as my cycle is irregular. any thoughts on this?

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Astah Llabore

I had my FET last 12/14 and my 1st HCG check was 12/22 and it was 22. Then, I went back on 12/24 and the HCG went to 55. Last 12/27, I had too much cramping , bit of pain and spotting. I had my HCG test again last 12/24, and my HCG was 86. Though, I still have spotting today but now it looks more dark red. (few days were dark brown only). I’m going to have another HCG test tomorrow. Hoping for a good result, though!

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Tara

Hi Dr. Sher,

My first beta today was 501 11dp3dt. I did transfer two 6 cell and 8 cell with 20 percent frags. I’ve had a lot of quality issues. Thoughts on this high beta? Goal is a healthy singleton. Thanks!

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Katrina

Hi Dr Sher!
I just had my 2nd beta test today 12/28 and it came back at 117 the first beta was on 12/23 and it was 44.
What are your thoughts? I’m very nervous

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Dr. Geoffrey Sher

The rise is slow. Repeat in 2 days. It should be greater than 220U.

Good luck!

Geoff Sher

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Dr. Geoffrey Sher

On face value that looks good but it depends on what day the test was done and whether the level is rising appropriately!

Good luck!

Geoff Sher

Tara

Hi Dr. Sher, I just wanted to update. It is in fact twins. Both embryos took. Both look good on my 7w scan. Still adjusting to the idea. Thanks again.

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Tara

First beta 11dp3dt 501
Second beta 13dp3dt 1421.

I’m worried it’s 2 plus or a molar. Both day 3 embryos were from a cycle when I was 32. They were the only fertilized embryos from a duo stim cycle.

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Dr. Geoffrey Sher

It looks promising to me. Could be twins. Only time will tell!

I doubt it is molar…

Geoff Sher

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Sarah C

Day 5 embryo transfer (single embryo) on Nov. 29th, HCG levels on Dec. 11th were 946. This seems high to me – do I need to be concerned about a molar pregnancy?

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Win

My HCG at around 9/10DPO is 12 and progesterone is 25 – should I be worried? My RE says this is OK based on how early but I’m nervous based on a previous chemical. Thanks. Testing again on Friday at 13/14 DPO.

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Dr. Geoffrey Sher

It is a low level, but only time will tell. Repeat the hCG serially and ultimately do an US at 6-7 weeks.

Geoff Sher

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Mariana

Hello! I got an IUI on Oct 14th, then on Oct 30th my HCG was 52, on Nov 3rd, 99 and today 86. This means I’m loosing the pregnancy?

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cmg

Hi Dr. Sher,

I posted last week, but wanted to follow up. My first hcg (2 weeks post retrieval w/ 3dt) was 50. Then, 72 hours later, it went up to 174. My newest number, 96 hours later, is 1200. It’s currently doubling every 34 hours. Progesterone is 43 and estrogen is 339. Staying rational and partially optimistic – still nervous, though.

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AS

Hello, on 10/23 transvaginal US, Dr put this on my notes on my chart:
TVUS: small circular GS 0.44 x 0.66 cm
im not sure how far along i am right now. my hcg was 3,500 at that time.
My concern Since she put small sac, is that very small or nothing to be concerned about right now?

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Ammy

Hello doctors
My hcg at 4weeks 2days was 120
Then at 5weeks came at 93
Have no bleeding ..
I’m so worried now could it be ectopic
Or what
Thank you

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Dr. Geoffrey Sher

I doubt this is anything other than a chemical pregnancy. In my opinion, it is unlikely to be an ectopic!

Geoff Sher

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Ammy

Hello doctor
After my hcg went to 93 from 120 I had my transvaginal scan but she saw nothing …
What is your suggestion
Thank you

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Dr. Geoffrey Sher

Repeat the hCG test in 2 days. Hopefully it will double!

Good luck!

Geoff Sher

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cg

Had my first beta two weeks after retrieval (3 day transfer) and it was 50. Today, 72 hours later, it is 174. I’m trying to stay optimistic, but this seems promising?!

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Dr. Geoffrey Sher

It does look quite promising! However, only time will tell!~

Good luck!

Geoff Sher

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Julieann Yerks

I messaged before about my hcg levels. My newest level went from 29 to 47 in 58 hours. I ha e another scheduled Fri. What number am I looking for? Also they rising accordingly, 60-65% but at what point do I get concerned that they are not high enough to visualize anything on I/s? Based on ovulation I’m 4w4d today

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Dr. Geoffrey Sher

The levels should double each time. Then at 6-7 weeks, an US will be definitive.

Good luck!

Geoff Sher

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Amber S

Hello Dr,
Aug 31st I started to miscarry.
10/22 found out I was pregnant and unsure how far along we are. Had Blood HCG levels 3,543
10/23 had TVUS Dr did only see small gestational sac. progesterone level 7.5 but dr order me to take progesterone suppositories’ as I have 3 miscarriage. (2 this year)
10/26 Dr reorder Blood HCG – level is now 11,590. Nurse order me to go next Friday Nov 6th for US.
My question is from my first HCG to the second HCG (thurs to Monday) is that high rise in HCG good or concern? Also is it a concern that a small sac only was seen?

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Dr. Geoffrey Sher

It is +ve but it needs to double every 48h. Repeat the test in 2 days.

Geoff Sher

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AB

Hello Doc
My hcg and progesterone-
3w2d- 88; progesterone 34
3w6d-1152; progesterone 30
4w6d-23347; progesterone 41

Does it look normal or high at early pregnancy?

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Emily Brodersen

Hi Dr.
Here’s my story im 29 with PCOS and this is my second IUI

10/3 monitoring app. Showed 21, 19, 18, 17, 17 and 4 to 5 more around 15mm. Triggered
10/4 IUI
10/18 positive test spoting when wipe
10/19 HCG 30 spotting turned heavy at night progesterone 10.6 and estrogen 58 started estrogen patch and 1 shot of progesterone that night
10/20 very light flow called they had me do a morning shot of progesterone, passed a clot about 2 pm. Called said to still do shot and come in. Bleeding slowed to spotting
10/21 HCG 36 progesterone 21 said to continue 2x a day progesterone
10/22 light spotting did need a liner
10/23 spotting at night with cramping
10/24 no blood
10/25 spotting with cramping in the evenings
10/26 no bleeding HCG 246

They said abnormal pregnancy. Not sure what that means. No bleeding yet today. RE thinks I lost one of multiple in the start of all this. I am 4w5d today and they want to do an ultrasound at 5w5ds. Does this sound ectopic? After the clot passed my pregnancy tests have gotten darker and darker.

Thank you for your time and helping me understand what’s going on.

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Dr. Geoffrey Sher

Vaginal bleeding occurs in about 25% of all pregnancies. When it happens, it almost invariably raises the concern of pregnancy loss (miscarriage). Bleeding can also be a sign of a tubal (ectopic) pregnancy, and in cases where the distended Fallopian tube ruptures it can precipitate a life-threatening crises. However, a small amount of painless vaginal bleeding can also be the result of normal embryo implantation (i.e. implantation bleeding) or it can result a local erosion of the vagina or cervix and/or trauma during intercourse.

Geoff Sher

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Emily B

Hi Dr.

I am 29yo I got a positive on 10/8/2020 with IUI. Folicule scan day of trigger was 21, 19, 18, 17,and 17mm folicules plus 3 or 4 close the the 15mm mark.
10/19 my batas came back 30. With progesterone at 10.6 and estrogen at 58. They started me on the patch for estrogen. And progesterone shots since i was already doing suppositories. I started some heavy spotting that night turing into a very very light flow Tuesday. They told me to start 2x a day progesterone. I passed a nickel size clots that afternoon.

I went in for batas 10/21/2020 my progesterone was at 21 they didn’t give me estrogen numbers and my HCG was 36.

10/26/2020 I went in for another blood draw and had 246 for HCG.

They told me this was classified as an abnormal pregnancy. Should I be worried going into my 5w5d ultrasound in 11/2?

Does this sound like ectopic? Should I prepare myself for bad news?

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Dr. Geoffrey Sher

I am not pessimistic here. Wait for an US at 6-7 weeks. It would not surprise me if all is well!

Good luck!

Geoff Sher

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Julieann Yerks

Are these numbers adequate?
9/10 Dpo hcg 4 progesterone 9.5
11/12 dpo hcg 11 progesterone 8.6
14/15 dpo hcg 29 progesterone 16.2

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Julieann Yerks

My hcg was
4 @ 10 Dpo
11@12 dpo
29@15 dpo
And progesterone was
8.6 @ 12dpo
16.2@15dpo
My doctor will call me tomorrow, but what do you think is going on? Chemical? Possible ectopic? Or a possiblity it’s a normal show rising pregnancy

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Julieann Yerks

Follow up hcg today 47 and progesterone 16.8.
I’m scheduled for more blood work Fri. What should that number be? Also when do I get concerned that the level isn’t high enough to see anything on I/s. I’m 4w4d based on ovulation 5w1d based on lmp

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Dr. Geoffrey Sher

Based on the date of last period onset…you should have the US at 6-7 weeks!

Geoff Sher

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Dr. Geoffrey Sher

It is on the low side. However, repeat in 2 days to see if it doubles. Then an US at 6-7 weeks will be definitive.

Good luck!

Geoff Sher

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Alex

Hello,

These were my latest HCG
23 days post 5 day transfer – 19149
26 days post 5 day transfer – 28160 (we saw a heart beat on this day)

This also began as a twin pregnancy and now there is just one. Does this look OK even though it’s not doubling?

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