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.

2,478 Comments

Stephanie

Hello! History of recurring losses and just looking to see if I can be hopeful or if I should prepare myself.

LMP 8/14/20
Beta 1 – 9/15/20 4933 (around 12 pm)
Beta 2 – 9/17/20 7846 (around 10:30 am)

Progesterone 1 – 7.41
Progesterone 2 – 15.70

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Hayley McGurgan

Hello Doctor. I have an unexpected pregnancy with the mirena iud. My hcg level was 99 on tuesday, but 85 yesterday. I’m going for another blood test tomorrow and while I know the outcome doesnt look good is it possible it may still be viable? It was a shock but a lovely one and this is our last chance as husband had a vasectomy a week ago.

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Emily

Hi Dr Sher,
I am 5 weeks 4 days pregnant. I had some bleeding/dark brown discharge last week and my GP advised me to get HCG blood tests done. The results:
9/9/2020 – 1485
11/9/2020 – 2824
14/9/2020 – 7261
16/9/2020 – 11604
My HCG doubling rate has slowed down and is more than 48 hours, do you think I should be concerned?
I have booked a private scan on 24/9/2020 for reassurance.
Many thanks

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Dr. Geoffrey Sher

The rise in hCG levels slows don after 5000.

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.

Good luck!

Geoff Sher

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Kimmy Bunch

Hi Doctor Sher,
I am currently 5 weeks and 5 days into my pregnancy. We found out at 8 DPO because we had been trying to catch the first egg which happened when I was just over 15 months pp. The same night I found out I had some dark brown blood mostly when I wiped along with chunks, maybe lining? It went on about 48 hours and some of it was bright red. Due to this my OB ordered a blood test. 10 DPO my HCG was 8 and 12 DPO it was 32. Due to pregnancy tests not getting dark they ordered another blood test at 18 DPO which was still 32. 24 DPO my level had gone up to 114 and was tested again today (2 days after last test) my HCG is 200. I had an ultrasound done 2 days ago too that didn’t show anything yet. I have had a slight pain in my right groin area and some slight pain in my mid left abdomen. My neck has been a little stiff the past day or so too. Is it still possible to have a healthy pregnancy or most likely an ectopic?

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Dr. Geoffrey Sher

It is too early to say. Give it about 2 weeks and do another US. In the interim, be on the look out for sudden pain or bleeding and if this occurs, seek urgent medical care immediately.

Good luck!

Geoff Sher

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Kimberly Bunch

After another 48 hour wait my HCG only rose to 310. Waiting on my OB to call me to see what the next step is. But devastated because I believe it is an ectopic pregnancy.

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Rebecca Kidd

Hi Dr. Geoffrey,
at 9 dpo my Hcg was 9
14dpo – 28 Progesterone – 23
16dpo – 45
20dpo – 96 Progesterone – 16
I chart my cycles based off my BBT so I know I found out extremely early. My doctor told me there is nothing to worry about as some women take the full 72 hours to double. I have mention my concerns about progesterone to him as well and he told me my levels are fine. However, I have been on 100mg of Prometrium since 7dpo. I have had 2 previous losses prior to this and they were before 5 weeks. I’m worried this could be an ectopic pregnancy because of how low my HCG is.

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Dr. Geoffrey Sher

This is a slow rise and is not promising. Indeed your RE should also be on the look-out for an ectopic pregnancy!

Geoff Sher

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AG

Hello Doctor,
I had my 3rd day ET on 31st August, and I checked my HCG level on 12/09 they were 28.64. Doctor asked me to check again in 48 hrs, which I did on 14/09 and levels were 37.51. Can I still cling to any hope?

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Dr. Geoffrey Sher

Unfortunately, this is not very promising! Recheck the beta in 2 days.

Good luck!

Geoff Sher

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Michelle

I had a transfer on the 1st of September. Today I had an hcg test that came back as 74. The nurse said to be aware it was on the low side. Progesterone was 36.8. What’s your opinion? Nervous it’s not high enough.

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Sarah S

Hi Dr.,

Levels as follows:
17 dpo: 499
48 hrs later 1025
44 hrs later 1733

Thoughts on viability?
Thank you!

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Dr. Geoffrey Sher

I am optimistic that all will be well! Do an US in a week from now for confirmation.

Geoff Sher

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Ali Rodriguez

Hello there! I just received my beta levels after a 3 day frozen embryo transfer and would love to know what you think.

11 days after transfer – 1018
13 days after transfer – 2400

Could this be twins? Thank you!

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marie

I was tested for pregnancy 8/24 because I had an procedure that put me under and test was negative. 9/5 my test showed positive I was able to get into doctor to get blood done due to history of miscarriages. 9/9 my blood was then and my hcg was 12,657 and progesterone 9.5. They haven’t done repeat labs but im wonder why level are high when the 8/24 test was negative

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Dr. Geoffrey Sher

It means you conceived after the 1st test!

Your progesterone may be on the low side. Talk to yourvtreating doctor re supplementation

Good Luck!

Geoff Sher

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Kat

Hi Doctor:

My levels went from 127, to 202, 300, and 427 (each 48 hours in between.) Then, 4 days later, it went up to 1417, and then a week later, 4296.

At around the 1000 hcg mark, they saw a gestational sac and a tiny yolk sac.

My percentage rises have been: 59%, 49%, 42%, 55%, and 37% – perhaps the last one took longer to rise because HCG is higher?

Is there any hope here? Going in for an ultrasound on Monday and just heartbroken.

Kat

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Dr. Geoffrey Sher

I suggest a repeat US in 1 week to ascertain whether there is a viable conceptus.

Geoff Sher

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Kathy

Hi doctor. I just came home from my ultrasound. The baby’s heartbeat is 152 but he is measuring behind, a week! Is this worrisome?

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Ann

Hi Dr. Sher,

Thank you so much for all of the time you devote to your website and answering blog comments! I have found it to be a wonderful resource, as I am sure many others have as well.

I was hoping you could give your thoughts on my early hCG levels. They were more than doubling at first but seemed to have slowed.

13 dpo – 96
15 dpo – 248
19 dpo – 1671
23 dpo – 4038
27 dpo – 8972

Do you think there is still a chance of this being viable? Could the low rise have been caused by a vanishing twin? I will be having my hCG checked again at 30 dpo. What level should I hope to see?

Thank you so much!

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Dr. Geoffrey Sher

I do believe this will turn out to be a viable pregnancy. I hope I am right!

Good luck!

Geoff Sher

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Jolene

Doctor,

My hcg levels have been trending up appropriately after transferring 2 embryos from an IVF cycle, until now. I was up to 1195, then two days later it plateaued at 1194. I’m scheduled for a repeat test tomorrow. My doctor said this could be from one of the two embryos failing. Any thoughts? Is it possible that we still have one, or unlikely? Thank you.

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Dr. Geoffrey Sher

It is possible. You will need an US in about 1 week to determine if one viable pregnancy is present.

Geoff Sher

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