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.

2,800 Comments

Yisraela

Hi,
I only got my hcg levels tested once at 6 weeks 3 days after LMP/29 DPO. My result was 45192.4. Is that normal? I don’t have earlier numbers to see the progression.

Thank you!

reply
Yisraela

Thanks for your quick reply!
Based on a lot of comments I’ve been seeing here, it seems that high hcg can be a sign of multiples or a molar pregnancy. Is my HCG considered high that these things can be likely?
Thanks for your help!

reply
Steph Pare

hello,
i am 35 with CML my po chemotherapy was stopped na di am being closely monitor went through IVF, had a 5 days embryo transfer on october 10 then on october 21st i have my first beta it was 21 on the 23rs it was 43 which double but on the 25th it increased but not double at 60 my last progesterone level is in the 30’s , no bleeding, but increased urination i will be repeating on the 27th my home pregnancy are positive and getting darker and darker, + on digital ones too, i do not know what to think should i ask for an early US technically as of today i am 5 weeks as of today… i am not too regular i ws on nuvaring , my last period was september 21st

reply
Dr. Geoffrey Sher

Unfortunately, an US prior to 6-7 weeks is not very helpful.

I wish you the very best!

Geoff Sher

reply
Hasel

Hello Dr,
My last period eas on Sept 7.
On October 3 prrgnancy test was barely positive, second line was so hard to notice.
10/5 HCG was 221,
10/9 hgc 640
10/13 hcg 797 and US showed 3mm gest sac
10/14 hcg 1063
10/15 US showed 6mm gest sac and hematoma
I was told i should expect mc and to come for 7 days if bleeding does not start
10/19 hcg 1656
No bleeding and US on
10/23 there was fetus crl 3mm with cardiac activity seen (5w and 5days per US).
I started with progresterone tablets 3×1 daily.
Next US is on 11/2
I had never had hcg levels checked with my first pregnancy. I am 37 yrs old, no MC before and one pregnancy 6yrs ago with a healthy baby.
Also with first pregnancy i was on clexane due to lower levels of placenta blood vessels trough cord.
Please let me know do you think this could be viable pregnancy due to beta low rise. My OB told me not to check hcg anymore since cardiac acitivity is seen.

reply
Dr. Geoffrey Sher

Hard to say. I suggest you wait 2 weeks and repeat the US!

Good luck!

Geoff Sher!

reply
Corrine Cullen

Thank u…do you think its a twin pregnancy by the results?
I’ve had 7 miscarriages and 2 rainbow babies so I’m hoping this goes well!

reply
Dr. Geoffrey Sher

It could be! However, please review the following:

When it comes to reproduction, humans are the poorest performers of all mammals. In fact we are so inefficient that up to 75% of fertilized eggs do not produce live births, and up to 30% of pregnancies end up being lost within 10 weeks of conception (in the first trimester). RPL is defined as two (2) or more failed pregnancies. Less than 5% of women will experience two (2) consecutive miscarriages, and only 1% experience three or more.
Pregnancy loss can be classified by the stage of pregnancy when the loss occurs:
• Early pregnancy loss (first trimester)
• Late pregnancy loss (after the first trimester)
• Occult “hidden” and not clinically recognized, (chemical) pregnancy loss (occurs prior to ultrasound confirmation of pregnancy)
• Early pregnancy losses usually occur sporadically (are not repetitive).

In more than 70% of cases the loss is due to embryo aneuploidy (where there are more or less than the normal quota of 46 chromosomes). Conversely, repeated losses (RPL), with isolated exceptions where the cause is structural (e.g., unbalanced translocations), are seldom attributable to numerical chromosomal abnormalities (aneuploidy). In fact, the vast majority of cases of RPL are attributable to non-chromosomal causes such as anatomical uterine abnormalities or Immunologic Implantation Dysfunction (IID).
Since most sporadic early pregnancy losses are induced by chromosomal factors and thus are non-repetitive, having had a single miscarriage the likelihood of a second one occurring is no greater than average. However, once having had two losses the chance of a third one occurring is double (35-40%) and after having had three losses the chance of a fourth miscarriage increases to about 60%. The reason for this is that the more miscarriages a woman has, the greater is the likelihood of this being due to a non-chromosomal (repetitive) cause such as IID. It follows that if numerical chromosomal analysis (karyotyping) of embryonic/fetal products derived from a miscarriage tests karyotypically normal, then by a process of elimination, there would be a strong likelihood of a miscarriage repeating in subsequent pregnancies and one would not have to wait for the disaster to recur before taking action. This is precisely why we strongly advocate that all miscarriage specimens be karyotyped.
There is however one caveat to be taken into consideration. That is that the laboratory performing the karyotyping might unwittingly be testing the mother’s cells rather than that of the conceptus. That is why it is not possible to confidently exclude aneuploidy in cases where karyotyping of products suggests a “chromosomally normal” (euploid) female.
Late pregnancy losses (occurring after completion of the 1st trimester/12th week) occur far less frequently (1%) than early pregnancy losses. They are most commonly due to anatomical abnormalities of the uterus and/or cervix. Weakness of the neck of the cervix rendering it able to act as an effective valve that retains the pregnancy (i.e., cervical incompetence) is in fact one of the commonest causes of late pregnancy loss. So also are developmental (congenital) abnormalities of the uterus (e.g., a uterine septum) and uterine fibroid tumors. In some cases intrauterine growth retardation, premature separation of the placenta (placental abruption), premature rupture of the membranes and premature labor can also causes of late pregnancy loss.
Much progress has been made in understanding the mechanisms involved in RPL. There are two broad categories:
1. Problems involving the uterine environment in which a normal embryo is prohibited from properly implanting and developing. Possible causes include:
• Inadequate thickening of the uterine lining
• Irregularity in the contour of the uterine cavity (polyps, fibroid tumors in the uterine wall, intra-uterine scarring and adenomyosis)
• Hormonal imbalances (progesterone deficiency or luteal phase defects). This most commonly results in occult RPL.
• Deficient blood flow to the uterine lining (thin uterine lining).
• Immunologic implantation dysfunction (IID). A major cause of RPL. Plays a role in 75% of cases where chromosomally normal preimplantation embryos fail to implant.
• Interference of blood supply to the developing conceptus can occur due to a hereditary clotting disorder known as Thrombophilia.

2. Genetic and/or structural chromosomal abnormality of the embryo.Genetic abnormalities are rare causes of RPL. Structural chromosomal abnormalities are slightly more common but are also occur infrequently (1%). These are referred to as unbalanced translocation and they result from part of one chromosome detaching and then fusing with another chromosome. Additionally, a number of studies suggest the existence of paternal (sperm derived) effect on human embryo quality and pregnancy outcome that are not reflected as a chromosomal abnormality. Damaged sperm DNA can have a negative impact on fetal development and present clinically as occult or early clinical miscarriage. The Sperm Chromatin Structure Assay (SCSA) which measures the same endpoints are newer and possibly improved methods for evaluating.

IMMUNOLOGIC IMPLANTATION DYSFUNCTION
Autoimmune IID: Here an immunologic reaction is produced by the individual to his/her body’s own cellular components. The most common antibodies that form in such situations are APA and antithyroid antibodies (ATA).
But it is only when specialized immune cells in the uterine lining, known as cytotoxic lymphocytes (CTL) and natural killer (NK) cells, become activated and start to release an excessive/disproportionate amount of TH-1 cytokines that attack the root system of the embryo, that implantation potential is jeopardized. Diagnosis of such activation requires highly specialized blood test for cytokine activity that can only be performed by a handful of reproductive immunology reference laboratories in the United States.
Alloimmune IID, i.e., where antibodies are formed against antigens derived from another member of the same species, is believed to be a relatively common immunologic cause of recurrent pregnancy loss.
Autoimmune IID is often genetically transmitted. Thus it should not be surprising to learn that it is more likely to exist in women who have a family (or personal) history of primary autoimmune diseases such as lupus erythematosus (LE), scleroderma or autoimmune hypothyroidism (Hashimoto’s disease), autoimmune hyperthyroidism (Grave’s disease), rheumatoid arthritis, etc. Reactionary (secondary) autoimmunity can occur in conjunction with any medical condition associated with widespread tissue damage. One such gynecologic condition is endometriosis. Since autoimmune IID is usually associated with activated NK and T-cells from the outset, it usually results in such very early destruction of the embryo’s root system that the patient does not even recognize that she is pregnant. Accordingly the condition usually presents as “unexplained infertility” or “unexplained IVF failure” rather than as a miscarriage.
Alloimmune IID, on the other hand, usually starts off presenting as unexplained miscarriages (often manifesting as RPL). Over time as NK/T cell activation builds and eventually becomes permanently established the patient often goes from RPL to “infertility” due to failed implantation. RPL is more commonly the consequence of alloimmune rather than autoimmune implantation dysfunction.
However, regardless, of whether miscarriage is due to autoimmune or alloimmune implantation dysfunction the final blow to the pregnancy is the result of activated NK cells and CTL in the uterine lining that damage the developing embryo’s “root system” (trophoblast) so that it can no longer sustain the growing conceptus. This having been said, it is important to note that autoimmune IID is readily amenable to reversal through timely, appropriately administered, selective immunotherapy, and alloimmune IID is not. It is much more difficult to treat successfully, even with the use of immunotherapy. In fact, in some cases the only solution will be to revert to selective immunotherapy plus using donor sperm (provided there is no “match” between the donor’s DQa profile and that of the female recipient) or alternatively to resort to gestational surrogacy.
DIAGNOSING THE CAUSE OF RPL
In the past, women who miscarried were not evaluated thoroughly until they had lost several pregnancies in a row. This was because sporadic miscarriages are most commonly the result of embryo numerical chromosomal irregularities (aneuploidy) and thus not treatable. However, a consecutive series of miscarriages points to a repetitive cause that is non-chromosomal and is potentially remediable. Since RPL is most commonly due to a uterine pathology or immunologic causes that are potentially treatable, it follows that early chromosomal evaluation of products of conception could point to a potentially treatable situation. Thus I strongly recommend that such testing be done in most cases of miscarriage. Doing so will avoid a great deal of unnecessary heartache for many patients.
Establishing the correct diagnosis is the first step toward determining effective treatment for couples with RPL. It results from a problem within the pregnancy itself or within the uterine environment where the pregnancy implants and grows. Diagnostic tests useful in identifying individuals at greater risk for a problem within the pregnancy itself include:

Karyotyping (chromosome analysis) both prospective parents
• Assessment of the karyotype of products of conception derived from previous miscarriage specimens
• Ultrasound examination of the uterine cavity after sterile water is injected or sonohysterogram, fluid ultrasound, etc.)
• Hysterosalpingogram (dye X-ray test)
• Hysteroscopic evaluation of the uterine cavity
• Full hormonal evaluation (estrogen, progesterone, adrenal steroid hormones, thyroid hormones, FSH/LH, etc.)
• Immunologic testing to include:
a) Antiphospholipid antibody (APA) panel
b) Antinuclear antibody (ANA) panel
c) Antithyroid antibody panel (i.e., antithyroglobulin and antimicrosomal antibodies)
d) Reproductive immunophenotype
e) Natural killer cell activity (NKa) assay (i.e., K562 target cell test)
f) Alloimmune testing of both the male and female partners

TREATMENT OF RPL
Treatment for Anatomic Abnormalities of the Uterus: This involves restoration through removal of local lesions such as fibroids, scar tissue, and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.
Treatment of Thin Uterine Lining: A thin uterine lining has been shown to correlate with compromised pregnancy outcome. Often this will be associated with reduced blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil and possibly aspirin.
Sildenafil (Viagra) Therapy. Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
Use of Aspirin: This is an anti-prostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81 mg orally, daily from the beginning of the cycle until ovulation.
Treating Immunologic Implantation Dysfunction with Selective Immunotherapy: Modalities such as IL/IVIg, heparinoids (Lovenox/Clexane), and corticosteroids (dexamethasone, prednisone, prednisolone) can be used in select cases depending on autoimmune or alloimmune dysfunction.
The Use of IVF in the Treatment of RPL
In the following circumstances, IVF is the preferred option:
1. When in addition to a history of RPL, another standard indication for IVF (e.g., tubal factor, endometriosis, and male factor infertility) is superimposed.
2. In cases where selective immunotherapy is needed to treat an immunologic implantation dysfunction.
The reason for IVF being a preferred approach in such cases is that in order to be effective, the immunotherapy needs to be initiated well before spontaneous or induced ovulation. Given the fact that the anticipated birthrate per cycle of COS with or without IUI is at best about 15%, it follows that short of IVF, to have even a reasonable chance of a live birth, most women with immunologic causes of RPL would need to undergo immunotherapy repeatedly, over consecutive cycles. Conversely, with IVF, the chance of a successful outcome in a single cycle of treatment is several times greater and, because of the attenuated and concentrated time period required for treatment, IVF is far safer and thus represents a more practicable alternative
Since embryo aneuploidy is a common cause of miscarriage, the use of preimplantation genetic diagnosis (PGD), with tests such as CGH, can provide a valuable diagnostic and therapeutic advantage in cases of RPL. PGD requires IVF to provide access to embryos for testing.
There are a few cases of intractable alloimmune dysfunction due to absolute DQ alpha matching where Gestational Surrogacy or use of donor sperm could represent the only viable recourse, other than abandoning treatment altogether and/or resorting to adoption. Other non-immunologic factors such as an intractably thin uterine lining or severe uterine pathology might also warrant that last resort consideration be given to gestational surrogacy.
The good news is that if a couple with RPL is open to all of the diagnostic and treatment options referred to above, a live birthrate of 70%–80% is ultimately achievable.
I strongly recommend that you visit http://www.SherIVF.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

______________________________________________________
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).

PLEASE SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Sarah

Does seeing a heartbeat on ultrasound supersede betas? I had bloodwork that showed a decrease from 3200 (the week before) to 2200 on the same morning as we saw a heartbeat at 6w3d. Not sure which to follow

reply
Dr. Geoffrey Sher

The US is much more definitive. A repeat US in 1 week should be conclusive, one way or the other.

Geoff Sher

reply
Yasmina

What do you think of my betas? They are now so slow:
14 dpo-66
16-194
23-2078
25-3009
30-5213

The doubling time has no slowed to 6 days. Is miscarriage imminent?

reply
Dr. Geoffrey Sher

Not necessarily doom and gloom! Have a diagnostic US done ASAP.

Good luck!

Geoff Sher

reply
Sarah

Hi I got my first positive pregnancy test at 8dpo. It was a dark line and received a positive on the digital test.
At 11 DPO my HCG was 162 and at 13 DPO 482. Is this promising?

reply
Sarah

Does heartbeat via ultrasound Trump hcg levels?
We had a heart rate this am at 6w3d but then got a phone call that my hcg dropped significantly from last week (2200 today). My progesterone level is fine. Thanks!

reply
Dr. Geoffrey Sher

US confirmation of viability is the most important. However, given the drop in hCG, I suggest you repeat the US in 1 week.

Geoff Sher

reply
prichopra686

Hi Doctor Sher,

Hope you are doing well!!

I posted earlier as well that I have conceived triplets with IUI. I had my ultrasound yesterday at 7 weeks, below are the details from the ultrasound-
Fetus a – 12mm with heart beat 163BPM, 7w3d
Fetus b – 12mm with heartbeat 159BPM,7w3d
Fetus c – 6.6mm with heartbeat 144BPM, 6w4d
Fetus c is measuring small but doctor said it might be due to the angle of ultrasound, she suggested for an ultrasound after 2 weeks again but she doesn’t seem worried as all are doing fine with good heartbeat.
What are your thoughts on this?

reply
prichopra686

Hi Doctor Sher,

My doctor is also suggesting for fetal reduction as triplet pregnancy is very risky. What are your thoughts on this?

Honestly, I don’t want to do such thing.

reply
Ruwanthi

Hello Dr Sher,

I was wondering if you would take a look at my hcg levels.
28/09 12 dpo – 24
29/09 13dpo – 41
06/10 -1860
16/09 – 9056
So there was a slowing down in the doubling time in the last ten day period. I had a TVS on the 17/10 which showed a gestational sac measuring 5 + 5 weeks and a barely visible yolk sac. No fetal pole. (I thought I was 6 + 6 weeks at that point). I was asked to repeat the uss in 10 days.
On the 19/10 I had a repeat hcg which was 12 862. Doubling in roughly 96 hours. I read that hcg levels >6000 double in 96 hours or more. Is this normal. Do I have a hope based on my hcg readings.

Thank you so much.

reply
Dr. Geoffrey Sher

This looks promising but it is too early for asn US to be definitive. I suggest an US at 7 weeks.

By the way, the hCG level usually increases more gradually after it reaches about 5,000U.

Good luck!

Geoff Sher

reply
Ruwanthi

Thank you so much Dr Sher! This is my first pregnancy and I have been worrying ever since. Thank you for clarifying that hcg level rise is more gradual after a certain level. Everyone keep saying 48 – 72 hours and didn’t mention this slowing down. Thank you so much!

reply
Ruwanthi

Just a clarification as well the beta collected on the 16th was close to midnight so technically the 17th.
17/06 – 9056
19/06 – 12862

reply
Ruwanthi

Hello Dr Sher,
My repeat hcg on the 21/10 was 15506.
19/10 12862
17/10 9056
I’m fast losing hope. The ultrasound is booked for 7 weeks. But rate of the rise is slowing down fast. What do you think.

reply
Dr. Geoffrey Sher

At this stage the rate of rise can and often does slow down dramatically. Wait for the US.

Geoff Sher

Ruwanthi

Thank you for taking the time to reply Dr Sher!
The hcg was 15506 48 hours later (done on the 21/10). I’m actually losing hope.

reply
Natasha

Hi I did 3 home test all positive one said 2-3 weeks pregnant done blood test on the 14th oct and came back 35hcg done another test 16th oct came back 85hcg and done another test 19th and came back 161hcg got another test tomorrow 20th icy does this sound bad or okay if im so early?

reply
Dr. Geoffrey Sher

The rate of rise in hCG is slightly below ideal. At this point I would give measurement of hCG a break and then do an US in 2 weeks for a definitive answer.

Good luck!

Geoff Sher

reply
Blaine

History of 2 biochemical losses between 5 – 6 weeks.
Tested early this 3rd time and started lovenox, progesterone, and prednisone (4 days ago) as soon as I got a positive test.
First HCG =26
2 Days Later = 101
Would you say this is good news/on the right path?

reply
Betsy Gallion

Dr. Sher,
My hcg beta taken at my RE office on September 28 was 291 (progesterone 20.47) and more than tripled on October 1 to 2336. At 6 weeks 4 days, October 14 I visited my OBGYN and sonogram showed baby and heartbeat (125 bpm). However, my beta came back at only 5849 (progesterone 26.7). Should I be concerned? I would’ve thought my beta would come back more than triple since October 1.

reply
Dr. Geoffrey Sher

The US should be overriding and more definitive. Repeat it in 1 weeks to monitor growth and development.

Geoff Sher

reply
D

Hi Dr.
My first hcg 39 my second was 721 and my third is 1625 My Lmp was 9/10 I’m 19 days dpo should I be concerned

reply
Kimberly

Hi Dr Geoffrey,

I had emailed you early with some early betas. You were right, they were promising and revealed an embryo with a heart flutter at 6 weeks 0 days.

I’m now very anxious about my HCG.
On 10/9 hcg was 7,635 and on 10/17 it only rose up to 17,035. Does this suggest things are likely headed south??

Kim

reply
Dr. Geoffrey Sher

Not at all because after 5,000 (or so) the betas rise significantly more slowly.

Geoff Sher

reply
Dee

My first hcg was 39 five days later it was 721 two days later it was 1625 should I be worried

reply
Hope Rodriguez

Hi,
My hcg is not doubling (IVF transfer 9/24)
10/6: 322
10/8: 429 ( increase 32%)
10/10:566( increase 32%)
10/13: 1072 ( in 3 days increase 90%(30%per day)
10/15: 1762( increase 64.5% in 2 days)

The ultrasound did yesterday at 5 weeks and 4 days they only saw a gestational sac with 3D measurements: 4.7mmx 5.2mmx 4.3mm.

Do you think is a no viable pregnancy?
The told me if I want I can stop the meds or wait until my next ultrasound this 10/20. I
Don’t know what to do because my hcg is increasing but at the same time I want to be realistic with my situation.
Thanks for your time.

reply
Dr. Geoffrey Sher

Sadly, this does not look promising. I hope I am wrong!!

Do an US in 10days from now and you will no doubt have a definitive answer!

Good luck and G-d bless!

Geoff Sher

reply
Hope Rodriguez

Hi,
Even if it star slow (32% in 48hr) and the rise (64.5% in 48hrs).
Do you think it fail implantation?
I was thinking of doing the ERA test?
Do you suggest other test?

Thanks for your help

reply
Dr. Geoffrey Sher

An ERA test is not applicable. I suggest an US at 6-7 weeks for a definitive answer.

Good luck!

Geoff Sher

Amy J

Dr Sher,

I had FET on 9/27 of only one 5 day embryo. And here are my numbers

HCG – 195, Progesterone – 120 (10dpt)
HCG – 255 (12dpt)
HCG – 642 (16dpt)

Definitely slowing rising and I’m not very optimistic about the outcome (although the nurse said it could still happen). I will have anther beta done on 18dpt then ultrasound after 6 weeks. My question is, if it IS a viable pregnancy, what could be the cause of slow rising hcg? What could be the cause of progesterone being so high? This is our try for our second baby and with my first baby my progesterone was around 50 @10dpt. Both have same protocols of progesterone injections. Thank you so much!

reply
Dr. Geoffrey Sher

This is not a healthy rise in hCG and is very likely a failing implantation. I hope I am wrong in this!

Good luck!

Geoff sher

reply
Maria palermo

My HCG dpo 13 is less than 5 and today i am 16dpo still BFN

Should i give up?

Thank you

reply
Dr. Geoffrey Sher

I hope I am wrong but, it does not look as if this is a viable pregnancy!

Sorry!

Geoff Sher

reply
Maria

Hello Dr. Geoff
13 dpo – less than 5 hcg
17 dpo – bfn
Still on progesterone day 6 today. no signs of af, what can this be?

Thank you

Maria

reply
Giovanna

Dear Dr. ,
After an ICSI with transfer on October 1st, these were my HCG levels:

12 Oct – 50
14 Oct – 81
16 Oct – 112 (with prog. dropping from 12 to 10).

We stopped the medications and I started to take Letrozole.

There was no hope for a viable pregnancy, right? What should I expect next?

Thank you!

Gio

Dr. Geoffrey Sher

It does not look promising, I am afraid!

Sorry!

Geoff Sher

Leah

My first hcg was 81 and 77 hours later it was 125 should I give up hope ? Seems like my symptoms r gone15 dpo

reply
Dr. Geoffrey Sher

No! Do not stop yes. First repeat the hCG one more time (in 2 days).

G-d bless!

Geoff Sher

reply
Casey

Hello Dr. Sher,

I had my HCG levels checked after having spotting for two weeks. My initial level on 10/5 was 4,233 my second read On 10/7 was 4,038 showing a decrease. I had an ultrasound on 10/9 and was measuring accurately at 7 weeks with a 153 heart rate.

My doctor stated he feels it’s a 98% chance of miscarriage and had me retest hcg today 10/12 and again on Wednesday 10/14.

What would be your thoughts?

Thank you so much!

reply
Dr. Geoffrey Sher

Since there was a HB, I would wait a week and repeat the US.

Good luck!

Geoff Sher

reply
Sasha

Hi Dr.
I got a Beta done today at 10/12 and it was 52. I’m between 14-16dpo. Is that low?

reply
Dr. Geoffrey Sher

No that is in the normal range. Repeat in 2 days to see if it doubles!

Good luck!

Geoff Sher

reply
Evelyn

Hello,
I had FET of two embryos on the 14th of September. My betas were doubling great at the start but when they reached over 2000 slowed right down. They were:
23.09 – 9dp5dt- 134
25.09 – 11dp5dt- 324
30.09 – 16dp5dt – 2271
05.10 – 21dp5dt – 6761
So the doubling time between 16 days passed transfer & 21 days passed transfer had gone up to 76 hours. I’ve read online that once beta reaches over 1200 that it’s normal for it to take 72-96 hours to double Is that true?
I had a scan at 6 weeks exactly and it showed everything as it should be with a Gestational sac measuring 11mm and an embryo measuring 2.5mm with a heartbeat.
Should I be optimistic that this is viable or concerned about my betas slowing down?
I have bad morning sickness.
Thanks a lot for your help!

reply
Evelyn

Thank you so much for your reply! I’ve had a missed miscarriage before so more nervous than most. Your words are reassuring!

reply
Hayley Richardson

According to LMP I would be 6 weeks
I had an iui on 16 September I tested 2 weeks later as instructed and got a positive test

I then started bleeding red blood but it wasn’t as much as a normal period but heavier than spotting

It has now stopped I was referred to early pregnancy unit and they did a blood test on 9th October and hcg was only 127 hcg I went back today 12 October and the hcg is only 160 so they have said they will scan me tomorrow again as the previous scan they couldn’t see a sac in either uterus or tube

What could be the reasons for such a low increase?

reply
Leah

on Oct my HCG was at 58 and took another HCG test 2 days later and it dropped to 47 should i be concerned? waiting for the doctor to call back and see what i should do.

reply
Dr. Geoffrey Sher

Sadly, this does not look promising Leah! I hope I turn out to be wrong.

Geoff Sher

reply
Milka

Hello dr Sher,

I had my FET transfer on 15 September, 2 embryos – 3 days old.
I did my blood tests and this is my Beta HCG:
13 days past transfer – 29.1
15 days past transfer – 81.65
17 days past transfer – 273.6

I am wondering what do you think about the numbers? The scheduled my first ultrasound on 20 October.
Thank you.

reply
Dr. Geoffrey Sher

hCG rise started slow but seems to have picked up. Only time will tell through an US in about 2 weeks time.

Good luck!

Geoff Sher

reply
Milka

Dear dr Sher,

I wanted to leave an update.

Had my ultrasound on 20 October and we have a heart beat and one baby on the way!

Best,
Milica

Elizabeth

Hi Dr.,

Thank you for answering questions here. I’m concerned that my previously doubling HCG has slowed significantly. Here are my numbers:

12dpo- 9
14dpo- 27
17dpo- 120
26dpo- 3495
28dpo- 4609

I have had 3 early miscarriages. My doctor seems to think it still could be ok as it’s still rising. I have been spotting intermittently for a week. I plan to go for an ultrasound on Thursday.

Thanks for your thoughts.

Dr. Geoffrey Sher

The US should be definitive!

Good luck and G-d bless!~

Geoff Sher

Erica

Dr. Sher,

I did a Fresh Embryo Transfer in June that resulted in a miscarriage, the embryo wasn’t growing and hcg stayed at 180. I stopped taking the progesterone and instantly miscarried. I then, underwent a Frozen Embryo Transfer on September 25th, tested positive on October 4th and did a blood test on October 5th from my OB. From the day of the transfer, for 10 days, I was also on a blood thinner to help increase the blood flow to the uterus (they thought that might have been an issue last time). I ask about refilling when I went to do my blood test on Monday never got an answer or call back from the doctor. Then, went in yesterday for another test and asked about refilling prescriptions. The doctor was able to come out and talk to me and continued the blood thinner as well as the progesterone. Today, I got a call about my results–20 hcg. I am so confused, upset, and hurt. It seems the embryo is just NOT growing. They told me to come in Tuesday for another blood test and then Wednesday we’ll go over everything. I’m going to continue the blood thinner and progesterone but overall, I’m thinking it’s my blood circulation. I know I have very poor circulation just from having cold feet and hands ALL the time, but never put two and two together when trying to conceive it will be an issue. The reasoning for going the IVF route is because of a low sperm count from my husband and now I’m thinking I may have “cold uterus”, is that really what they call it? Any precautions or follow-on treatments I should consider. I have a few more eggs in the freezer with my 22-egg retrieval that happened in June but obviously, that’s one more try until I do this all over again. Any advice? I feel so sad.

reply
Dr. Geoffrey Sher

When it comes to reproduction, humans are the poorest performers of all mammals. In fact we are so inefficient that up to 75% of fertilized eggs do not produce live births, and up to 30% of pregnancies end up being lost within 10 weeks of conception (in the first trimester). RPL is defined as two (2) or more failed pregnancies. Less than 5% of women will experience two (2) consecutive miscarriages, and only 1% experience three or more.
Pregnancy loss can be classified by the stage of pregnancy when the loss occurs:
• Early pregnancy loss (first trimester)
• Late pregnancy loss (after the first trimester)
• Occult “hidden” and not clinically recognized, (chemical) pregnancy loss (occurs prior to ultrasound confirmation of pregnancy)
• Early pregnancy losses usually occur sporadically (are not repetitive).

In more than 70% of cases the loss is due to embryo aneuploidy (where there are more or less than the normal quota of 46 chromosomes). Conversely, repeated losses (RPL), with isolated exceptions where the cause is structural (e.g., unbalanced translocations), are seldom attributable to numerical chromosomal abnormalities (aneuploidy). In fact, the vast majority of cases of RPL are attributable to non-chromosomal causes such as anatomical uterine abnormalities or Immunologic Implantation Dysfunction (IID).
Since most sporadic early pregnancy losses are induced by chromosomal factors and thus are non-repetitive, having had a single miscarriage the likelihood of a second one occurring is no greater than average. However, once having had two losses the chance of a third one occurring is double (35-40%) and after having had three losses the chance of a fourth miscarriage increases to about 60%. The reason for this is that the more miscarriages a woman has, the greater is the likelihood of this being due to a non-chromosomal (repetitive) cause such as IID. It follows that if numerical chromosomal analysis (karyotyping) of embryonic/fetal products derived from a miscarriage tests karyotypically normal, then by a process of elimination, there would be a strong likelihood of a miscarriage repeating in subsequent pregnancies and one would not have to wait for the disaster to recur before taking action. This is precisely why we strongly advocate that all miscarriage specimens be karyotyped.
There is however one caveat to be taken into consideration. That is that the laboratory performing the karyotyping might unwittingly be testing the mother’s cells rather than that of the conceptus. That is why it is not possible to confidently exclude aneuploidy in cases where karyotyping of products suggests a “chromosomally normal” (euploid) female.
Late pregnancy losses (occurring after completion of the 1st trimester/12th week) occur far less frequently (1%) than early pregnancy losses. They are most commonly due to anatomical abnormalities of the uterus and/or cervix. Weakness of the neck of the cervix rendering it able to act as an effective valve that retains the pregnancy (i.e., cervical incompetence) is in fact one of the commonest causes of late pregnancy loss. So also are developmental (congenital) abnormalities of the uterus (e.g., a uterine septum) and uterine fibroid tumors. In some cases intrauterine growth retardation, premature separation of the placenta (placental abruption), premature rupture of the membranes and premature labor can also causes of late pregnancy loss.
Much progress has been made in understanding the mechanisms involved in RPL. There are two broad categories:
1. Problems involving the uterine environment in which a normal embryo is prohibited from properly implanting and developing. Possible causes include:
• Inadequate thickening of the uterine lining
• Irregularity in the contour of the uterine cavity (polyps, fibroid tumors in the uterine wall, intra-uterine scarring and adenomyosis)
• Hormonal imbalances (progesterone deficiency or luteal phase defects). This most commonly results in occult RPL.
• Deficient blood flow to the uterine lining (thin uterine lining).
• Immunologic implantation dysfunction (IID). A major cause of RPL. Plays a role in 75% of cases where chromosomally normal preimplantation embryos fail to implant.
• Interference of blood supply to the developing conceptus can occur due to a hereditary clotting disorder known as Thrombophilia.

2. Genetic and/or structural chromosomal abnormality of the embryo.Genetic abnormalities are rare causes of RPL. Structural chromosomal abnormalities are slightly more common but are also occur infrequently (1%). These are referred to as unbalanced translocation and they result from part of one chromosome detaching and then fusing with another chromosome. Additionally, a number of studies suggest the existence of paternal (sperm derived) effect on human embryo quality and pregnancy outcome that are not reflected as a chromosomal abnormality. Damaged sperm DNA can have a negative impact on fetal development and present clinically as occult or early clinical miscarriage. The Sperm Chromatin Structure Assay (SCSA) which measures the same endpoints are newer and possibly improved methods for evaluating.

IMMUNOLOGIC IMPLANTATION DYSFUNCTION
Autoimmune IID: Here an immunologic reaction is produced by the individual to his/her body’s own cellular components. The most common antibodies that form in such situations are APA and antithyroid antibodies (ATA).
But it is only when specialized immune cells in the uterine lining, known as cytotoxic lymphocytes (CTL) and natural killer (NK) cells, become activated and start to release an excessive/disproportionate amount of TH-1 cytokines that attack the root system of the embryo, that implantation potential is jeopardized. Diagnosis of such activation requires highly specialized blood test for cytokine activity that can only be performed by a handful of reproductive immunology reference laboratories in the United States.
Alloimmune IID, i.e., where antibodies are formed against antigens derived from another member of the same species, is believed to be a relatively common immunologic cause of recurrent pregnancy loss.
Autoimmune IID is often genetically transmitted. Thus it should not be surprising to learn that it is more likely to exist in women who have a family (or personal) history of primary autoimmune diseases such as lupus erythematosus (LE), scleroderma or autoimmune hypothyroidism (Hashimoto’s disease), autoimmune hyperthyroidism (Grave’s disease), rheumatoid arthritis, etc. Reactionary (secondary) autoimmunity can occur in conjunction with any medical condition associated with widespread tissue damage. One such gynecologic condition is endometriosis. Since autoimmune IID is usually associated with activated NK and T-cells from the outset, it usually results in such very early destruction of the embryo’s root system that the patient does not even recognize that she is pregnant. Accordingly the condition usually presents as “unexplained infertility” or “unexplained IVF failure” rather than as a miscarriage.
Alloimmune IID, on the other hand, usually starts off presenting as unexplained miscarriages (often manifesting as RPL). Over time as NK/T cell activation builds and eventually becomes permanently established the patient often goes from RPL to “infertility” due to failed implantation. RPL is more commonly the consequence of alloimmune rather than autoimmune implantation dysfunction.
However, regardless, of whether miscarriage is due to autoimmune or alloimmune implantation dysfunction the final blow to the pregnancy is the result of activated NK cells and CTL in the uterine lining that damage the developing embryo’s “root system” (trophoblast) so that it can no longer sustain the growing conceptus. This having been said, it is important to note that autoimmune IID is readily amenable to reversal through timely, appropriately administered, selective immunotherapy, and alloimmune IID is not. It is much more difficult to treat successfully, even with the use of immunotherapy. In fact, in some cases the only solution will be to revert to selective immunotherapy plus using donor sperm (provided there is no “match” between the donor’s DQa profile and that of the female recipient) or alternatively to resort to gestational surrogacy.
DIAGNOSING THE CAUSE OF RPL
In the past, women who miscarried were not evaluated thoroughly until they had lost several pregnancies in a row. This was because sporadic miscarriages are most commonly the result of embryo numerical chromosomal irregularities (aneuploidy) and thus not treatable. However, a consecutive series of miscarriages points to a repetitive cause that is non-chromosomal and is potentially remediable. Since RPL is most commonly due to a uterine pathology or immunologic causes that are potentially treatable, it follows that early chromosomal evaluation of products of conception could point to a potentially treatable situation. Thus I strongly recommend that such testing be done in most cases of miscarriage. Doing so will avoid a great deal of unnecessary heartache for many patients.
Establishing the correct diagnosis is the first step toward determining effective treatment for couples with RPL. It results from a problem within the pregnancy itself or within the uterine environment where the pregnancy implants and grows. Diagnostic tests useful in identifying individuals at greater risk for a problem within the pregnancy itself include:

Karyotyping (chromosome analysis) both prospective parents
• Assessment of the karyotype of products of conception derived from previous miscarriage specimens
• Ultrasound examination of the uterine cavity after sterile water is injected or sonohysterogram, fluid ultrasound, etc.)
• Hysterosalpingogram (dye X-ray test)
• Hysteroscopic evaluation of the uterine cavity
• Full hormonal evaluation (estrogen, progesterone, adrenal steroid hormones, thyroid hormones, FSH/LH, etc.)
• Immunologic testing to include:
a) Antiphospholipid antibody (APA) panel
b) Antinuclear antibody (ANA) panel
c) Antithyroid antibody panel (i.e., antithyroglobulin and antimicrosomal antibodies)
d) Reproductive immunophenotype
e) Natural killer cell activity (NKa) assay (i.e., K562 target cell test)
f) Alloimmune testing of both the male and female partners

TREATMENT OF RPL
Treatment for Anatomic Abnormalities of the Uterus: This involves restoration through removal of local lesions such as fibroids, scar tissue, and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.
Treatment of Thin Uterine Lining: A thin uterine lining has been shown to correlate with compromised pregnancy outcome. Often this will be associated with reduced blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil and possibly aspirin.
Sildenafil (Viagra) Therapy. Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
Use of Aspirin: This is an anti-prostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81 mg orally, daily from the beginning of the cycle until ovulation.
Treating Immunologic Implantation Dysfunction with Selective Immunotherapy: Modalities such as IL/IVIg, heparinoids (Lovenox/Clexane), and corticosteroids (dexamethasone, prednisone, prednisolone) can be used in select cases depending on autoimmune or alloimmune dysfunction.
The Use of IVF in the Treatment of RPL
In the following circumstances, IVF is the preferred option:
1. When in addition to a history of RPL, another standard indication for IVF (e.g., tubal factor, endometriosis, and male factor infertility) is superimposed.
2. In cases where selective immunotherapy is needed to treat an immunologic implantation dysfunction.
The reason for IVF being a preferred approach in such cases is that in order to be effective, the immunotherapy needs to be initiated well before spontaneous or induced ovulation. Given the fact that the anticipated birthrate per cycle of COS with or without IUI is at best about 15%, it follows that short of IVF, to have even a reasonable chance of a live birth, most women with immunologic causes of RPL would need to undergo immunotherapy repeatedly, over consecutive cycles. Conversely, with IVF, the chance of a successful outcome in a single cycle of treatment is several times greater and, because of the attenuated and concentrated time period required for treatment, IVF is far safer and thus represents a more practicable alternative
Since embryo aneuploidy is a common cause of miscarriage, the use of preimplantation genetic diagnosis (PGD), with tests such as CGH, can provide a valuable diagnostic and therapeutic advantage in cases of RPL. PGD requires IVF to provide access to embryos for testing.
There are a few cases of intractable alloimmune dysfunction due to absolute DQ alpha matching where Gestational Surrogacy or use of donor sperm could represent the only viable recourse, other than abandoning treatment altogether and/or resorting to adoption. Other non-immunologic factors such as an intractably thin uterine lining or severe uterine pathology might also warrant that last resort consideration be given to gestational surrogacy.
The good news is that if a couple with RPL is open to all of the diagnostic and treatment options referred to above, a live birthrate of 70%–80% is ultimately achievable.
I strongly recommend that you visit http://www.SherIVF.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

______________________________________________________
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).

PLEASE SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Zara

I am 12dpo
My hcg 10dpo was 28 now at 12 dpo it is 140
My progesterone today was 180, is this too high?
Is it a sign of multiple?

reply
Dr. Geoffrey Sher

I don’t think this is a multiple, but I could be wrong!

Good luck!

Geoff Sher

reply
Annie Cheruvelil

9/23/2020 HCG 168.35
9/25/2020 HCG 397.46
i started having some cramping and spotting
10/1/2020 HCG 175.36
10/6/2020 HCG 348

should i be concerned for ectopic?

reply
Dr. Geoffrey Sher

You should be watched. Discuss with your Doctor. However, this pregnancy likely will not proceed normally

Sorry!

Geoff Sher

reply
April

Hello Dr,

I had a frozen 3 day transfer on 9/25. Should I be concerned that my beta doubling time has slowed. My betas are:

10/6 – 180
10/8 – 386
10/12- 1241

Thank you very much for your insight

reply
Dr. Geoffrey Sher

I think the rise is still in the range of acceptable. Do an in about 1 week!

Geoff Sher

reply
Ryan

I transferred 2 PGS tested normal emrbyo’s on 10/5. My first beta 11dp5dt was 501
15dp5dt was 1,778
I thought on 15dp5dt our numbers should be over 2,000 if they were doubling as they should?
I would appreciate your thoughts! Our ultrasound is scheduled for 11/9.

Dr. Geoffrey Sher

I think you are still OK. Do an US at 6-7 weeks for a definitive answer!

Good luck!

Geoff Sher

Heather

Hi Doctor,

I was diagnosed with PCOS in December 2017 but with the help of a fertility clinic, using puregon injections, I was able to have my son in March 2019. My husband and I have been trying again for baby #2 since March and have had no luck. We were finally able to get into the clinic and had my pre-cycle blood work done when they called to tell me (to my surprise) I had a positive beta test. My HCG was 40 on 09/29/20. I repeated my blood work every 48 hours and my results were as follows…

96 on 10/01/20
150 on 10/03/20
66 on 10/05/20

The clinic called me today to tell me that since my HCG has dropped, its a chemical pregnancy. The bleeding I’m currently experiencing, is that a true period? Is there no hope that a repeat in my blood work will show an increase in HCG?

Thanks for the help!

reply
prichopra586

Hi Doctor Sher,

Hope you are doing well!!

I again had IUI on 11 Sep as I mentioned in my last post and I got pregnant this time. My first HCG on 25 Sep was 285.8 and second test came as 995.5 on 28th Sep. She didn’t schedule 3rd blood test as hcg are doubling every 40 hours. My doctor has scheduled first ultrasound on 5th October. Do you think everything is fine this time? My HCG looks little on higher side, am I carrying twins?

reply
prichopra586

Thanks for the reply doctor, I will update you after the ultrasound tomorrow.

Thank you so much!!

reply
prichopra586

Hi Doctor Sher,

I had ultrasound today and we saw three sacs, all measuring 5 weeks and 2 days. My doctor said all is fine apart from the risk of multiple pregnancies. She has scheduled next ultrasound after 2 weeks. What are your thoughts on this? What is risk with triplets?

Dr. Geoffrey Sher

Hopefully all will be well. However the risks increase for miscarriage, placenta previa; Pre-eclampsia (pregnancy-induced hypertension), premature delivery. Cesarean section and post-partum hemmorhage.

You need to be under the care of a high-risk maternal-Fetal Medicine doctor!

Good luck!

Geoff Sher

Kelly

Hello Dr. Sher,

After my first IUI, my first HCG on 9/24, came back as only 22. However it has continued to double over time.
My results are:
•9/24- 22
•9/26- 86
•9/28- 336
•9/30- 852
•10/2: 1515

My doctor is concerned and wants to continue to keep an eye out due to my first low HCG. Is it possible to have a viable pregnancy with a first HCG of 22? Or will this lead to a miscarriage in the future? What has your experience been?
Thank you!

reply
Dr. Geoffrey Sher

I think you are doing OK. I would do an US in 10 days for a definitive answer.

Good luck!

Geoff Sher

reply
Belinda

Hi Geoff,

I lost my last comment and couldn’t find it.

Just wondering how long it takes for a pregnyl 5000 trigger to leave the system. I took mine 10 days ago before my FET which was four days ago.
Thanks Geoff 🙂

reply
Belinda

Hi Geoff,

It’s been 13 days since my trigger and I’m 6 days past 5/6day frozen transfer. I tested yesterday and got an extremely faint line which I’m still getting today. It’s so faint but there on an frer. What are your thoughts? I would have thought if I was pregnant I would actually be registering an obvious positive by now. I usually test positive around 8-9dpo when I’m pregnant naturally. Does it take longer with a frozen transfer? Or has it not worked and it’s still the pregnyl 5000 trigger from 13 days ago. This was my only embryo and it was PGT no result. I’m feeling very upset today.
Thanks Geoff

reply
Dr. Geoffrey Sher

It is about 3 days early. Repeat then!

Good luck!

Geoff Sher

samantha

Hi Dr. Sher. I am concerned about high hcg levels. HCG – 5w3d 13,600 and 5w5d 20,500. Progesterone- 5w3d 16.9 and 5w5d 18. Confirmed dating by ultrasound. Are these hcg levels too high, meaning there is potential for molar or other complications? Thank you!

reply
C Brooke

Hi Dr. Sher,

I know it may be too early to tell but on 10/7 my first Hcg blood test after 5 day Fet was 122. On 10/9 the Hcg had only risen to 196, or 60% increase. Is this cause for concern?

reply
Dr. Geoffrey Sher

Repeat after the weekend. It should double every 2 days at this stage.

Good luck!

Geoff Sher

reply
Jennifer

Dear Dr Sher,

I had a pleasant surprise a few weeks ago after we had a positive pregnancy test after having a dose of PRP earlier on in the year.

The initial level was 62. 3 days later, 152, 3 days later 388 , then 4 days later 776.

from then levels have been 772 after 2 days, then 726 after another 2 days, 727 after another 2 days and 727 after another 3 days. Thus for about 10 days, the readings have hovered around 700-800.

I am still feeling preg symptoms such as breast tenderness nauseaat times bloating and easy tiredness. My doctor has me on a regime of prog supplements, low dose naltrexone, clexane injections and 2 weekly intralipid infusions.

Previously some prolactin levels were performed outside of pregnancy which were generally normal apart from one isolated reading slightly high in the vicinity of 19-20 ng/ml. However, this is just one reading and the other 3-4 readings were normal.

I am resigned to the fact that this is unlikely a viable pregnancy. However, I am not sure what this may be i.e. impending miscarriage, ectopic pregnancy, vanishing twin syndrome, or even a viable pregnancy with a period of plateau before it then rises.

I also read somewhere that the HCG level needs to be above 1200 for an ultrasound to see a gestational sac whether that be with an ectopic pregnancy or empty gestational sac. It appears that it may be difficult to get a definitive answer with any investigations currently thus, I’m not sure whether I should continue these current meds, go for the scheduled us in a few days time anyway, or postpone the ultrasound until the levels drop or start to climb again.

Any thoughts that you have regarding this would be greatly appreciated.

Jennifer

reply
Dr. Geoffrey Sher

I cannot disagree with anything you said. Frankly I do not feel optimistic in any way with regard to this pregnancy. I would do an US in about 10 days from now.

I wish you the very best!

Geoff Sher

reply
CarolAnn

9/18 HCG 22
9/21 HCG 51
9/25 HCG 119

Nurse said even though levels are low they are rising appropriately. I’m concerned about the HCG 51 increase to 119 four days later. I love read everywhere it needs to double every 48 hours. What are your thoughts? Are these numbers appropriately rising?

reply
Dr. Geoffrey Sher

In my opinion, this is a slow rise in hCG. Only time will tell through serial blood hCG tests and ultimately an US at 6-7 weeks, can provide reliable indicators.

Geoff Sher

reply
CarolAnn

Could this be a viable pregnancy? Nurse said that it is rising appropriately but it didn’t double from 51 to 119 in a matter of 4 days

reply
Dr. Geoffrey Sher

You will need to ultimately wait for confirmation by ultrasound at 6-7 weeks!

Geoff Sher

reply
Lwena

Hi doctor, im 42 years old and had a miscarriage 2 month ago, now in pregnant again, first ultrasound at 5 weeks showed a sac but was not clear, first HCG 19700 at 6 weeks and two days later 29300, I know is increasing but is not doble and I’m a little bit confused, next ultrasound in a week, what do you think? Here a colleague that can’t think like a doctor anymore

reply
Dr. Geoffrey Sher

I am not overly concerned because the increase in hCG level starts to slow down quite substantially when it goes above 5,000!

Good luck!

Geoff Sher

reply
Lwena

Thanks so much for answering so fast. You are an angel, ill wait then. Tahnks again

reply
SB

Hello Dr. Sher,

I had an ectopic pregnancy. My levels have dropped to 190 a week after the methotrexate shot. What can I expect to happen when I hit zero? Will I start bleeding? Will the bleeding prompt my first period? Also, what is your recommendation of time for TTC after the shot? My doctor said after your first cycle, but I’ve seen varied opinions online. What should I do for the next pregnancy since I will be at higher risk for another ectopic pregnancy? How early would you have your patients come in after they test positive again? Thank you for your time and help!

reply
Dr. Geoffrey Sher

Once the hCG level falls to zero, you should have a period. I would wait 1 full cycle thereafter, before trying to conceive again. Then report to your OB, soon after having a subsequent +ve pregnancy test.

Good luck!

Geoff Sher

reply
Tara

Hi Dr Sher. I had a transfer of two 7 cell “fair” embryos 9/2.

First beta 9/14 139
Second beta 9/16 326
Third beta 9/22 1300

My doubling times slowed to 72 hours. My ultrasound is next week. Is it ok that my times slowed so much?

reply
Tara

Just wanted to update. Ultrasound at 6w4d, no fetal pole and questionable 6.4mm sac. Not the outcome I was hoping for. Thanks for your time.

reply
Jane

Hi doctor. Are my beta levels normal?
1st hcg levels 10days past 5days transfer was 320
2nd beta 14 days past transfer came back at 2400
3rd beta 19 days past transfer was 15000
Please advice if this is normal or its on the high side

reply
Rhian

Good Afternoon Dr I am hoping you can shed some light as I am quite confused.

I had beta HCG done at 14dpo it was 258 I was only 3 weeks + 6 days so Dr said I was above the normal range for 3 weeks.
I had my beta HCG repeted at 18dpo it was 725. I was 4 weeks +3 days. Dr said i was still above the normal range for 4 weeks. But then he said HCG only doubling every 63-64 hours.

Should I be concerned being above normal range for week made me feel positive but then for him to say it not doubling in 48 hours make me wonder if I should be concerned? He made no mention of repeating the test again or booking an ultrasound.

I don’t know if it is relevent but I have had 7 miscarriages, and I don’t feel pregnant at all.

Thank you

reply
Dr. Geoffrey Sher

Hard to say. The rate of rise is slowish! Repeat in 2 days and see if it starts to rise more rapidly. Ultimately you will need an US at 6-7 weeks for a definitive answer.

Good luck!

Geoff Sher

reply
Rhian

Thank you Dr.

I had my bloods repeated at 5 weeks which came back at 3415 compared to the 725 from 4 days before so has now more than doubled.

My Dr still seems negative he had already commented that my first 2 readings were above the range for my gestation and even though my new numbers are I the normal range for 5 weeks he said if I repeated 2 days later I would be above gestational range again.

Do you know why he might be so hung up on my numbers being above? I thought high numbers was a good thing. Thank you

reply
Jenna

Hi Dr. Sher,

Thank you so much for all the time you spend answering people’s concerns! My beta levels after a 5 day frozen embryo transfer are concerning to me.

11 days post transfer- 171
13 days post transfer- 275
15 days post transfer- 481
18 days post transfer- 1450

Until the 18 day level, my betas have not doubled in the 48 hours range- about a 60% increase the first time around and with a slightly larger increase each time from there. I did have an ultrasound done at 19 days post transfer, and a gestational sac and yolk sac was visible, but my Dr. has let me know that I am still at a greater risk of a miscarriage based on my beta levels. I know there are no exact answers, but can you give me some idea of how predictive slow rising beta levels are of miscarriages later in pregnancy?

reply
Dr. Geoffrey Sher

Of course it is somewhat concerning BUT the detection of a getational sac is a positive. Repeat the US in 1 week. That should be more definitive.

Good luck!

Geoff Sher

reply
Pauline

Hi Doctor,

My last period was August 3rd, 2020. My period cycle is about every 33-36 days. When I hit the 7th day mark, I took a pregnancy test and it came out positive. Estimating from my last period, I should of been approximately 6 weeks pregnant. Doctor was not able to see a sac and assured me I am definitely not 6 weeks and sent me to labs for HCG.

9/15 – 297 mIU HCG
9/17 – 515 mIU HCG

From the first day of finding out I am pregnant, I’ve been having mild back pain and cramping. Almost feels the same way when baby starts moving, On 9/14 I experienced spotting for 2 days and then 9/17 & 9/18 I have been having constant light bleeding. Enough for me to need to wear a thin pad and also light pink when wiping. Should I be concerned of miscarriage or an ectopic pregnancy? Does my pregnancy seem viable to you?

reply
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.

Good luck!

Geoff Sher

reply
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

reply
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.

reply
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

reply
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

reply
Emilee

My LMP was 9/01/20. At approximately 4w + 6d beta hcg was 281. Two days later I returned for a repeat blood draw, being approximately 5w +1d and beta was 772. I see so many others with higher numbers at this stage, should I be worried? I have an ultrasound coming up when I’ll be approximately 7 weeks, and am not sure if I should be hopeful or not.

reply
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?

reply
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

reply
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.

reply
Kimmy Bunch

On September 18th my HCG was 310. September 25th my HCG was 1,291. I also had an US on the 25th that ruled out an ectopic pregnancy. (Should have been 7 weeks that day.) They saw a gestational sac but no yolk sac or fetal pole yet so I have another US on October 5th. What are the chances it is a viable pregnancy with really slow rising HCG levels? If it was a blighted ovum would my HCG levels continue to rise? I still have not had any bleeding or really any pain.

Dr. Geoffrey Sher

If your dates of 7w are accurate and there was no yolk sac or conceptus seen, the likelihood is that the pregnancy is lost!

Sorry!

Geoff sher

Kimmy Bunch

On 9/14 my endometrial lining was 8.2 mm. On 9/25 it was 9.5. Could it be a good sign that it is getting thicker?

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.

reply
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

reply
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?

reply
Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

reply
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.

reply
Sarah S

Hi Dr.,

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

Thoughts on viability?
Thank you!

reply
Dr. Geoffrey Sher

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

Geoff Sher

reply
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!

reply
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

reply
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

reply
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

reply
Dr. Geoffrey Sher

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

Geoff Sher

reply
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?

reply
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!

reply
Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

reply
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.

reply
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

reply
Emily Gill

Dr. Sher

My LMP was 8/25/2020 and had very very faint positive test towards 9/19/2020. I have yet to start my period. Had blood drawn 9/30/2020 and it was .4. My OB told me to test 2 weeks later which it has been and I still haven’t had my period yet and getting negative pregnancy tests. What could be the reasons and why wouldn’t my dr order another blood test when I asked. I have a history of miscarriage and ectopic.

reply
Dr. Geoffrey Sher

That hCG level is insignificant.(I suggest an Ultrasound to look for a functional ovarian cyst.

Geoff Sher

Ask a question or post a comment

Your email address will not be published. Required fields are marked *