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.

2,867 Comments

Angela Antuchiewicz

Hello Dr Sher,
How true is the recommended doubling times? this will be my 10 pregnancy with 1 child. every pregnancy have had faster doubling times and higher HCG’s than this one.
107 – 14 dpo
240 – 16 dpo 41.19 hours doubling
487 – 18 dpo 47 hours doubling
1391 – 21 dpo 47.55 hours doubling
10,410 29 dpo 66 hours doubling

what are your thoughts on the doubling time and levels.

Thank you so much

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Anna

Hello!
D9 after single day 5 blastocyst transfer: HCG 270
d11: 750

Is this compatible w singleton pregnancy? I am worried about multiples! Thank you.

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Anna

transferred a single d5 blastocyst
9 days after (32 days after lmp/16 days after trigger): 272
11 days after transfer: 760

are these levels compatible with singleton pregnancy? I am so worried about multiples. awaiting ultrasound . Thank you!

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Dr. Geoffrey Sher

In fact it looks quite encouraging to me!

Good luck!

Geoff Sher

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GaRhonda Odom

Had a miscarriage last due to low progesterone. April 30th had a positive test but labs showed progesterone was a 2.22 and HCG of 150. Today labs showed a small increase to 450 and I started progesterone pills twice daily. I’m concerned at 4 weeks like last year this will end in another miscarriage.

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Dr. Geoffrey Sher

Unfortunately only time will tell. Repeat the blood hCG test in 2 days to see if it doubles (as it should). Then do an US at 6-7 weeks for final determination of viability.

Good luck!

Geoff Sher

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Lindsay Gordon

I’m a terrible person and ordered my own bloodwork at 5dp5dt (3 hours shy if we’re being technical) and my beta was 6 so I’m preparing myself for a chemical pregnancy as Betabase median at 10dpo was 36.

Should I most likely prepare to hear the news of a chemical pregnancy or am I putting myself through unnecessary worry because I got a “beta version” beta so early? Official beta is 8dp and it was a PGT tested embryo.

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Dr. Geoffrey Sher

In my opinion , if this was a blastocyst transfer, you ordered the BW much too early.

Geoff Sher

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Amelia

LMP – 3/14/21
IUI- 3/25/21

1st Beta HCG- 38.84
2nd Beta HCG- 110.10

I am taking progesterone and have light spotting?

Do you think these numbers are looking promising with the light brown spotting?

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Dr. Geoffrey Sher

Depending on how long between the tests…YES it could be promising!

Good luck!

Geoff Sher

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GaRhonda Odom

Had a miscarriage (blighted ovum) last due to low progesterone. April 30th had a positive test but labs showed progesterone was a 2.22 and HCG of 150. Today labs showed a small increase to 450 and I started progesterone pills twice daily. I’m concerned at 4 weeks like last year this will end in another miscarriage.

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Dr. Geoffrey Sher

I am afraid it does not look very promising. However, only time will tell. You need to repeat the hCG blood test in 2 days. It should double. Then an US at 6-7 weeks will be definitive!

Hang in there!

Geoff Sher

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Amber Koshney

I thought based on allllll the apps that because of my last period being 2/25 that we were 6.5 weeks pregnant. Got an early ultrasound because I had brown discharge 1 morning when I wiped. Ultrasound found NOTHING accept a thickened uterine wall. Which is good. So we we through my periods for a year added the length divided by 12 and got 36 not 28 usual length between periods, that evidence paired with an ovulation date of March 19th puts me at roughly 5weeks today. Okay, whew. My progesterone came back (yesterday) as 11 and HCG as 600. Is this viable? Ty so much

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Amy

FET of a 6 day blast on 3/14/21

HCG 3/22-46.4
HCG 3/24-86.2

I am worrying some, my hcg is always slow but is that too slow? I also know I’m only 10 days post transfer

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Dr. Geoffrey Sher

It is OK! Repeat in 2 days again, to see if it doubles (as it should)!

Geoff Sher

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Ruchi

Hi Doc,
My LMP started on the 16th of Jan 21, but I was tracking my ovulation which happened on the 25th of Feb(late). I got my 1sy HCG done on 3/17 which came to 437. got my 2nd one done on 3/20 which came 834 (around about the same time). My doc ordered an ultrasound and I have an appointment for 3/25.

Do you think this could be an Ectopic pregnancy?

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Dr. Geoffrey Sher

Yes! but don’t count a viable intrauterine pregnancy out!

Geoff Sher

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Julieann Yerks

Hi Doc,
You were very accurate with my last question which ended as an early loss back in November. Here I am again!!
What do you think
10 dpo = 15 prog. 30 so not rechecked
12 DPO = 43
17 dpo = 283
I have early US at 6 wks, does this look good? Should I push for 1 more before than? How likely are these numbers to have a + outcome??
Thank you for your time!!

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Lana Johnson

Hi Doc,

based on my LMP (Jan 20th, 2020), I should be 5 weeks and 4 days. I used OPK strips to track ovulation, so I believe I ovulated on Feb 2nd or 3rd. I went to my ob/gyn on Feb. 23 to check my hcg levels. They were 297.5, my doctor wanted me to get my hcg levels checked again 48 hours after, on Feb.25 my levels risen to 558.30. Is this good or bad? I have to get it checked again in a few days. I’m a little worried but hopeful. Is this normal? What could this mean? Thank you.

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Dr. Geoffrey Sher

It is likely OK. However, I suggest a confirming US at 6-7 weeks!

Good luck!

Geoff Sher

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Sarah

Hello, Dr. Sher!

I had an IUI on February 23rd at 9:00AM and had my first beta done on March 8th (13dpiui). I felt like I ovulated a day or two later than the IUI, even though I had a trigger shot at 11:00PM on February 21st. LMP February 10th, 2021.

Betas are as follows:
3/8/21 – 10
3/10/21 – 20
3/12/21 – 57

I am aware this is very low and am bracing for another miscarriage. Have you ever seen anyone go on to have a healthy pregnancy with numbers so low?

Many thanks,
Sarah

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Dr. Geoffrey Sher

Indeed, this could be a viable pregnancy. Repeat the US in 2 days. It should be >100 and if so, have an US done around 6-7 weeks for a definitive answer.

Good luck!

Geoff Sher

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Vanessa C

Hello,

I had a miscarriage and fell pregnant before my period came. My first HCG was 11, 48 hours later it was 30. The OB said it’s doubling well but because I didn’t have a period, he isn’t sure where I stand. I know I had sex 12 days ago from my 30 HCG. Are these bad?

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Dr. Geoffrey Sher

Repeat the hCG test at 2 day intervals to see if it keeps doubling. If it does so then an US at 6-7 weeks should be definitive.

Geoff Sher

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Richelle

I had my Fet transfer on 01/20. My 1st beta was 14, then the 2nd beta was 173 and the 3rd beta test is 296 progesterone 43. Should I be worried

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Dr. Geoffrey Sher

That is a slowish rise to your c3rd beta. You should repeat again in 2 days at which time the level should be around 600.

Thereupon, an US done at 6-7 weeks should be definitive.

I wish you good luck!

Geoff Sher

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lilly

Hi,
i went into doc. for vaginal brown tissue discharge. LMP was 12/3/2020, which i was supposed to be 6 weeks. He did ultrasound and saw nothing. He ordered blood work
1/19 – 19,991
1/22- 18,102
1/25- 21,146
still have dark brown discharge , think its old blood. But now don’t know what to think. Had a miscarriage 7 years ago at 12 weeks. scheduled for ultrasound in a couple of days.
What are your thoughts? Thank you

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Dr. Geoffrey Sher

It is a little concerning. I am afraid, you will need to wait for the US for confirmation.

Good luck!

Geoff Sher

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Carla Langley

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

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Samantha

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

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Astah Llabore

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

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Tara

Hi Dr. Sher,

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

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Katrina

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

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

Tara

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

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Tara

First beta 11dp3dt 501
Second beta 13dp3dt 1421.

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

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Dr. Geoffrey Sher

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

I doubt it is molar…

Geoff Sher

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Sarah C

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

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Win

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

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Dr. Geoffrey Sher

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

Geoff Sher

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Mariana

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

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cmg

Hi Dr. Sher,

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

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AS

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

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Ammy

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

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Dr. Geoffrey Sher

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

Geoff Sher

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Ammy

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

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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cg

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

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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Julieann Yerks

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

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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Amber S

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

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Dr. Geoffrey Sher

Looks promising to me!

Get an US done in 2-3 weeks for a definitive answer.

Good luck!

Geoff Sher

Dr. Geoffrey Sher

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

Geoff Sher

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AB

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

Does it look normal or high at early pregnancy?

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Emily Brodersen

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

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

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

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

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Dr. Geoffrey Sher

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

Geoff Sher

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Emily B

Hi Dr.

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

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

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

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

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

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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Julieann Yerks

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

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Julieann Yerks

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

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Julieann Yerks

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

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Dr. Geoffrey Sher

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

Geoff Sher

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Julieann Yerks

Good afternoon Doc,
I’m impatiently waiting for my 6 US tomorrow morning. I have so much anxiety. My numbers are dbling, but I’m freaked out of a blighted ovum. Do numbers rise accordingly with a blighted ovum?
10dpo = 15
12. = 43
17. =283
19. = 786
23. = 3994

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Dr. Geoffrey Sher

I am quite optimistic for you!

Good luck!

Geoff Sher

Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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Alex

Hello,

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

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

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