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.

856 Comments

Jane

Hi, i transferred 3 embryos and the following are the results:
14dp6dt HGC 439
11dp6dt HGC 210
9dp6dt HCG 108
Is it a concern that it started off doubling in 48 hours and now has slowed down already to 68 hours?
Thank you for your help!

reply
Dr. Geoffrey Sher

I am guardedly optimistic for you!

Good luck!

Geoff Sher

reply
Jane

Thank you so much for your optimism! In general, does the HCG follow a consistent pattern of doubling in the beginning, or this can vary and slow down and speed up, etc. Thanks!

reply
Dr. Geoffrey Sher

It usually slows down after hitting 4000-6000.

Geoff Sher

reply
Chelsea

I got my blood work back this morning and I don’t understand what this means:
HCG:
@ 12dpo my hcg was 13
@15 dpo my hcg was 64

Do you think this is positive or negative

reply
Dr. Geoffrey Sher

This is evidence of implantation, but the levels are low. I would repeat it in 4 days when it should be >60.
___________________________________________________________
ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed IVF- treatment and related procedures on patients who, elected to travel to Las Vegas to be managed by me. However, with the launching of Sher-Fertility Solutions (SFS) in April 2019, I have taken on a new and expanded role. Now, rather than having hands-on involvement I confine my services to providing hour-long online Skype consultations to an ever-growing number of patients (emanating from >40 countries), with complex Reproductive problems, who seek access to my input, advice and guidance. All Skype consultations are followed by a detailed written report that meticulously describes and explains my recommendations for treatment. All patients are encouraged to share this report with their personal treating doctor(s), with whom [subject to consent and a request from their doctor] I will, gladly discuss their case with the “treating Physician”.
Through SFS I am now able to conveniently provide those who because of geography, convenience and cost, prefer to be treated at home or elsewhere by their chosen Infertility Physician.
“I wish to emphasize to all patients with whom I consult, that in the final analyses, when it comes to management, strategy, protocol and implementation of treatment, my advice and recommendations are always superseded by that of the hands-on treating Physician”.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 (in the U.S.A or Canada) or 702-533-2691, for an appointment. Patients can also enroll online on my website, http://www.SherIVF.com, or email Patti at concierge@SherIVF.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

PLEASE HELP SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Maren

Hi!

I had a FET on 4/6.

My HCG levels have been:
10 dp5dt: 360
12 dp5dt: 594
14 dp5dt: 1040

My RE is “cautiously optimistic” with these levels and wants me to come in next week for additional betas. This is my 4th FET (1st ended as a blighted ovum so I’ve been down this road before….)
Do these levels seem concerning to you?

Thanks in advance!

reply
Dr. Geoffrey Sher

They are borderline “acceptable”. Only time will tell.
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:
o 3 weeks LMP: 5 – 50 mIU/ml
o 4 weeks LMP: 5 – 426 mIU/ml
o 5 weeks LMP: 18 – 7,340 mIU/ml
o 6 weeks LMP: 1,080 – 56,500 mIU/ml
o 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
o 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:
o A recovering implantation, destined to develop into a clinical gestation
o A failing implantation (a chemical pregnancy)
o A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
o 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.
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.

• A Fresh Look at the Indications for IVF
• 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
• Genetically Testing Embryos for IVF
• IVF Failure and Implantation Dysfunction:
• Management of Immunologic Implantation Dysfunction (IID).
• The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• Avoiding High Order Multiple Pregnancies (Triplets or Greater) with IVF
• The Role of Nutritional Supplements in Preparing for IVF
• Ectopic Pregnancy
• Molar pregnancies

ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed IVF- treatment and related procedures on patients who, elected to travel to Las Vegas to be managed by me. However, with the launching of Sher-Fertility Solutions (SFS) in April 2019, I have taken on a new and expanded role. Now, rather than having hands-on involvement I confine my services to providing hour-long online Skype consultations to an ever-growing number of patients (emanating from >40 countries), with complex Reproductive problems, who seek access to my input, advice and guidance. All Skype consultations are followed by a detailed written report that meticulously describes and explains my recommendations for treatment. All patients are encouraged to share this report with their personal treating doctor(s), with whom [subject to consent and a request from their doctor] I will, gladly discuss their case with the “treating Physician”.
Through SFS I am now able to conveniently provide those who because of geography, convenience and cost, prefer to be treated at home or elsewhere by their chosen Infertility Physician.
“I wish to emphasize to all patients with whom I consult, that in the final analyses, when it comes to management, strategy, protocol and implementation of treatment, my advice and recommendations are always superseded by that of the hands-on treating Physician”.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 (in the U.S.A or Canada) or 702-533-2691, for an appointment. Patients can also enroll online on my website, http://www.SherIVF.com, or email Patti at concierge@SherIVF.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

PLEASE HELP SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Maren

Thank you so much for taking the time to respond.

I mistyped … my HCG on 14 dpt was 1,140 (not 1,040).

My HCG today (16 dpt) was 2,133.

I’m feeling hopeful, but know that anything is possible at this point.

Thanks again for your insight!

reply
Dr. Geoffrey Sher

I think you have reason for guarded optimism!

Good luck!

Geoff Sher

reply
EF

We are 14dpt of a 5 day old frozen embryo. Our original HCG read at 10 dpt was a 195 and the fertility group was very optimistic. On 12dpt our levels had increased to a 246, and today at 14dpt to a 344. The numbers are steadily increasing, but not doubling. The wait is painful-are we likely looking at an impending loss?

reply
Dr. Geoffrey Sher

It is a slow rise. However, if >1 embryo was transferred, it could be that >1 pregnancies took at the outset and that the other is failing. Only time will tell!

Good luck!

Geoff Sher

reply
EF

We got 17 dpt result of 636 today. We are trying to hang in there. Gestational sac was seen, but yolk sac not yet visible. It’s really tough to balance hope and potential loss.

reply
Dr. Geoffrey Sher

You are still a little early. Wait about 10 days and repeat the ultrasound.

Good luck!

Geoff Sher

reply
Stella Dube love

I check my blood level yesterday and was said it’s borderline value is 54. Please reply is it positive or negative.

reply
Dr. Geoffrey Sher

It is positive, but without more information, I cannot say any more at this time.

Good luck!

Geoff Sher

reply
Angelica Villarreal

Dr. Sher, my levels were as follows, going in for a 3rd test in 4 days. I’m very anxious, being told the rise is slower than anticipated. :/

8 dpt: 57 HCG / 33.0 Pro / 325 Est

10 dpt: 77 HCG / n/a / n/a

reply
Dr. Geoffrey Sher

This sadly does not look very promising Angelica. I hope I am wrong. I wish you well!

___________________________________________________________
ADDENDUM:
INTRODUCING SHER FRERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed the actual hands-on treatment of all patients who, seeking my involvement, elected to travel to Las Vegas for my care. However, with the launching of Sher-Fertility Solutions (SFS), I will as of March 31st take on a new and expanded consultation role. Rather than having hands-on involvement with IVF procedures I will, through SFS, instead provide fertility consultations (via SKYPE) to the growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input , advice and guidance. In this way I will be able to be involved in overseeing the care, of numerous patients who previously, because they were unable to travel long distances to be treated by me, were unable to gain access to my input.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 for an appointment,enrolling online on my website, http://www.SherIVF.com, or 702-533-2691; or emailing Patti at concierge@SherIVF.com or . sher@sherivf.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

PLEASE HELP SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Julie M

Hello

I had a chemical pregnancy in January through FET. I just had a second FET. Are my beta results in a healthy range for where I am in my cycle? I started HCG injections every 3 days on 11dp5dt.

9dp5dt – 84
11dp5dt – 162
14dp5dt – 522

reply
Karina Rhem

I had my 1st beta at 9dp5dt and it was 108. The 2nd beta at 12dp5dt and it was 518. The 3rd beta at 15dp5dt and it was 1171. What are your thoughts. Thank you

reply
Dr. Geoffrey Sher

Very promising!

Good luck!
___________________________________________________________
ADDENDUM:
INTRODUCING SHER FRERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed the actual hands-on treatment of all patients who, seeking my involvement, elected to travel to Las Vegas for my care. However, with the launching of Sher-Fertility Solutions (SFS), I will as of March 31st take on a new and expanded consultation role. Rather than having hands-on involvement with IVF procedures I will, through SFS, instead provide fertility consultations (via SKYPE) to the growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input , advice and guidance. In this way I will be able to be involved in overseeing the care, of numerous patients who previously, because they were unable to travel long distances to be treated by me, were unable to gain access to my input.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 for an appointment,enrolling online on my website, http://www.SherIVF.com, or 702-533-2691; or emailing Patti at concierge@SherIVF.com or . sher@sherivf.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

PLEASE HELP SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Latoya

Hi I went in this Monday to do a hcg test my level came back at 8,562 went in again on Wednesday morning and today my levels came back at 10,562 is this good or bad. I don’t understand it. Please help. Thank you

reply
Dr. Geoffrey Sher

The levels are high enough for you to go in and do an US examination for a definitive answer.

Good luck!

Geoff Sher

reply
Teresa

Thank you for all of your insights here!
I had a frozen embryo transfer on March 5, two embryos transferred. In addition, my follicles were stimulated and I received a trigger shot. My HCG level on day 10 after transfer was 18. Day 14 it was 80, day 17 it was 500. I retested 4 days later and it was 1472. It did not quadruple as it should. Should I be concerned?

reply
Dr. Geoffrey Sher

I would still be guardedly optimistic. Do and ultrasound examination in about 10 days for an answer!

Good luck!

___________________________________________________________
ADDENDUM:
INTRODUCING SHER FRERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed the actual hands-on treatment of all patients who, seeking my involvement, elected to travel to Las Vegas for my care. However, with the launching of Sher-Fertility Solutions (SFS), I will as of March 31st take on a new and expanded consultation role. Rather than having hands-on involvement with IVF procedures I will, through SFS, instead provide fertility consultations (via SKYPE) to the growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input , advice and guidance. In this way I will be able to be involved in overseeing the care, of numerous patients who previously, because they were unable to travel long distances to be treated by me, were unable to gain access to my input.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 for an appointment,enrolling online on my website, http://www.SherIVF.com, or 702-533-2691; or emailing Patti at concierge@SherIVF.com or . sher@sherivf.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

PLEASE HELP SPREAD THE WORD ABOUT SFS!

Geoff Sher

reply
Divya

Hi Dr Sher,
I had 2 embryo 5dt. First HCG was 15dp5dt at 1276. I’m waiting to get the next draw tomorrow at 17dpo. I just wanted to check if 1276 is a good number for 15dp5dt.

Thanks in advance..

reply
Kay

Hi Dr Sher,

I had two Day3 embryos transferred.

Hcg 10dp3dt 92
13dp3dt 364
16dp3dt 814
18dp3dt 1399

Is this still hopeful?

Thank you,
Kay

reply
Dr. Geoffrey Sher

I am guardedly optimistic for you.

Geoff Sher

Kat

Hi Dr. Sher,

I had an IUI done on 3/3/2019, and had blood work done on 3/15 and 3/18. The results are as follows:

12 dpiui: 39 HCG/ 24.4 Progesterone
15 dpiui: 168 HCG/ 32.18 Progesterone

The nurse said that these numbers are a low, which is making me worry about the viability of this pregnancy. What do you think?

reply
Dr. Geoffrey Sher

In my opinion they are fine!

ADDENDUM

Sher-Fertility Solutions (SFS) will be officially launched in April 2019. Through SFS I will provide fertility consultations (via SKYPE) to an ever-growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input and guidance.

In the past, I have limited my consultations with patients from afar to those who expressed a willingness to travel to Las Vegas for treatment by me. But now with the “birth” of SFS, all this is about to change. With one notable exception I will, as of April, 2019, no longer be conducting and performing hands-on IVF treatments. Rather, I will focus on providing SKYPE consultations and guidance to as many patients as possible. The one important exception will apply to approximately 1,000 existing patients who, following IVF previously performed by me, have remaining eggs or embryos stored (cryopreserved) at SIRM-LV and wish for me to perform their Frozen Embryo Transfers (FETs). I have agreed to accommodate such patients…..but only through August, 2019.

Patients will have ready access online, to SFS: by going to http://www.SherIVF.com; by phone (1-800-780-7437 or 702-533-2691) and via email (sher@sherivf.com or concierge@sherIVF.com). A onetime fee of $400.00, will provide enrollees with access to: a full review of all their medical records (+ assistance in requisitioning additional records, as needed); a comprehensive initial 1 hour, SKYPE consultation with me; additional SKYPE consultations (as might be required); a written medical report (which will include a recommended plan of action) that you can share with a Physician(s) of choice. I would, subject to your approval and a request by such Physician(s), also be willing to discuss your case with him/her/them. I will in due course post on my website, a list of Fertility Physicians in key locations all over the United States and abroad, whom I endorse and to whom I would be willing to direct SFS patients for subsequent treatment.

I have good news for those of you who are interested in traveling to Las Vegas for IVF. Dr Russel Foulk, Medical Director of SIRM-LV has expressed a willingness to be receptive to, treatment plans that I recommend for SFS patients Moreover, Dr Foulk has graciously agreed to interact with me during such treatments. I highly recommend Dr Foulk to those of you who, following consultation with me, wish to have me remain involved in the implementation of your treatment. This having been said, the final say in any management decision is always up to the treating physician.

It is both my objective and commitment to serve as a resource to SFS patients on complex RD issues such as: Unexplained IVF failure; Recurrent Pregnancy loss (RPL); Immunologic Implantation Dysfunction-IID; Genetic/chromosomal issues; effects of Diminished Ovarian Reserve (DOR) and advancing age on reproductive performance, etc.

I hope to ultimately expand the National and International reach of SFS, through my website (www.sherIVF.com) , through online webinars as well as Town hall- type consumer-based seminars, workshops and through social media. At the same time I will continue blogging on my website and doing bi-weekly Live-feed Facebook presentations (at “Dr Geoffrey Sher”) on a variety of subjects and topical issues.

For me this is a very exciting venture. Please become part of the SFS family and help spread the word!

I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

Geoff Sher

reply
Tina

Dr Sher, betas were : ( we did a 2 day transfer of 2 embryos on 4/9/19.

12dpt 141
14 dpt 273
17dpt 576

Will I miscarry?

reply
Kim

Hi Dr. Sher,

I had a FET of a blastcyst on Feb. 19. The first beta was on Feb. 28, and the hcg level came back at 66. I’ll be doing the 2nd beta tomorrow and hopefully it doubles. The nurse was telling me my hcg level was on the lower end, and that they wanted see at least 100 at 9 days post transfer – I’m just wondering if this is correct? Thank you for your time in advance!

reply
Dr. Geoffrey Sher

It all depends on the next beta hCG done 2 days after the last one. It needs gto diuble every 2 days at this stage.

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:
o 3 weeks LMP: 5 – 50 mIU/ml
o 4 weeks LMP: 5 – 426 mIU/ml
o 5 weeks LMP: 18 – 7,340 mIU/ml
o 6 weeks LMP: 1,080 – 56,500 mIU/ml
o 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
o 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:
o A recovering implantation, destined to develop into a clinical gestation
o A failing implantation (a chemical pregnancy)
o A multiple pregnancy which is spontaneously reducing (i.e., one or more of the concepti is being lost) or,
o 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.
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.

• A Fresh Look at the Indications for IVF
• 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
• Genetically Testing Embryos for IVF
• IVF Failure and Implantation Dysfunction:
• Management of Immunologic Implantation Dysfunction (IID).
• The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• Avoiding High Order Multiple Pregnancies (Triplets or Greater) with IVF
• The Role of Nutritional Supplements in Preparing for IVF
• Ectopic Pregnancy
• Molar pregnancies

ADDENDUM:
INTRODUCING SHER FRERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed the actual hands-on treatment of all patients who, seeking my involvement, elected to travel to Las Vegas for my care. However, with the launching of Sher-Fertility Solutions (SFS), I will as of March 31st take on a new and expanded consultation role. Rather than having hands-on involvement with IVF procedures I will, through SFS, instead provide fertility consultations (via SKYPE) to the growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input , advice and guidance. In this way I will be able to be involved in overseeing the care, of numerous patients who previously, because they were unable to travel long distances to be treated by me, were unable to gain access to my input.

Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 for an appointment,enrolling online on my website, http://www.SherIVF.com, or 702-533-2691; or emailing Patti at concierge@SherIVF.com or . sher@sherivf.com .

I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .

Geoff Sher

reply
Sowmya

Hello Dr Sher,

I had FET on 02/05/2019 with two blastocysts. Beta hcg value on 02/15/2019 is 43.4. Is that a good number . Can I hope that this will stick?

reply
Dr. Geoffrey Sher

It needs to double every 2 days during the early part of pregnancy. I suggest you repeat.

Good luck!

Geoff Sher

reply
NH

Good Afternoon, Dr. Sher:

My first HCG was 165 on 2/4 after transfer of a 5 day blastocyst on 1/24. On 2/6, HCG was at 203 and on 2/8, HCG was 309. I had a good start but the lack of doubling makes me concerned. What are your thoughts? Thank you.

reply
Dr. Geoffrey Sher

To be sure, this is somewhat disturbing, but only time will tell how it plays out. Be sure tom have your RE be on the look out for a possible Tubal (ectopic) pregnancy.

Good luck!

Geoff Sher

reply
Kathy

Hi Dr. Sher!

We transferred two 5 day embryos on 10/14.

8dpt beta 67.4
10dpt beta 105.8.

Only a 56% increase. What do you think? I’m very worried. Going back again in 48 hours.

Thank you!!!

reply
Jennifer

Hello Dr. Sher

I’m 5 weeks 2 days as a result of my 2nd IUI, and am 40 years old. Yesterday I had an ultrasound in which they saw a small gestational and yolk sac, but the nurse called later with my HCG levels and I noticed they have doubled only every 86 hours. She was not concerned and told me to come back in a week for an2nd ultrasound and my 4th HCG draw, but I’m incredibly nervous about my levels (below).

HCG LEVELS
77 Wednesday 1/30: 15dpiui
162 Friday, 2/1: 17dpiui
628 Friday, 2/8: 24dpiui

Should I request another HCG test earlier, or do you think I’m needlessly worried? This is my first pregnancy. Thank you so very much!

reply
Dr. Geoffrey Sher

I personally would give it a week and then repeat both the beta hCG test and the ultrasound.

Good luck and G-d bless!

Geoff Sher

reply
Kat

Hello Dr. Sher,
I recently recieved a positive pregnancy after first cycle of Follistim. I am also on endometrim 3x daily. My HCH levels are double up slightly, 1/23/19 -19, 1/30/19 -254, and 2/1/19- 456. I believe I am around 4-5 weeks. I had an ultrasound performed and there was nothing visible in the uterine cavity. My doctors believes that I may have an ectopic pregnancy due to the HCG levels not being normal. Should I be concerned?

reply
Dr. Geoffrey Sher

It is too early to exclude an intrauterine pregnancy in my opinion. Repeat the US in 1 week. In the interim, if you have any pain, light headedness or Rt shouklder tip pain, go straight to the ER …just in case it ia an ectopic.

Please let me know how things turn out.

Geoff sher

reply
Cmon

Hi Dr Sher,
I did an FET on 01\10\2019. 5 days blastocyst. On 1/21/2019 hcg was 697. Second hcg 01/25/2019 was 1693. Got a call from the nurse saying that the HCG should be higher. So I go back on the 01/29/2019 for another hcg and ultrasound. What are your thoughts please and thank you?!

reply
Dr. Geoffrey Sher

I am not really that concerned. I think things look relatively good still. But in truth, onlytime will tell.

Geoff Sher

reply
Ayla Sharp

Hi, I saw you responding to everyone and I had hoped to get some input. I’m in Alaska due to my husband being military so being able to talk to an actual specialist, is pretty much out of the question.

I am currently with my 4th pregnancy. About 5 weeks ish, as my LMP was Nov 22nd 2018.
I’ve miscarried twice, and have an 8 year old.

-My first pregnancy resulted in a D&C due to a “missed miscarriage” at 7/8 weeks when I was suppose to be 11/12 weeks.
-My second, I started severely cramping and heavily bleeding at 8 weeks, on saw slight heart beat, put me on progesterone and I now have an 8 year old.
-My 3rd pregnancy I miscarried at 8 weeks, I had to take medication to push things along as my body wasn’t fully doing it itself.

I had 3 different OBs suggest being put back on progesterone if I were to become pregnant again and one fertility specialist also agreed due to the one successful pregnancy I had was during taking progesterone.

I no longer have access to those people due to my husband being stationed here in Alaska.

Here I am, worrying about this pregnancy as I keep being told progesterone doesn’t do anything and testing progesterone levels is not necessary…

We have also been trying for 5 years (new marriage) and was told I may only be able to conceive with IVF, due to endometriosis.

I’ve had 3 beta HCG levels done.
—Dec 19th :(1-2 days before my missed period) my levels were 21.01
—Dec 21st : 50.19
—Dec 29th :(due to cramping at ER) my levels were 1558.

The ER dr kept saying she didn’t know how the levels correlated. She also said, she didn’t see ectopic, and she said the radiologist, saw what they believe was a yolk sac.

I’m confused about my levels and also, the use of progesterone and testing progesterone.
Also, they refuse to do anymore HCG levels although my miscarriages both had to be pushed along.

Please and thank you.
Thank you also for taking the time to answer these other women’s questions and concerns.
Not many drs go out of there way to reaaaally help or ease someone’s mind these days.

reply
Dr. Geoffrey Sher

Hi Ayla,

I agree with your doctor that measuring progesterone and supplementing with same, at this stage is unlikely to do any good. This having been said, your blood hcG level seems to be rising appropriately. Unfortunately however, it is too early to confirm a viable intrauterine pregnancy. You need to repeat the US in about 1 week for such confirmation.

I can only but imagine the anguish that you are currently experiencing but unfortunately only time will tell.

I am guardedly optimistic about this pregnancy and would appreciate it if you would keep me in the loop!

I wish you a happy 2019.

Geoff Sher

reply
Ayla Sharp

Hi, it’s Ayla Sharp again.
Giving an update. I had an ultrasound 5 days after the one in the ER that I had told you about. She couldn’t measure the heart rate and said I was about 6weeks and 1 day and saw a slight flicker and said that she thinks it’s the start of the cardiac activity.

Here I am a week later and another ultrasound… still worried.

reply
Dr. Geoffrey Sher

I would be somewhat optimistic based on that finding.

Good luck!

Geoff Sher

reply
Amanda

Fet cycle
8dp5dt hcg 6
10dp5dt hcg 14

Thoughts please?
My embryoys have been frozen for 4 yrs. Can that make it an extra dliw implanter or likely it’s just a chemical?

reply
Dr. Geoffrey Sher

That is a low starting hCG level. It could be a chemical but since the level has >doubled in 2 days, there is hope. Only time will tell.

Good luck!

Geoff Sher

reply
BA

Hi Dr. Sher,
I am 13 DP5DT and my first beta was 272 on 10 DPT followed by 648 on 12 DPT. I am thrilled with my hCG numbers, especially compared to past cycles, but my progesterone was only 11.8 at 10 DPT and 14.2 on 12 DPT. Would you be alarmed with that level? I am on daily PIO shots of 1 mL. They did not increase my progesterone for some reason. Thank you!

reply
Dr. Geoffrey Sher

No I would not be alarmed but keep up the hormone supplementation. I think this looks promising.

Good luck!

Geoff Sher

reply
BA

Thank you! I’m hoping so! Would you increase the progesterone supplementation (P4 15.2 @ 13dp5dt)?

reply
BA

Hello again, thank you for your advice! I requested a third beta test today and my number doubled again and is now over 1500, but my progesterone is now 8.6! Thank god I requested another check. They’re recommending twice daily Crinone now. At what point would you panic? Thank you!

Dr. Geoffrey Sher

I agree with the twice daily Crinone 8%. However, please bear in mind that vaginal progesterone is absorbed directly into the uterine circulation before passing into the general circulation. As such the level in the uterus is far higher than in the general circulation. Thus do not expect a significant rise in blood P4, recognizing that in this situation, uterine P4 may be at therapeutic levels without this being reflected in systemic blood P4….So don’t panic if blood levels do not rise much on this treatment.

Geoff Sher.

Stephanie

Had frozen embryo transfer with 2 frozen embryos on 12/4. First beta at 9dp5dt was 231. My 2nd beta at 13dp5dt came back at 1707. Is this high jump only 4 days apart cause for concern?

reply
Stephanie

Hi there, I had a 5 day transfer on 4th December. All my tests are showing positive but my first blood result was only 37 on 14th December. The nurse said it probably won’t result in pregnancy. Do I have any chance?

reply
Dr. Geoffrey Sher

I would repeat the beta hCG 2 days later. If it doubles at least, you still have a chance.

Good luck!

Geoff Sher

reply
Christy Ward

I had an Hcg of 110 at 4weeks 2days, hcg 250 at 4 w 4 d, then 508 at 4 weeks 6 days. Should I be concerned? Pregnancy with only Famera used.

reply
Dr. Geoffrey Sher

Please re-post the original question along with this. i cannot recall what the level was!

Geoff Sher

reply
Marisa

Hi Dr.,

I had a 5 day single embryo transfer on 11/18. My hcg levels have been: 11/27 207.3, 11/30 544.5, and 12/4 1600. My RE seems very concerned with my slowing doubling rate and wants me to come in for an ultrasound on 12/6. Do these hcg levels seem off to you? It also seems like 12/6 could be too soon to see anything on the ultrasound because I will only be 5wks2days.

Thanks in advance!

reply
Dr. Geoffrey Sher

I suspect all will be fine, but I suggest waiting to 6w-7w before doing an ultrasound to confirm the viability of the pregnancy.

Geoff Sher

reply
Crystal

Hello Dr!
I had two 5 day embryo transfer completed last week Tuesday (Oct. 16). I had my first beta HCG test done 8 days later on Wednesday, (Oct. 24th) and the result was 246. I had my second beta HCG test done today Friday, (Oct. 26th) and the result was 487. Not quite a “full” doubling so I will retest on Monday. Thoughts?

reply
Teresa

I was 4 weeks and 2 days on October 19 (based on the date of my IUI). My HCG level was at 29,448, then on Oct 22 it increased to 51,145. I did take Follistim, would that have any effect on why my HCG levels are so high for 4 weeks and 5 days? Those numbers look very high! If it’s not the Follistim, I am fearing the worst which is a molar pregnancy. Any advice or information would be great appreciated. Thank you!

reply
Dr. Geoffrey Sher

If you took the Pregnyl after you were already pregnant this could at least in part explain the high hCG level. But perhaps you are carrying twins. Have an US ASAP.

Good luck!

Geoff Sher

P.S. I don’t think it is molar.

reply
BP

Hi Dr. Sher,
What is your opinion on testing frozen embryos? I have nine left that I froze when I had just turned 36 and they have good ratings – most are one 1AA a few are slightly lower. I just had a chemical pregnancy after my first FET and I would rather avoid that again if possible, but I understand that it may be risky to the already frozen embryos. Thank you in advance!

reply
Dr. Geoffrey Sher

While pregnancies are reported through such secondary testing, it is my opinion that the thaw for biopsy…the refreeze to await a result and finally another thaw to transfer takes its toll and is ill-advised. I advise against it. Most importantly, testing will definitely not improve embryo quality. It is only a selection process.

Geoff Sher

reply
Naz

5 day frozen embryo transfer,
At 10 days hcg 553 and at 14 days (4 days later) 5833. Doubling rate 28 hours. Should I be concerned? We only transferred one?

reply
Dr. Geoffrey Sher

Likely one implanting but there is the possibility of it having split into 2 (uniovular twins).

Good luck and G-d bless!

Geoff Sher

reply
Danielle

We transferred two (2) fair quality Day 6 frozen blastocysts from a prior cycle on 8/13. My hcg level 7dpt6d was 25.9 (8/20). Retested on 8/27 (14dpt6d?) and the hcg level was 915. What are your thoughts on this rapid rise within 1 week?

reply
Jen

I’m concerned that at 12dp5dt hcg was 1302, then at 14dp5dt hcg was 2311. It was 46hrs in between blood draws. I’m almost 40, and we transferred 2 fresh untested “beautiful blasts.” We had 3 remaining blasts that we sent for PGS/frozen. Those results came back that only 1 of the 3 is normal. This makes me think that the odds for the current pregnancy aren’t so great if only 1 out of the remaining 3 is normal, coupled with the HCG that didn’t double. I’m 15dp5dt today, and scheduled for ultrasound at 19dp5dt.

reply
Dr. Geoffrey Sher

Hi Jen,

I understand your consternation. However, unfortunately the answer will have to wait for an ultrasound confirmation.

Good luck!

Geoff Sher

reply
Jen

Just an update- @19dp5dt- hcg was 15,660 E2- 2787 and P4- greater than 60. I was told to stop taking Estradiol at this point. 2 gestational sacs were found (one measuring 5w1d and the other 5w2d). Now we have to wait and see if both develop.

reply
Candice

I was wondering if you could give me your thoughts on my low hcg levels.
10 dpo- hcg 20, Prog 42
12 dpo- 34
14 dpo- 54
18 dpo- 149
20 dpo- 314
24 dpo- 1472
26 dpo- 1887
28 dpo- 3298
33 dpo- 6817
I have my first ultrasound in a week. Does this look promising? I’m concerned that the levels are low (even though they are considered normal on beta charts). Thank you for your time!

reply
Dr. Geoffrey Sher

It is an abnormal rise. Unfortunately you will have to wait for the ultrasound result!

But there is a chance….?

Geoff Sher

reply
BP

Hello Dr. Sher,
Thank you so much for your post about interpreting hCG results! This is a better explanation than I have gotten from my doctor and nurses! I am currently 10dP5dt with my first FET. I have had one loss last February after a Clomid cycle and positive tests and betas (although slow rising) up to 4 weeks, but nothing showing up on ultrasound followed by another loss after a spontaneous pregnancy in March, when we were able to see the sac on the ultrasound at 6 weeks, but nothing ever developed in the sac. We had the products of conception tested showing trisomy 16 for that loss. We had genetic blood testing, revealing nothing, and I also had recurrent loss testing revealing a “borderline” anticardiolipin AbIgm level of 16, for which I’m now on Lovenox (plus baby aspirin). We froze embryos two years ago and decided to use them now as we have six grade one AA embryos frozen! I got a positive HPT the night of 4DP5 DT and The lines have been getting darker every day, but my first Beta today at 10dp5dt was only 23.6. I know you need to know the rate of increase to be sure and I’m going in again in 2 days, but do you think there is still a chance? If so, is it only a small chance? My doctor’s office is not giving me much hope.

Thank you!

reply
BP

Forgot to mention – my progesterone was 11.9 today I am on twice daily Crinone and Pio shots every other day. They said that it is OK that my P4 was only 11.9 because the Crinone “does not show up in the blood“.

reply
Dr. Geoffrey Sher

The earliest and the most important indicator of IVF outcome is the blood beta hCG level. It is first measured about 10 days after egg retrieval with fresh (conventional) IVF, 10 days after ovulation in natural-cycle IVF and 10 days after initiating progesterone in embryo recipient cycles (frozen embryo transfer-FET; embryo donation; egg donation transfers; and embryo donation). The 1st measurement should be >10MIU/ml. This value should (roughly double every 48 hours until about 6 weeks into gestation and thereupon rises more slowly. Failure to follow this trend and sequence, usually is the result of failing implantation (a chemical pregnancy), an impending early miscarriage and in cases where the level continues to rise but erratically or slowly, could also indicate a tubal (ectopic pregnancy). If the level rises faster and more than doubles in the early stage of pregnancy, it could suggest a multiple gestation and if it sky-rockets upward to very high levels in the early stage of pregnancy it could suggest a molar pregnancy. In cases where the level starts high, then drops down for a day or two whereupon it resumes the doubling effect every 48 hours it may indicate that a multiple pregnancy has reduced spontaneously, to a singleton. In rare cases, the beta hCG might initially be undetectable or start off <5MIU/ml and thereupon start doubling appropriately, culminating in a viable pregnancy. This is why it is important to measure the hCG level at least twice before discounting a viable pregnancy being on the make.

Good luck!

Geoff Sher

reply
Elle

Hi Dr. Sher,
Asking for your help/opinion all the way from the Netherlands… We did a double FET (4BB and 2BB blastocyst) on 9/6/2018 and I received my first beta 8dp5dt, it was only 18. Didn’t expect anything very hopeful but got really surprised when my beta 11dp5dt turned out 140 and 13dp5dt 363. Should I be hopeful?

Kind regards, Elle

reply
Patel

Hello Dr

I have done fet this month. My first beta at 9dp5dt is 31. Second beta at 11dp5dt is 63. Progesterone level is around 20. I am so worried. Is this viable pregnancy?

reply
NIKO

Can clexane injection influence beta hcg test, depending on time blod was taken after this thetapy.. Meaning that after injection concentration can be a bit lower? Thank you

reply
Kiki

My beta 10 days past 5dt of 2 Perfect blasts was 998
5 days later it was 7,357.
Doubling rate of 41 hours.
Should I be worried about molar pregnancy? Is that even possible with IVF?

reply
Dr. Geoffrey Sher

Not really! However a multiple pregnancy is very possible!

Good luck!

Geoff Sher

reply
Kiki

Thank you Dr.! This is my first time being pregnant after 7 years of TTC and I think I am paranoid!

reply
Dora

sir LMP 1st July 2018, iui 13,14th July … but ruptured on 14th July with free fluid . July24th positive on clear blue preg test digital . 26th July beta HCG 82 repeat 28th July 252 … August 1st 696 … I’m worried about the last one . And August 1st early morning had very minimal brown discharge (very light brown) . Anything to worry . I’m on susten injection once a week and everyday susten tablet 300 mg … today 32days since LMP…

reply
Dr. Geoffrey Sher

I do not think…… so but I suggest you discuss with your RE.

Geoff Sher

reply
Trisha Ghosh

Hi I had a fresh cycle 5 day blastocyte transfer of two grade A quality on 16/04/2019 .I did a beta hcg on 25/04 /19 ,.It came out to be 3.48 miu/ml Is there any chance of viable pregnancy ?

Dr. Geoffrey Sher

Sadly, although possible, it is not likely to be a viable pregnancy! Repeat the hCG test in 2 days to see if the remotely possible becomes possible.

So sorry!

Geoff Sher

Kelli

I have just gone through my first ivf cycle (after 6 failed iui’s – 2chemical pregnancies over the past year) and received a beta of 45 at 7 dp5dt of a 3AA embryo. I know the doubling factor is what matters most, and I’ll be getting another beta tomorrow. What are your thoughts about a beta of 45 at this point? Thanks so much for your help!

reply
Kayte

Hello; 4th round of IVF; 5dt on 7/9/2018. First hcg was 14dp5dt 331 then exactly 48 hrs later 16dp5dt is 655. I go back in 2 days to do another beta test. Nurse doesn’t seem worried, BUT google has gotten the best of me, and I see ladies who are 5 weeks, like I am supposed to be today with numbers in 1000’s should I be worried?

reply
RS

Hi dr Sher.
I did a transfer of a day 6 blastocyst exactly one week ago and because of spotting had an early blood test this morning. The level came back as 6. Can you tell me if this is a chemical at this stage? I’ve been told to keep taking the medications and repeat the test on Friday (48 hours from now).

Your answer is so appreciated. Thank you in advance.

reply
Dr. Geoffrey Sher

You should repeat the hCG assay in 2 days. If it doubles (or better), you could still be in the running. However this is a very low level of hCG and it is quite likely that the pregnancy is not viable.

Geoff Sher

reply
April

Hi Dr. Sher,
I did a FET 5 day embryo transfer on 6/29/18. My first beta was (7/11/18) 141, 48 hrs later it was 323, 72 hours later 939.8 and then 72 hrs after that one it was 1572. Very concerned about this last one it did not double at 72 hours, i have another one on Monday 7/23/18. Have you seen where the beta slows down picks up again? Or could this mean i will miscarry. I am 5 weeks and 5 days

reply
Dr. Geoffrey Sher

I think this could still turn out fine. Have an ultrasound in 7-10 days.

Geoff Sher

reply
Melly

Good afternoon doctor, I just received a call today from my clinic 9days post FET. My beta came back at 5.8…they said it’s a very very low positive and to stop all meds immediately….do you think there is still hope? Should I ask them to check me again in 48 hours to see if my levels rise? Is this too low to ever end up in a viable pregnancy??? Ive been crying for the past 3 hours and am feeling hopeless…this would be my second failed IVf after going through failed IUIs and being on meds for a year now while ttc for about 2 and a half years….

reply
Dr. Geoffrey Sher

Respectfully, I would not stop meds. I would repeat the test in 2 days to see how it changes. If it >doubles you might still be OK!

G-d bless~!

Geoff sher

reply
Angela Oscarson

Good Morning Dr. Sher,

My husband and I had our 5 day 1 embryo transfer on 5 July, we did our first blood test on 13 July, 8dp5dt and our HCG level was 83. The nurse advised that this was a good sign that for the first test anything over 50 is a good level. We have our next HCG test on Monday the 16th, currently on progesterone suppository, No bleeding, nausea, occasional bloating and cramps and breast tenderness, but does this first HCG level seem okay or too low?

Thank you.

V/R,

Angela

reply
Maggie

I am 10dp5dt. One embryo. On days 7,8,9 HPT were all positives. Today, I took two (same brand as before and first urination of the day like before). Both came back negative. My blood test was this afternoon and my doctor called and said my HCG is low. He wants me to continue the meds for two days and redraw. I’m feeling very scared and anxious. I haven’t seen any positive literature on decreasing hcg. He didn’t give me the exact lab number but said it was pretty low. Thoughts? Thank you

reply
Dr. Geoffrey Sher

I share your concern but I would wait to see if the hCG doubles in the next two days!

Geoff Sher

reply
Lori

Hello doctor. I had 2 embryo 5dt. First HCG was 8dp5dt at 26. Went back 2 days later 10dp5t doubles to 67. Could this be a late implantation? I am a little worried. Tomorrow I will be testing again and that will be 14dp5dt. I have an US scheduled for end of next week. On day 9 past transfer I had a little bleeding and some spotting which didn’t last for more than an hour. Please give me your thoughts. Thank you so much!

reply
Dr. Geoffrey Sher

I am not overly concerned about your slight painless bleed. Time will be the determinant.

Good luck!

Geoff sher

reply
Alana

I had a very late starting hcg, but it has doubled more or less normally (I think!). It was 22 at 14dp5dt, then 136 at 18dp5dt, then 291 at 20dp5ft, 500 at 22dp5dt, and 1296 at 26dp5dt. I have been asked to come in for a scan in two weeks’ time, no more blood tests. I assume it will not end well, because of the low numbers (and why did it take so long to get started?). But others are saying it’s the doubling that counts and that this is fine. What do you think?

reply
Dr. Geoffrey Sher

It could still be OK. Have an US done in 1 week from now.

Geoff Sher

reply
Swetha

Hi Dr Sher,

My hcg level 10 days post IUI is 53. I’m waiting to get the next draw tomorrow at 12dpo. I just wanted to check if 53 is a good number for 10 days after IUI

reply
Swetha

Hi Dr Sher,
I got my results back from second blood draw at 13dpo and it is 140. Doubling time is 51.5 hours. I’m a little worried because the doubling time is usually less than 48 hours this early in pregnancy.
Thank you so much

reply
swetha

Hi Dr Sher,

Thank for your quick response. I really appreciate it.
I got my results from 15dpo and HCG is only 236. It increased from 140 to 236 in 48 hours. Now the doubling time is 63.5 hours. I’ve heard that 48-72 hours is ok but the doubling time is just increasing. I have another blood draw at 17dpo. I had a blighted ovum and a chemical pregnancy recently. Is there any hope at this point?

Dr. Geoffrey Sher

I would wait a week + andf do an ultrasound for an indication of viability!

Good luck!

Geoff Sher

swetha

Hi Dr Sher,
Thank you for your response. My doctor is not giving the ultrasound until atleast 2 weeks more. Following are my HCL levels. I’m listing them again for your reference
10 DPO 53
13DPO 140 (Doubling time 51 hours)
15DPO 236 (Doubling time 64 hours)
17DPO 592 (Doubling time 36 hours)
I will be going for another hcg tomorrow at 20DPO.
I would really appreciate if you can share your opinion based on my HCG levels.

Dr. Geoffrey Sher

Sorry Swetha,

Only time will tell!

Geoff Sher

Swetha

Hi Dr Sher,
I wanted to share an update. My hcg levels increased every 36 hours later on. We had an ultrasound today at 6 weeks 1 day. Doctor could see two sacs with fetal poles and heartbeats. Baby A had heart rate of 110 and baby B had heart rate of 105. Are these normal rates for 6 weeks 1 day ?

Dr. Geoffrey Sher

It is a little on the slow side but give it 1 more week and see. It could all turn out fine still!

Good luck!

Geoff Sher

Nicola

Sorry not sure what happened to my notes, here is the correct HCG/Blood work so far:
9 dpt: 12 HCG/ 9.0 Pro / 60 Pro / 118 Est.
15 dpt: will be taken in 2 days

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Nicola

9 dpt: 12 HCG / 9.0 Pro / less than 50 Est.

12 dpt: 23 HCG / 60+ Pro / 118 Est.

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Dr. Geoffrey Sher

That is a slow rise and in my opinion is of some concern . Follow up with hCG tests and in 2 weeks an ultrasound.

Geoff Sher

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Dr. Geoffrey Sher

That is different. I would need to see the new results when they are in.

Geoff Sher

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