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

Meg

Hi Dr Sher –
I had a 5d FET with a PGS tested embryo on October 15. On 9pt (14 dpo), I had an HCG of 150. On 13dpt (18 dpo), it was 902 (so doubling every 37 hours). I just had a third one this morning (15dpt/20dpo) and it came back at 1761, so now doubling every 49 hours. I’m worried that the doubling time has increased so significantly. Is it normal for doubling rates to slow down like this? I won’t have an ultrasound until next week (at 5w6d). My clinic is not worried but after two miscarriages (chromosomal), I am! Thank you so much for your time!

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Brittany

Dr. Sher,
At 5 weeks 3 days, my HCG quan was 4,035. My tech told me my sac was there but the yolk was very small.

My symptoms such as sore breasts and nausea have seem to subside and I can’t help but worry. Should I go back sooner to do a viability test or wait for my 1st OB at 7 weeks?

reply
Dr. Geoffrey Sher

I would wait for the 7 week US. It is too early at 5W.

Good luck!

Geoff Sher

Anon.

My little guy didn’t double in 48 hours and his first HCG was 65. And he was our successful cycle.

They’re so different.

I hope this is your take home baby.

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Desirae Schulze

Hi Dr. Sher! I’m currently pregnant from Gonal F, Ovidrel and IUI. I had 3 mature eggs that released confirmed by a follow up ultrasound 3dpiui showing 3 beautiful looking Corpus Luteums. My 10dpiui HCG was 30 with progesterone at 50.3 and my 13dpiui HCG was 243. My doubling time is 23.9 hours. I will go back for a repeat beta tomorrow at 15dpiui. Do you think it is just one or twins/triplets? Around where would you expect my beta to be 48 hours later if it was more than one? Thanks you in advance for your response!

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Dr. Geoffrey Sher

Hard to tell at this stage, but looking good so far…could be > 1 baby!

Good luck!

Geoff Sher

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Desirae Schulze

Morning Dr. Sher! I got my 3rd beta back from this morning. It went from 243 13dpiui to 700 15dpiui! Doubling time of 30 hours. I go for another one Friday. Do you think we could have two in there or still too early? Also when is the earliest you could see a gestational sac?

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Joanne Scalici

Hi I.am 9 dpt. Frozen First HCG 128. Will have another one Monday. Hope I am in a good place.

Desirae Schulze

Morning Dr. Sher! I just wanted to give you an update. I went in for an early ultrasound yesterday at 4w6d (20dpiui) and it was confirmed that we are having TWINS!! We were able to see both gestational sacs and the start of both yolk sacs as well. They were both measuring at 5w2d. Is it normal for them to measure a little ahead and if so is that a good or bad thing? We go back next week to see the heartbeats. Here are how my betas went:

10dpiui 30
13dpiui 243
15dpiui 700
17dpiui 1,476
20dpiui 4,448

I am 36 years old and have never had infertility issues until recently. I have a 14 and 2.5 year old sons conceived naturally. Our first IUI was a success earlier this year but ended in miscarriage due to Trisomy 15. My current pregnancy was from our 5th medicated IUI. Do you think all looks good so far and this could be a viable pregnancy? I’m so nervous now about losing one/both of them…

Dr. Geoffrey Sher

It looks very encouraging!

Good luck and G-d bless!

Geoff Sher

Mikaley P

Hi doctor.
I had my first prenatal apt yesterday and had a vaginal US done. Ultrasound confirmed I am 5 weeks pregnant. Saw a gestational sac, and a small yolk sac. After the test I have had vaginal bleeding followed with mild cramps. Bleeding kinda resembles a period when I go the bathroom. I had a HCG quantitative blood test done this evening- 1,044. Is this a promising number right now? Or am I experiencing a miscarriage. I haven’t been told if or when they want me to come back for more testing. I am very nervous and scared as this is my first pregnancy. Just looking for some advice! Thanks

reply
Dr. Geoffrey Sher

I would not be over concerned. The bleeding is likely due to contact cervical abrasion at the US and not from the uterus.

Good luck!

Geoff Sher

reply
LF

Hi Dr. Sher

We are using a Gestational Carrier due to implementation issues with myself. MFI with my husband. We are used PGS embryo’. Our GC miscarried last cycle with beta’s of 350,1033, 4031, all taken 3 days apart., never made it to ultrasound. This cycle her betas are 131 at 11DPT, 451 at 14 DPT, 792 at 16 DPT, and 1255 at 18 DPT. I am sure you cannot be sure without an U/S, which we are scheduled for in a few days and will likely know more, but are these numbers concerning? Doubling time is increasing as time went on.

reply
Dr. Geoffrey Sher

I wish I could reassure all is well, but without an ultrasound, but I simply cannot do so. I am however hopeful that all will turn out fine.

Please keep me in the loop!

Good luck!

Geoff Sher

reply
LF

Update: Scan yesterday showed Yolk sac and Fetal pole. No heart beat yet. Transfer was 20 days ago. 5 FET. Still concerned because of slow rising beta. Does this change our thinking or still too early?

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Dr. Geoffrey Sher

Still too early, I am afraid!

Repeat US in 1 week and then get back to mer.

Good luck!

Geoff Sher

reply
LF

Update: Heart Beat of 127 heard today and fetal pole measuring 7mm. We are exactly 6w5d today and looks in line to what our measurements are. Transfer was Oct. 10th.

LF

Update: HB today 127 bpm. Fetal pole 6.7mm. 6w5d with our transfer on Oct. 7th.

Do early beta’s matter once HB is found? Are we out of the woods yet?

Dr. Geoffrey Sher

It sounds as if you might be close to being out of the woods!

Good luck!

Geoff Sher

Susan

I had IVF FET 1 embryo. I had a hcg test at 13 days after the transfer with levels at 23. My clinic told me it was highly likely it is a chemical pregnancy. Does this level mean that I’ll have an inevitable miscarriage?

reply
Dr. Geoffrey Sher

It depends whether this was a cleaved embryo transfer on day 2-3 post fertilization or a blastocyst transfer on day 5-6. If the former, there could be hope. If the latter, then much less so!

Good luck!

Geoff Sher

reply
Miranda

Good afternoon,
I had 2 day 5 blasts (beautiful embryos) transferred on 10/9, had my day 12 post transfer HCG done on 10/21 and it was 577, repeat HCG done 10/23 and it was 1447, so I have 2 questions- first, could we be looking at twins? and second, do these higher levels help to indicate a good chance on ongoing pregnancy? Thank you so much!

reply
Dr. Geoffrey Sher

There is a chance of twins and yes, the high levels of hCG bode well for a good outcome!

Congratulations and good luck!`

Geoff Sher

reply
Ginu

My 4 cell embryos (2 of them) were transferred on 05OCT2019.

HCG test was on 19th OCT- 492
21OCT2019 (56 hrs) – 1871
24OCT2019(60hrs) -6,612

I am worried as the numbers seems to be more than tripling within 48-72 hours. Do you think this is a viable pregnancy or multiples?

Thank you!

reply
Tasha Jones

I transfer a fresh 5dt embryo. Midway lab my progesterone was 21.6 and Estradiol 581.. First beta was 191 , and progesterone 25 at 9dp5dt… Second beta is 321, progesterone 21, and Estradiol 1347. Should I be worried something a wrong?

reply
Lauren

Hello!
I had a two 3 day embryos transferred on October 8th. My first beta on October 18th was 369.9. My second beta on October 20th was 1044. I am now waiting for my first scan on November 1st. Do these look like singleton or twin numbers? Thank you!

reply
Shannon

Hi! I had a 5 day blast and 6day blast transferred on September 30. Got a positive FRER 4dpt. Beta levels tested today at 10dpt were 339.4. Could this be a twin pregnancy?

reply
Mayleenah

Hi,
i had a fresh 5 day embryo transfer on 09/26. first beta test was 10/07 which came back at a 5. dr had me stop PIO injections & suggested it was a chemical pregnancy. went back for another beta test on 10/10 which came back at 28. i was then instructed to restart the PIO injections that night. a couple hours prior to restarting the PIO injections, i started bleeding – dark & light amount. the next day it was heavy bleeding, still dark in color. lasted for a couple hours. i was then scheduled for another beta 10/12, which came back at 104. at this point in time i am having dark bleeding only noted when i wipe. next beta & US is scheduled for 10/18. i know beta results are supposed to double every 48-72hrs, but the bleeding is what is concerning to me. could this be a viable pregnancy or are my chances not looking too god?

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.
Notwithstanding, in virtually all cases the occurrence of early pregnancy vaginal bleeding congers concerns or even alarm regarding the possibility of miscarriage. And when this happens to women who conceived following infertility treatment, the alarm often turns into panic. However, the truth is that in most such cases the bleeding soon stops and the pregnancy proceeds unabated to the birth of a healthy baby. However, because some do progress and end in miscarriage, and in most cases, only time will tell how things will ultimately turn out, we use the term “threatened miscarriage” to describe such early bleeding. The term “inevitable miscarriage” is used once symptoms and signs confirm a miscarriage is in progress. The term “complete miscarriage” is used if all products of conception are passed, leaving the uterus “empty”. An “incomplete miscarriage” refers to cases where some products remain retained in the uterus.
Miscarriage: Mild painless vaginal bleeding (often referred to as “spotting”) is usually due to hormonally induced eversion of the glandular cells that line the inner cervical canal, such that erosion develops on the outer part of the cervix that protrudes onto the vagina. The everted glandular tissue is fragile and susceptible to contact trauma, brought about sexual penetration or the insertion of vaginal suppositories. Since such local bleeding does not involve the developing conceptus located inside the uterus it is almost always innocuous. The diagnosis of a local cause of bleeding requires visual inspection of the vagina and cervical inlet a speculum examination. Thereupon, provided that the pregnancy has advanced beyond 5-6 weeks, a concomitant sonogram could confirm the presence of an unaffected pregnancy. Patients are advised to be more careful in inserting vaginal suppositories and to avoid sexual penetration until the bleeding has stopped for at least 1 week.
Sometimes bleeding occurs behind the conceptus inside the uterus (retrochorionic bleeding). Some blood will usually track down through the cervix and into the vagina. A speculum examination will often reveal blood tracking into the vagina through the cervical canal and a sonogram will reveal the presence of a retrochorionic blood clot. Although such retrochorionic bleeding can become an inevitable miscarriage, it often abates and over time the blood clot in the uterus absorbs, and the pregnancy continues normally. Treatment involves careful observation, avoidance of aspirin and other non-steroidal anti-inflammatory medications, bed rest and avoidance of vaginal penetration until the condition stabilizes, is essential.
While mild painless vaginal bleeding is usually innocuous, bright red bleeding that increases in amount and is accompanied by escalating pain is another matter altogether. It often suggests an impending inevitable miscarriage.
Before the 7th week of pregnancy a normally rising blood hCG (pregnancy hormone) titers is a comforting indicator that the pregnancy is more than likely progressing normally. Likewise, the detection of a normal heartbeat detected by ultrasound examination done after the 7th week of pregnancy is a very reassuring finding. However, even such findings by no means exclude the possibility of an inevitable miscarriage.
The causes of a miscarriage are multiple and diverse. However in most cases it is due to the developing conceptus being chromosomally/genetically abnormal. However, early miscarriages that reoccur more than twice in a row (Recurrent Pregnancy Loss-RPL) often suggest of an underlying implantation problem that could be due to a poorly developed uterine lining (endometrium) or immunologic dysfunction involving activated immune cells known as uterine natural killer (NK) and/or T-cells. Treatment requires an accurate diagnosis of the cause and selective therapy.
An ectopic pregnancy must be excluded: .Bleeding in the first 2-3 months of pregnancy especially if associated with the sudden onset of acute abdominal pain that is aggravated by movement and is accompanied by right shoulder tip pain, and light headedness or fainting could point to a bleeding ectopic pregnancy (one that is located in a Fallopian tube, outside the uterus) . The condition can be life endangering and warrants an immediate trip to the hospital as it often requires emergency surgery.
Molar pregnancy: Molar pregnancies are due to rapid overgrowth of the trophoblastic tissue that forms the placenta. Although infrequent they can cause early vaginal bleeding in pregnancy. Bleeding from molar pregnancies is often present with typical bleeding which resembles “red currents floating in a red jelly”. Bleeding from a molar pregnancy can either painful or painless. The condition is often associated with severe vomiting in early pregnancy, disproportionate enlargement of the uterus, and very elevated blood levels of hCG. Ultrasound evaluation, often reveals a rather characteristic snow-storm like image.
Patients with vaginal bleeding are often told to stay in bed. While this might reduce visible blood loss, there is no tangible evidence that it will prevent a miscarriage. Unfortunately, there is no definite treatment for this kind of bleeding in the early stages of pregnancy. Alas, in most cases only time will provide the answer.

Good luck!

Geoff Sher
702-533-2691

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.
Notwithstanding, in virtually all cases the occurrence of early pregnancy vaginal bleeding congers concerns or even alarm regarding the possibility of miscarriage. And when this happens to women who conceived following infertility treatment, the alarm often turns into panic. However, the truth is that in most such cases the bleeding soon stops and the pregnancy proceeds unabated to the birth of a healthy baby. However, because some do progress and end in miscarriage, and in most cases, only time will tell how things will ultimately turn out, we use the term “threatened miscarriage” to describe such early bleeding. The term “inevitable miscarriage” is used once symptoms and signs confirm a miscarriage is in progress. The term “complete miscarriage” is used if all products of conception are passed, leaving the uterus “empty”. An “incomplete miscarriage” refers to cases where some products remain retained in the uterus.
Miscarriage: Mild painless vaginal bleeding (often referred to as “spotting”) is usually due to hormonally induced eversion of the glandular cells that line the inner cervical canal, such that erosion develops on the outer part of the cervix that protrudes onto the vagina. The everted glandular tissue is fragile and susceptible to contact trauma, brought about sexual penetration or the insertion of vaginal suppositories. Since such local bleeding does not involve the developing conceptus located inside the uterus it is almost always innocuous. The diagnosis of a local cause of bleeding requires visual inspection of the vagina and cervical inlet a speculum examination. Thereupon, provided that the pregnancy has advanced beyond 5-6 weeks, a concomitant sonogram could confirm the presence of an unaffected pregnancy. Patients are advised to be more careful in inserting vaginal suppositories and to avoid sexual penetration until the bleeding has stopped for at least 1 week.
Sometimes bleeding occurs behind the conceptus inside the uterus (retrochorionic bleeding). Some blood will usually track down through the cervix and into the vagina. A speculum examination will often reveal blood tracking into the vagina through the cervical canal and a sonogram will reveal the presence of a retrochorionic blood clot. Although such retrochorionic bleeding can become an inevitable miscarriage, it often abates and over time the blood clot in the uterus absorbs, and the pregnancy continues normally. Treatment involves careful observation, avoidance of aspirin and other non-steroidal anti-inflammatory medications, bed rest and avoidance of vaginal penetration until the condition stabilizes, is essential.
While mild painless vaginal bleeding is usually innocuous, bright red bleeding that increases in amount and is accompanied by escalating pain is another matter altogether. It often suggests an impending inevitable miscarriage.
Before the 7th week of pregnancy a normally rising blood hCG (pregnancy hormone) titers is a comforting indicator that the pregnancy is more than likely progressing normally. Likewise, the detection of a normal heartbeat detected by ultrasound examination done after the 7th week of pregnancy is a very reassuring finding. However, even such findings by no means exclude the possibility of an inevitable miscarriage.
The causes of a miscarriage are multiple and diverse. However in most cases it is due to the developing conceptus being chromosomally/genetically abnormal. However, early miscarriages that reoccur more than twice in a row (Recurrent Pregnancy Loss-RPL) often suggest of an underlying implantation problem that could be due to a poorly developed uterine lining (endometrium) or immunologic dysfunction involving activated immune cells known as uterine natural killer (NK) and/or T-cells. Treatment requires an accurate diagnosis of the cause and selective therapy.
An ectopic pregnancy must be excluded: .Bleeding in the first 2-3 months of pregnancy especially if associated with the sudden onset of acute abdominal pain that is aggravated by movement and is accompanied by right shoulder tip pain, and light headedness or fainting could point to a bleeding ectopic pregnancy (one that is located in a Fallopian tube, outside the uterus) . The condition can be life endangering and warrants an immediate trip to the hospital as it often requires emergency surgery.
Molar pregnancy: Molar pregnancies are due to rapid overgrowth of the trophoblastic tissue that forms the placenta. Although infrequent they can cause early vaginal bleeding in pregnancy. Bleeding from molar pregnancies is often present with typical bleeding which resembles “red currents floating in a red jelly”. Bleeding from a molar pregnancy can either painful or painless. The condition is often associated with severe vomiting in early pregnancy, disproportionate enlargement of the uterus, and very elevated blood levels of hCG. Ultrasound evaluation, often reveals a rather characteristic snow-storm like image.
Patients with vaginal bleeding are often told to stay in bed. While this might reduce visible blood loss, there is no tangible evidence that it will prevent a miscarriage. Unfortunately, there is no definite treatment for this kind of bleeding in the early stages of pregnancy. Alas, in most cases only time will provide the answer.

Good luck!

Geoff Sher

reply
Amanda

Hello Dr. Sher,

I had 5 day early blastocyst transferred on September 25. I went for my first Beta on October 6 and it was positive at 31. Second beta was 2 days later and was 68. I’ve had some abnormal brown bleeding since October 2. My clinic said I have about a 1-2% chance of this resulting in a viable pregnancy. I go back for another beta test tomorrow morning (October 10). Can you provide some input? Thank you.

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Dr. Geoffrey Sher

Respectfully, I differ with that opinion.

As long as the beta keeps doubling (or better) every 2 days at this stage of pregnancy there is a reasonable chance of success. Ultimately, an Ultrasound done about 2-3 weeks from would be definitive.

Good like!

Geoff Sher

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Linda

I had my 5 day fresh embryo blastocyst(2 of them placed) transfer on 9/24 and had my first beta hcg test on 10/4 with a level of 140.6. I go back for another test on 10/8. Does 140 for a first beta look promising?

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Diane M

Hi there – I had a 5 day FET. I had back pain about 9 days after the transfer resulting in some bleeding. When I went in for my pregnancy blood test – it was negative (below 5) I came back in to begin next cycle but the beta went up to 5.3 a few days later 8.7 a few days after 13 and now (2 days later) at 46.6. Doctors are doing “wait and see” in the hopes that this ends in biochemical and does not need methotrexate. Do you think this is early ectopic? Any possibility this will end in a viable pregnancy?

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Dr. Geoffrey Sher

Unfortunately, only time will tell.

Sorry In cannot give you a definitive answer.

Geoff Sher

reply
Dee

Hi,
I had a 5 day FET on 9/21 and got my first beta results today, 11dp5dt, with levels being 508.

Could this be a twin pregnancy?

Thanks in advance,

reply
Dee

Thank you for the response. I guess i can’t know for sure until my scan but today on 13dp5dt my levels are 1035 🙂

reply
Karla

Hi
I am 5 weeks pregnant today 9/30/19 I had A serum test on 9/16/19 which was negative . But a couple days before that I had 3 faint positive home pregnancy test.
I went back to the doctors to get my blood drawn For the hcg quantitive

9/23/19 hcg 225

9/25/19 hcg 575

9/30/19 hcg 6473

Two concerns
I don’t know why I’m so worried with this pregnancy that something will go wrong my last one was 7 years ago.
I do suffer from anxiety could it be that ?

Second concern/ thought could I be having twins ? I’ve had terrible heart burn very early and also SUPER fatigued !

Thank you for your time .

reply
Dr. Geoffrey Sher

I am quite optimistic but it is more likely to be a single implantation.

Geoff Sher

reply
Rhonda

Hello,
I had a 3day FET transfer on Sept 6, 2019. On Sept 16 (10dp3dt) my hcg was 27. At 12dp3dt my hcg was 53. Do these levels look low, or is it most important that the levels double every 2 days? I had implantation bleeding (I think) on 9/13/19. Could the lower levels be due to late implantation or can this be considered normal for the amount of time that has lapsed?
9/6/2019 2-grade A 3 day embryos transferred
9/16/2019 HCG 27
9/18/2019 HCG 53 (blood drawn slightly less than 48 hrs apart)

reply
Dr. Geoffrey Sher

I think it looks promising especially given that the first blood was drawn 10 days following a day-3 transfer.

Geoff Sher

reply
Vincent Ventimiglia

Dr Sher,

Perhaps you can clarify. Our fertility specialist has given us some guidance that confuses me. Our first HCG test was September 13th with a level of 355. Our second HCG test was 48 hours later on September 15th with a level of 1,100. Tomorrow is our next test (September 20th) and he said he wants to see at least 1,650 level. Wouldn’t that be extremely low considering levels should double every 48 hours and with that much time since the last test a score that low would mean failed pregnancy ?

reply
Dr. Geoffrey Sher

I would agree with you. I would want to see as doubling of the level 48nhrs after the last one.

Geoff Sher

reply
Tom

Hi Dr. Sher,

My wife and I had two rounds of IVF stimulation and three transfers that all were negative. We were waiting to start our next round of stims when we conceived naturally. Got a positive HPT on what we think was 16dpo, first beta the next day was 656, then 48 hrs later it was 1742. First US this Friday 9/20. I know the US is the real test, but how would you interpret these numbers? Have you seen similar numbers end up in MC? Just scared from the IVF failures.

Thank you!

reply
Dr. Geoffrey Sher

Miscarriage is always a possibility with any conception, but quite honestly, these beta hCG values seem solid to me and provide reason for optimism.

Good luck!

Geoff Sher

reply
Vincent V.

Hello Dr. Sher,

We performed FET with a 5 days Blast on 9/4/19, We had our first blood HCG test on 9/13/19 and got back a number of 355, tested again 48 hours later on 9/15/19 and the number came in at 1,100. We previously had a chemical only pregnancy but the numbers where far lower so even though this seems positive we are still worried should this be cause of concern?

reply
RMG

Hi Dr. Sher, We did a FET of 5-day blast on 8/26. HCG on 10dpt was 98 and 12dpt was 230. We are going in for confirmation US on 9/19 (6w1dpo).

Curious if okay process (and numbers) or if we should have done additional HCG before US.

reply
ebony

Dr.,
I had a beta of12.89 at 11dp5dt and at 16dp5dt my beta was 90. How do these numbers look to you? I expected higher numbers this long after the transfer.

reply
Brett

Hi! My wife had a 5AA (5 day frozen transfer) transferred on 9/16. On 9/23 (7dpt) her beta hcg was 83. On 9/25 (9dpt) her hcg was 177. Is this normal or high? Could it be twins?

reply
Hanna

Hello Dr Sher,
I had my hcg tested at 14 DPO and it was 110 and then at 16 DPO it was 180.
My progesterone is 54 nmol/l.
What are my chances of having viable pregnancy?
Thank you

reply
Dr. Geoffrey Sher

While on face value this does not look very good, I could be wrong. Repeat the beta hCG i 2 days. It needs to double.

Geoff Sher

reply
Hanna

Dr Sher,

Thank you for your response.
I tested hcg again on 20dpo and it is 540. Am I out of the woods or shall I keep testing?

reply
TARA

I am 11 DPO today and was able to turn a faint positive on a urine test for the first time. I had blood work done today as well and my HCG was only 7. I am feeling discouraged.

reply
Justine Bond

Hi Dr Geoff,

At 16 DPO my HCG was 24. Then 40 hours later is was 72. Is this promising that it tripled in 40 hours or still too low to be viable? Thanks so much 🙂

reply
Brandi

I am 5 weeks 0 days today. My HCG was 10.5 on 10/15, hcg 22.2 on 10/17, on 10/21 hcg 46. Is this promising with such low hcg levels? My progesterone was 4.9 on 10/5 and I am on progesterone oral 100mg three times daily. Thank you.

reply
Dr. Geoffrey Sher

I am afraid only time will tell. Do an ultyrasound in about 2w.

Good luck!

Geoff Sher

reply
Joann

5weeks
Hcg 109 to 413 over 48 hours
Progesterone 7.7
Doctor isn’t worried. Should I ask for progesterone prescription?

reply
Dr. Geoffrey Sher

If this was intramuscular progesterone administration, then perhaps yes! If it was by way of vaginally administered progesterone , then perhaps not. Discuss with your personal RE.

Geoff Sher

reply
Katie

Had a positive pregnancy test at 9DPO. At 14 days HCG blood levels were 219. Today at 16 days HCG is at 455. I did Gonal F with Ovidrel to trigger. Do you think this looks like one or two? Hoping for just one!!

reply
Dr. Geoffrey Sher

The banding techniques fall into two principal groups: 1) those resulting in bands distributed along the length of the whole chromosome, such as G-, Q- and R-bands and 2) those that stain a restricted number of specific bands or structure.

Geoff Sher

reply
Ash

Dear Dr,
My HCG was 38 at 13DPO, 70 at 15DPO, and 297 at 22DPO- I’m progressing around 61% every 48 hours- how does this look?

reply
Dr. Geoffrey Sher

It is concerning but there is hope and only time will tell, I am afraid.

Geoff Sher

reply
Cindy

Hello I did IUI with 3 eggs measuring 24mm 19mm and 14 mm at trigger and home pregnancy test at 10 dpo was positive 14 dpo hcg was 273 and 16 dpo is 558 does it look like a singleton number or multiple?

reply
Dr. Geoffrey Sher

cant be sure, but it looks like a singleton to me!

Geoff Sher

Julie

Hi Dr.

9dp5dt beta was 70.4
11dp5dt beta was 132.4

What are your thoughts? I cant Help but worry.

reply
Julie

Thank you. 13dp was 282 and 15dp was 569. Ultrasound is next week. Fingers crossed.

reply
Soph

Hi!

My first beta 10dpt was 62
Second beta at 13dpt was 174
Third beta at 15dpt was 379

How are these?

Candace

35yrs old, 4 children, 2 miscarriages. Last pregnancy was a miscarriage D&C completed 6.28.19. First cycle after D&C I became pregnant.

Could the below information possibly be twins??!

LMP: 7-31-19
Ovulated: 8-15-19
Positive Hpt: 8-25-19
8-26-19 @ 5pm 11dpo Hcg 22
.. 48hr later ….
8-28-19 @ 5pm 13dpo Hcg 102
…. 21.9 doubling time ….
9-01-19 @ 2pm 17dpo Hcg 764
….32hr doubling time….

9-01-19 Progesterone 13.4ng/ml (42.6nmol/l)

reply
Taisha Escribano

Hi Dr – I’ve been a ball of nerves on a beta roller coaster. It was an FET 5Day Top Quality Blast.

My betas are :

9DP5DT- 15
12DP5DT – 77
14DP5DT- 191
16DP5DT – 522

At this point I’m staying positive but realistic. Very hard to get excited yet as that low initial bet worries me a lot.

Any thoughts? Is it possible to have a healthy pregnancy come out of this?

Thank you in advance!

reply
Jackie

Hi Dr Sher,
I had a 5dt of an early blast. Had my first blood test today (9dp5dt) and pregnancy hormone level was 11. They said they would expect it to be around 25 on this day.
Is there any hope at all that this might still work?

reply
Dr. Geoffrey Sher

Hi Jackie,

A lot will depend on how the hCG level rises from here on out. It needs to roughly double every 2 days at this early stage of pregnancy.

Good luck!

Geoff Sher

reply
Janie

Hi Dr. Sher. I am 5dp5dt on an FET cycle with a 3aa blast. My estrogen levels were 327 at transfer and have decreased to 180 as of today, though I am on the same dose of estradiol patches. My progesterone is 37. I have my quantitative hcg this Friday. Should I be concerned about the mid-luteal decrease in estrogen?? Thanks for your time!!

reply
Dr. Geoffrey Sher

It could simply be an E2 patch absorption ..issue. I would not be over-concerned but I would report this to your RE, in case he/she wished to double the patch administrations.

Good luck!

Geoff Sher

reply
Lily

Hi Dr Sher,
I had a day3 embryo transfer on 7/24.
HCG levels are
14 days after transfer(8/7): 998
16 days after transfer(8/9): 3352
My nurse said it is a good result. But I found these numbers look higher than what I saw online. What is your opinion? Are these numbers too high?
Thank you very much!

reply
Kasha

Dr. Sher, I had a 5 day hatching blastocyst transferred on 7/20. Had my first beta done today 7/29 and my level was 45 I have another test on 8/1 to see if it increases. Is that number ok for a 9dpt ? Also my progesterone level was 8, I was told to increase my progesterone suppositories from 2 to 3. Should I be concerned? Thank you in advance for your help.

reply
Dr. Geoffrey Sher

It is OK but the level needs to double in 2 days! Then an ultrasound performed 2-3 weeks later should be definitive.

Good luck!

Geoff Sher

reply
Sueann

Hi Dr Sher,

I did a fresh ivf cycle and did a 5 day blastocyst transfer on 16/7. I went for my first beta today on 29/7 and my hcg reading was at 74. I’m asked to go back for another beta test 2 days later. I’m already at 13dp5dt and getting worried at the low hcg level. Could this be a late implanter?

reply
Dr. Geoffrey Sher

Wait and see what the next level is. If it is better than 150, it should be promising.

Good luck!

Geoff Sher

reply
Sueann

Hi Dr Sher,

Went for my 2nd beta today and hcg level was 157. It did double up so I’m still keeping my hopes up. Next beta will be on 6th August. Any words of assurance please?

reply
Veronica

Hi Dr, I did a 5 day blastocyst transfer on 12/14 and my first beta was 11dp5dt on 12/25 Which came back showing my hcg at 20 Dr. Told me to stop progesterone and wait for my period because I have a chemical pregnancy but to do a second beta test. I went back today 12/28 14days post transfer and hcg is came back at 80, I was told to do another beta on 10/30 and to do an ultrasound because it might be an ectopic pregnancy or a bad or pregnancy , do you think I have any hope that this could work out?

reply
Dr. Geoffrey Sher

These are low levels, but it looks as if the hCG level did double in 48 hrs. I would repeat the beta on the 29th. It should be >300 for you to be in the running here.

Good luck!

Geoff Sher

reply
Fay

Hi Dr

My hcg on the the 17th July was 8654
The on the 19th July (23 dpo) was 14461 and then on the 26th (30 dpo) was 31777
Should I be expecting the worse. My dr can’t call me for another few days and the nurses don’t have answers. I read after a certain level it takes longer to double. Super worried as I had a chemical last month.

reply
Dr. Geoffrey Sher

This actually looks quite promising. It is time for a confirmatory ultrasound examination.

Good luck!

Geoff Sher

reply
Samantha

Hi Doctor! Can you tell me if my levels are good?
I had a 6 day FET.
At 10 days post transfer /16dpo HcG was 119
At 13 days post transfer/ 19dpo HcG was 406
At 15 days post transfer/ 21dpo HcG was 820

Are these good numbers?

Thank you!

reply
Heena

Hi doctor,

I had 3 – 3day fet (all 8 cell).
I tested positive on 10dp transfer. My beta was as follows:

11dp3dt 193.64
13dp3dt 488.80

I have the next one scheduled at 15 days?

Do you think these numbers are indicative of twins?

reply
Dr. Geoffrey Sher

No I do not, but it looks like a potentially healthy and promising implantation.

Good luck and G-d bless!

Geoff Sher

reply
christina

Dr. Sher,
I had an IUI 15 days ago using femara and ovridel… also doing progestrone supp twice a day. my BETA was 5.5 yesterday. Its being redone tomorrow. Doesn’t look good right?

thanks

reply
Dr. Geoffrey Sher

I am afraid it does not look very encouraging. However follow-up beta hCG’s should be done.

Hang in there!

Geoff Sher

reply
Marie

Hello,
We had a FET of two 5 day blasts on July 9th
We just had the second beta done 72 hours after the first and the nurse is optimistic but I am concerned that it did not double in 48hrs. Going back for a repeat beta in 2 days but can you shed some light on if there is still a good chance for a viable pregnancy?

10dp5dt- 297
13dp5dt- 690

Thanks!

reply
Marie

Hello thank you for your response! I had another blood draw today at 15dp5dt which was 1284 so still not quite doubling but better. What do you think? My dr wants to wait for ultrasound in two weeks

reply
Dr. Geoffrey Sher

I think an US within 1 week should be definitive.

Good luck!

Geoff Sher

reply
Angelique

Hello, I was getting ready for my third transfer and got pregnant naturally! This is my 4th pregnancy in two years. One was a PUL (natural), second was an IUI (chemical), third was just last month and ended as a chemical as well. My clinic drew my levels for this one and 12dpo my level was 122 and 14dpo it was 207. I’m ver nervous as it didn’t quite double in 48 hours…what are your thoughts?

Thank you for your time!

reply
Angelique

Dr. Sher,

I so appreciate your optimistic and prompt response! I really needed to hear this as I’ve been so worried over these numbers. They are drawing me again Monday. Thank you SO much!

reply
Dr. Geoffrey Sher

You are very welcome Angelique!

Good luck!

Geoff Sher.

Angelique

Hello Dr. Sher,

I got my results back. It came back at 562. My numbers are now:

8/13 (12dpo): 122
8/15 (14dpo): 207
8/19 (18dpo): 562

What do you make of this? Is this another failed pregnancy? Im starting to think I won’t be able to have kids after 4 failures…

Dr. Geoffrey Sher

Wait 1 week and do an US.

It could still be OK!

Geoff Sher

Angelique

Dr. Sher,

We did another HCG today and now I’m at 2993! We have an ultrasound on Monday! We are shocked! What could explain the slower doubling levels earlier on and now having such a huge jump?

Dr. Geoffrey Sher

I told you so!

Good luck!

Please keep me in the loop!

Geoff Sher

Angelique

Hello Dr. Sher,

We went in for my US and we saw the gestational sac and yolk sac! The doctor said it was perfect for how far along I am (5w4d). We will be going back in again in two weeks to check for the fetal heart beat! I feel like I can take a breath for now.

Dr. Geoffrey Sher

Told you so!…… But it is a little early for absolute certainty.

Good luck!

Geoff Sher

Angelique

Dr. Sher,

Just an update: I went in at 7w4d and we saw and heard the little one’s heartbeat going at 157! We even saw the baby move twice! It was pure magic! The baby is measuring a little ahead at 8w. Thanks again for your encouragement. It’s been a tough road.

Sincerely,
Angelique

Dr. Geoffrey Sher

I am delighted for you Angelique!

Good luck and G-d bless!

Geoff Sher

Ian

Hi Dr. Sher,
I’m concerned about my wife’s hCG doubling time. On the first test it was 867 at 34 days since LMP, and on the second it was 1229 at 37 days since LMP. We’ve had unsuccessful IVFs in the past, and this is on a natural conception. Can hCG go up in a somewhat “staggered” fashion? Is the increase time different for natural vs IVF pregnancies? Any insights would be much appreciated.

reply
Dr. Geoffrey Sher

I understand your concern. Repeat the hCG at 2 day intervals and see if it picks up!

Good luck!

Geoff Sher

reply
Ian

Thanks Dr Sher. I really appreciate your prompt reply. It gives us some hope. I was hoping you could answer a few more questions

1) Do hCG levels and changes in hCG levels differ between IVF, IUI and naturally-conceived pregnancies?

2) Does our current level of hCG at 1229 on its own give any indications (positive or negative) based on being 37 days since LMP (we estimate we’re 21-25 days post ovulation). Or is the trend of changing hCG the only thing that matters (867 to 1229 over 3 days)

3) If I understand right, our rate of hCG increase (~27% every 48 hours) is not in the normal range. Is there reason to remain hopeful if slow rising hCG does pick-up to some threshold level of increase? Say >50% on the next test in two days?

4) When does it generally become concerning if hCG continues to climb, but below the normal range of increase?

5) Does or can progesterone supplementation through injections (or suppositories) affect hCG and the rate of increase?

Thanks again for your thoughtful responses

reply
Dr. Geoffrey Sher

1) Do hCG levels and changes in hCG levels differ between IVF, IUI and naturally-conceived pregnancies?

A: not necessarily.

2) Does our current level of hCG at 1229 on its own give any indications (positive or negative) based on being 37 days since LMP (we estimate we’re 21-25 days post ovulation). Or is the trend of changing hCG the only thing that matters (867 to 1229 over 3 days)

A: Although the rise is somewhat slowish , it could be that you started off with a single conceptus and one is in the process of absorbing.

3) If I understand right, our rate of hCG increase (~27% every 48 hours) is not in the normal range. Is there reason to remain hopeful if slow rising hCG does pick-up to some threshold level of increase? Say >50% on the next test in two days?

A: Same as #2 above

4) When does it generally become concerning if hCG continues to climb, but below the normal range of increase?

A: If OK, it should start to rise at the normal rate over the next few days. But ultimately, if it rises slowly, an ultrasound should be definitive in about a week or so.

5) Does or can progesterone supplementation through injections (or suppositories) affect hCG and the rate of increase?

A: Unlikely, I am afraid!

Good luck!

Geoff Sher

reply
Ian

Hi Dr. Sher,
We just received another hcg test result today. So far our results are as follows
July 10th 867
July 13th 1229
July 15th 1515

Is this cause for concern?

Thanks for any insights

Dr. Geoffrey Sher

I am afraid so! You need an ultrasound examination in about a week. If no intrauterine gestational sac is seen, your doctor needs to keep an eye out for a possible ectopic pregnancy!

Good luck!

Geoff Sher

Ian

Hi again Dr. Sher,
Sorry I forget to include in my post above that her progesterone result on July 15th was 170.3 nmol/L (when hcg was 1515). She is currently on progesterone injections (100mg dose through progesterone in oil).

Could this have an effect?

Dr. Geoffrey Sher

Copy and thanks!. That does not change my comment though!

Good luck!

Geoff Sher

Ian

Hi Dr Sher,
Thanks for answering all my questions. Its helped my wife and I get through a difficult time. We had an ultrasound on Monday that showed a intrauterine gestational sac, but the hcg levels remain plateaued around 1500.
Here’s a recap:
July 10th 867
July 13th 1229
July 15th 1515
July 17th 1450ish (different lab and don’t have exact value) + U/S showed intrauterine gestational sac
July 19th 1568

We’ve another hcg test and U/S scheduled for July 22nd

Are these results predictive of anything?

Dr. Geoffrey Sher

It says that implantation has occured and that it is an intrauterine gestation. An US this coming week should be definitive as to whether it is a viable pregnancy or not

Good luck!

Geoff Sher

Natalie

Hi Dr.
What are your thoughts on the following scenario: I did a HPT on June 26th and it was positive. On the 27th I went to have a blood draw because my doctor wanted to monitor me early; this is following an ectopic pregnancy where I had to get one tube removed. My levels have been:
6/27 – 27
6/29 – 90
7/2 – 314
7/5 – 540
7/8 – 1282
7/10 – 1968
7/12 – 2986
I went in for an internal and external sonogram on 7/11 and there was no evidence of a gestational sac or yolk sac. The endometrium and the doctor at the imaging center mentioned it looked homogenous. The results are still increasing at a similar rate, but not doubling. Thoughts? Thank in advance.

reply
Dr. Geoffrey Sher

Hi Natalie,

This is somewhat concerning. There should be evidence of a sac. Your doctor needs to be on the lookout for an ectopic pregnancy. If the levels of hCG keep rising for another few days and still no evidence of an intrauterine pregnancy, I would suggest the diagnosis of an ectopic and begin methotrexate therapy.

Approximately 1 out of every 100 embryos will implant and grow outside of the uterine cavity (almost always) in a fallopian tube. This is defined as an ectopic pregnancy. Infrequently, an ectopic pregnancy attaches to an ovary or to one or more other pelvic organs. On very rare occasions (1;1,000), one twin attaches and grows in the uterine cavity with the other growing outside the uterus (i.e. a heterotopic pregnancy).
There is an ever present risk that a tubal (ectopic) pregnancy might rupture causing potentially catastrophic internal hemorrhage. Accordingly any symptoms suggesting that such bleeding has started, requires immediate confirmation of the diagnosis followed by emergency treatment.
While on rare occasions, an extrauterine (ectopic) can proceed well into pregnancy, it almost always happens prior to the 8th week. There is an increase in the incidence of ectopic pregnancy after IVF conceptions where it reportedly occurs in about 3% of cases and a woman who has had one ectopic pregnancy has almost four times as great a risk of an ectopic in a future pregnancy. In fact with every subsequent ectopic this risk of a recurrence increases dramatically.

The fertilization of the human egg normally takes place in the fallopian tube. The embryo then travels into the uterus, where it implants into the endometrial lining 5-6 days after ovulation. Anything that delays the passage of the embryo down the fallopian tube can result in the embryo hatching and sending its “root system” into the wall of the fallopian tube and initiating growth within the tube. One of the most common predisposing factors is pelvic inflammatory disease (PID) in which microorganisms, such as Chlamydia, and Gonococcus damage the inner lining (endosalpinx) and eventually also the muscular walls of the tube(s) by the formation of scar tissue. The endosalpinx has a very complex and delicate internal architecture, with small hairs and secretions that help to propel the embryo toward the uterine cavity. Once damaged, this lining can never regenerate. This is one of the reasons why women who manage to conceive following surgery to unblock fallopian tubes damaged by PID, have about a 1:4 chance of a subsequent pregnancy developing within the fallopian tube (ectopic).

Congenital malformations of the fallopian tube, associated with shortening of, or small pockets and side channels within, the tube are capable of interrupting the smooth passage of the embryo down the fallopian tube, is another cause of an ectopic pregnancy.

Since the lining of the fallopian tube does not represent an optimal site for healthy implantation, a large percentage of pregnancies that gain early attachment to its inner lining will usually be absorbed before the woman even knows that she is pregnant. This is often referred to as a tubal abortion.

The advent of advanced sonographic and hormonal monitoring technology now makes it possible to detect an ectopic pregnancy much earlier than previously, …usually well in advance of it rupturing. A decade or two ago, the diagnosis of an ectopic pregnancy, ruptured or not, was an indication for immediate laparotomy to avoid the risk of catastrophic hemorrhagic shock. This often resulted in the affected fallopian tube having to be completely removed, sometimes along with the adjacent ovary. In the late 1980’s, early conservative surgical intervention by laparoscopy began replacing laparotomy (a wide incision made in the abdominal wall) for the treatment of ectopic pregnancy, often allowing the affected fallopian tube to be preserved and shortening the period of post-surgical convalescence. In the 90’s, early detection combined with the advent of medical management with methotrexate (MTX) has all but eliminated the need for surgical intervention in the majority of patients. If administered early enough, MTX will allow spontaneous resorbtion of the pregnancy and a dramatic reduction in the incidence of catastrophic bleeding. This was especially true in ectopic pregnancies arising from In Vitro Fertilization, where the early progress of pregnancy is usually carefully monitored with hormone levels and ultrasound.

Classically women with an ectopic pregnancy present with the following symptoms:

• Missed menstrual period: Although some patients will have spotting or other abnormal bleeding. The pregnancy test will be positive in such cases.

• Vaginal bleeding. When a pregnancy inadvertently implants in the fallopian tube the lining of the uterus undergoes profound hormonal changes associated with pregnancy (primarily associated with the hormone progesterone). When the embryo dies, the lining of the uterus separates. Initially, vaginal bleeding is dark and usually is quite scanty, even less than with a normal menstrual period. In some cases, of ectopic pregnancy will bleeding is more severe, similar to that experienced in association with a miscarriage. This sometimes leads to an ectopic pregnancy initially being misdiagnosed as a miscarriage and is the reason to examine the material that is passed vaginally, for evidence of products of conception.

• Pain. In the early stages this is typically cramp-like in nature, located on one or another side of the lower abdomen. It is caused by spasm of the muscular wall of the fallopian tube(s). When a tubal pregnancy ruptures the woman will usually experience an abrupt onset of severe abdominal followed by light headedness, coldness and clamminess and will often collapse due to shock. Her pulse will become rapid and thready and her blood pressure will drop. Miscarriage. Sometimes the woman will experience pain in the right shoulder. The reason for this is that that blood which tracts along the side of the abdominal cavity finds its way to the area immediately below the diaphragm, above the liver (on the patient’s right side), irritates the endings of the phrenic nerve, which supplies that part of the diaphragm. This results in the referral of the pain to the neck and the right shoulder. The clinical picture is often so typical that making the diagnosis usually presents no difficulty at all. However, with less typical presentations the most important conditions to differentiate from an ectopic pregnancy are: a ruptured ovarian cyst, appendicitis, acute pelvic inflammatory disease (PID), or an inevitable

• Vaginal bleeding. When a pregnancy inadvertently implants in the fallopian tube the lining of the uterus undergoes profound hormonal changes associated with pregnancy (primarily associated with the hormone progesterone). When the embryo dies, the lining of the uterus separates. Initially, vaginal bleeding is dark and usually is quite scanty, even less than with a normal menstrual period. In some cases, of ectopic pregnancy will bleeding is more severe, similar to that experienced in association with a miscarriage. This sometimes leads to ectopic pregnancy initially being misdiagnosis as a miscarriage and is the reason that we often want to examine the material that is passed vaginally, for evidence of products of conception.

The easiest and most common method of diagnosing an ectopic pregnancy is by tracking the rate of rise in the blood levels of hCG. With a normal intrauterine pregnancy, these usually double every two days throughout the first few weeks. While a slow rate of increase in blood hCG usually suggests an impending miscarriage, it might also point to an ectopic pregnancy. Thus the hCG blood levels should be followed serially until a clear pattern emerges.

A vaginal ultrasound examination usually will clinch the diagnosis by showing the ectopic pregnancy within a fallopian tube and if the tube has already ruptured or internal bleeding has occurred, ultrasound examination will inevitably detect the presence of free fluid into the abdominal cavity.

If there has been a significant amount of intra-abdominal bleeding, irritation of the peritoneal membrane will cause the abdominal wall to become hard tense and, depending on the amount of internal bleeding abdominal distention will be evident. Palpation of the abdominal wall will evoke significant pain and when a vaginal examination is done, movement of the cervix will produce excruciating pain, especially on the side of the affected fallopian tube.

Surgical Treatment: In questionable situations laparoscopy is usually performed for diagnostic purposes. If an ectopic pregnancy is in fact detected, a small longitudinal incision over the tubal pregnancy will allow its removal, without necessitating removal of the tube. (linear salpingectomy). Bleeding points on the fallopian tube can usually be accessed directly and appropriately ligated (tied) via the laparoscope. Sometimes the damage to the fallopian tube has been so extensive that the entire tube will require removal.

On occasions where very severe intra-abdominal bleeding heralds a potential catastrophe, a laparotomy (an incision made to open the abdominal cavity) is performed to stop the bleeding post haste. In such cases a blood transfusion is usually required and may be life saving.

Medical Treatment: The introduction of Methotrexate (MTX) therapy for the treatment of ectopic pregnancy has profoundly reduced the need for surgery in most patients. MTX is a chemotherapeutic that kills rapidly dividing cells, such as those present in the “root system” of the conceptus. Extremely low doses of MTX are used to treat ectopic pregnancy. Accordingly the side effects that are often associated with such chemotherapy used for the treatment of other conditions are seldom seen. It is important to confirm that the ectopic pregnancy has not yet ruptured prior to administering MTX.

MTX is given by intramuscular injection. Prior to its administration, blood is drawn to get a baseline blood hCG level. After the injection of MTX the patient is allowed to return home with strict instructions that she should always have someone with her and never be alone in the ensuing week. The concern is that were the patient to be on her own and an intraabdominal bleed were to occur, she might not readily be able to access someone who could get her to the hospital immediately. Instructions are also given to look for early signs that might point towards severe intra-abdominal bleeding such as the sudden onset of severe pain, light-headedness or fainting.

The patient returns to the doctor’s office four days later to check the blood hCG level. Three days later (7 days after MTX), the level is checked again. By this time the hCG level should have dropped at least 15% from the value on day 4. If not, a second MTX injection is given and the blood levels are tested twice weekly until hCG level is undetectable. Once this occurs, vaginal bleeding will usually ensue within a week or two.

It is important to note, especially in cases where more than one embryo or blastocyst has been transferred to the uterine cavity or fallopian tube (as with Tubal embryo transfer –TET/ZIFT), that implantation may occur in two sites simultaneously (i.e. in the fallopian tube as well as inside the uterine cavity). This is referred to as a heterotopic pregnancy. It is therefore important that before administering MTX, which will cause the death and absorption of any early pregnancy, that the physician makes certain that he/she is not dealing with a heterotopic pregnancy. In such cases, surgery is required to treat the tubal ectopic, while every precaution is taken to protect the pregnancy growing within the uterine cavity.

When an ectopic pregnancy occurs following infertility treatment, there is the added advantage that the physician will be on the lookout for the earliest possible signs of trouble. The performance of a vaginal ultrasound within two weeks of a positive blood pregnancy (HCG) test following IVF allows for early detection of the unruptured pregnancy and timely intervention with MTX and/or laparoscopy.

___________________________________________________
ADDENDUM: PLEASE READ!!
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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 .
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PLEASE HELP SPREAD THE WORD ABOUT SFS!

reply
Natalie

Thank you for all the information. I do not have any symptoms currently (no bleeding, cramps, pain, etc.). Obviously every ectopic is different and I do know what to be on the lookout for. I thought the results were somewhat concerning as well and I appreciate the insight. I was really hoping it wouldn’t be another ectopic. The imaging center mentioned a molar pregnancy but from what I’ve read about that, my numbers would be through the roof, which they aren’t. Could the sac have been just missed or with the advanced technology would that not be likely?

Also, to note, this is natural not through IVF/IUI if that makes a difference.

reply
Dr. Geoffrey Sher

Highly unlikely to be molar with those findings and those numbers.

Yes, a pregnancy could have been missed, but this too is improbable!

Good luck!

Geoff Sher

reply
Karen

Hello Dr.

I am very worried about the change in doubling time in my last HCG results after it was almost tripling every 48h. Is this normal?

4w =147.5
4w2d= 422 (doubling time of 31.7h)
4w4d=1192(doubling time of 32.0h)
4w6=3200 (doubling time of 33.7h)
5w1d=5600 (doubling time of 59.5h)

reply
Dr. Geoffrey Sher

I would not be over-concerned. This looks quite optimistic.

Geoff Sher

reply
Barat

Hi Dr.Sher,
My wife had a FET on 07/02. We transferred 1 5 day blastocyst which was PGS tested and found to be euploid with a grade of 3AA. On 07/12, the beta HCG level was 17.4. We repeated the test today, 07/15 and found that the level was 28.2. Should we be concerned that this is an ectopic? We are doing the next HCG test on 07/17. If this were an ectopic, what level of HCG should we expect?

reply
Dr. Geoffrey Sher

It is too soon to say. You should repeat the hCG level measurements at 2-4 day intervals to see how the level changes.

Good luck!

Geoff Sher

reply
janet

Hi Doctor, I transferred (2) 6 day blastocyst on June 25th. I got a positive beta 8dp5dt with HCG of 357, two days later at 10dp5dt HCG was at 617. Is this a reason for concern? it didn’t quite double in 48hrs. Double would have been 714+. Should I be worried?

reply
Dr. Geoffrey Sher

It is hopefully still fine. Repeat the test in 2 days.

Good luck!

Geoff Sher

reply
Esther

Hi
My situation is as follows:
1. 6 day Frozen embryo transfer on 9/3
2. First blood 24 HCG 7 days after transfer
3. Second blood 54 HCG 2 days later
4. Third blood 234 HCG 13 days after transfer
5. 489 HCG 2 days later
6. 2980 6 days later
7. 4536 6 days later (Sept. 30)
8. Doc was concerned. So he ordered blood every 2 days
9. Sept 30 4536 HCG
10. Oct. 2 5152 HCG
11. Oct. 4 5892 HCG
I saw my obgyn on Oct 2 and she saw a gestational and yolk sac but no heartbeat yet. She also said it’s not an ectopic either bc she clearly sees it’s in the uterus. She says we cant determine anything yet.
She says by the size since she measures it, my sac is 6 weeks 1 day and not 7 weeks.
I have no idea what to think. I see my specialist tomorrow to see if there’s a heartbeat. Have you seen this before? And can it still lead to a healthy pregancy?

reply
Dr. Geoffrey Sher

You are only about 6.3 weeks along. It could just be a little early. Repeat the ultrasound in 1 week for a definitive answer.

Good luck and G-d bless!

Geoff Sher

reply
Lara

Hi Dr. Sher, thank you so much for taking the time to answer these questions. I had my FET on 6/20/2019. We implanted two non-PGS tested embryos, one was day 5, 4AA; the other was day 6, also 4AA. I had not thought of this before, but could the transfer of embryos at different stages cause a problem or impact the development for one or the other?

And also, my day 12 post transfer hcg was 476 w progesterone 19.1. My day 14 post transfer hcg was 1142 w progesterone 21.3. Could this indicate twins? Or Down’s syndrome? Thank you again!

reply
Dr. Geoffrey Sher

The discordant stages of blastocyst development should not be a factor.It is possible that you are carrying twins, but no one could authoritatively predict.

Good luck!

Geoff Sher

reply
Lara

Thank you so much! How about Down’s syndrome? I read that higher hcg levels is a marker for it, but not sure if that applies early on. I have super low AMH and have had 3 miscarriages, so I’m extra worried about possible genetic abnormalities.

reply
Elsa

Hi Dr. Sher, I wanted to update my hCG and hormone levels for you, which I got yesterday (my earlier values are above). Hcg is now 13,505, progesterone is now 22.2, and estrogen is 414. I am in week 5 day 4. Does this seem to be an appropriate rise in hcg? Do the progesterone and estrogen values look ok? Do you think I might be having twins based on those numbers? (I have an ultrasound scheduled for the end of next week.)

Dr. Geoffrey Sher

You need to do an ultrasound to determine.

Good luck!

Geoff Sher

Heather

Do my betas look okay and should I be concern that they are having me come in for an Ultrasound when I will only be 4 weeks 6 days past transfer?

Beta 1= 89 *8dp5dt*
Beta 2= 403 *11dp5dt*

reply
Ola

Dear doctor,
I have sent to you varius posts and you always have responded. Thank you!
After 8 chemical losses in 5 years, today I discovered after a lot of pain in the lower abdomen and right side that my first hcg (213) is low. LMP 19 May and my cycle is 30 days. My doctor wants to exclude any ectopic pregnancy but I feel it is another chemical pregnancy. So many and why it happens? Where is the problem? I just think I will not be able to give birth to my own baby – I dont see any hope 🙁

I want to talk with you about these losses and wether you believe there is a treatment for me to try it before I sit down and think seriously for an IVF with PGS (I live abroad and here is very expensive). It will be my last chance

reply
Dr. Geoffrey Sher

I strongly urge you to call Patti (my assistant) at 800-7809-7437 and set up a Skype consultation with me to discuss.

___________________________________________________________
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
Kruti

Hello,
I had a single 5 day blastocyst frozen transfer recently. My hcg level 10 days post embryo transfer date was 206 and 48 hours later was 696. Is this normal since hcg increased more than twice in 48 hours. Do we need to worry?

reply
Portia

Hi Doc,

I had ET on June. 03 – 2 good looking embryos
On June 10 (7dp5dt) my first HCG Beta number was 23,
On June 12 (9dp5dt) my second HCG Beta number was 67
On June 14 (11dp5dt) my third HCG Beta number was 193
On June 16 (13dp5dt) my fourth HCG Beta number was 556
Still on Progestrone, and estrogen, baby aspirin but no pregnancy symptoms.

Are my beta level not low? What do you think?

reply
Sonia

Hello doctor,
Pls let me know if the below numbers are ok. Did a 5 day blastocyst transfer
Hcg levels
1. 7/6 – 40
2. 9/6 – 97
3. 11/6 – 248
4. 15/6 – 640

The 11/6 ad 15/6 result i guess has taken 72 hours or so to double. Is that normal?

reply
Chin

Hi Dr. Sher,
I had a blood test done ytd 5 days post transfer of a 6 day blastocyst. Hcg level at 2.0. Is it too earlier to detect pregnancy? Or it just didn’t implant?
Thanks.

reply
Dr. Geoffrey Sher

Too early to tell Chin. Give it another 3 days or so!

Good luck!

Geoff Sher

reply
Erica

Hi! We transfered a single 5 day frozen embryo! First Beta at 11dp5dt was 47, Second at 13dp5dt was 104, and at 18dp5dt (today) is at 903! Can I finally exhale? Is this trending appropriately? Next beta is in one week!

reply
Katie

I transferred two 5 day blasts. 10dp5dt hcg was 222. My next test wasn’t until 18dp5dt and it’s now 4524. What are the chances both blasts took? Do these numbers look good to you? Thanks.

reply
Dr. Geoffrey Sher

There is a good chance that both took!

Good luck!
___________________________________________________________
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
Haley

correction!! I was off on that, the first the lab draws were exactly 48 hours apart

May 13 – 10/11 dpo 50 (prog 35)
May 15 – 12/13 dpo 186
May 17 – 14/15 dpo 575

Today, may 22, 4594

I am 37 and my Mother is a twin 😉
I had a loss in January, so was just looking for some reassurance on these labs!

Thank you so much!

reply
Michaela

My first beta at 13dpo was only 15. At 15dpo it rose to 38. Some people have told it’s good because it doubled but I’m nervous these numbers are too low. O date could be off by a day.

reply
Dr. Geoffrey Sher

As long as it continues to +/- double every 48h.

Geoff Sher

reply
Mary Ann

Hello! I am a gestational surrogate. I had a FET on 4/29/19 of a single embryo. My first beta was performed on 5/9/19 (10 days pt). My second was performed today, 5/13/19 (14 days pt). Beta one was 203 and today it was 2,116! With only one embryo transferred, what do you think is the likelihood of a multiple pregnancy?

reply
Dr. Geoffrey Sher

I doubt it!

But the pregnancy looks very encouraging!

Geoff Sher

reply
Anna

Hi,
I had 5 and 6 day embryos transferred and 11 days later my hcg was 348. Do you think its possible its twins?

reply
Dr. Geoffrey Sher

Yes! It is possible!

_______________________________________________________
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
Lucy

Hi Dr Sher, this site and your blog are incredibly helpful. Thank you.

We have tried over 7 years with 4 egg donation IVF, 3 IUI, 1 IVF with my own egg. This is the first time I have ever been preganant in my life. My LMP was on Mar 28, the one before was on Feb 14. I usually have 28 to 30 days cycle but with all the back to back egg donation IVF, it has not been regular. We had two 5-day expanded blastocyst embryos transferred on April 17. On April 30 the blood test showed HCG at 749. On May 9 (day 43 from LMP) did an transvaginal ultrasound and blood work: hcg at 10390. Sac size 0.9cm, saw the yolk sac but not fetal pole or heart beat, 2 fibriods anteriorly at 7mm each, one posterior subserosal fibroid at 14mm. Progesterone at 57.

I’m 45 and very worried. The nurse mentioned about my multiple fabriod issue, the sac size being smaller than norm while progesterone is higher than the mean 25. Should i be worried? What’s your thought? Should i adjust my progesterone as I’m taking 700mg oral, 1 crinone 8%, 2 progrsterone injectable 25 ml each. I did the egg donation overseas but they don’t really respond anymore after i was tested pregnant. Any help is appreciated. Thank you

reply
Dr. Geoffrey Sher

Hi Lucy!,

I wish you well!

It is important to realize that fibroids in the uterine wall (intramural), unless very large will NOT usually prevent implantation or cause pregnancy loss. Please recognize that the causes of infertility are often the same as the one’s that cause early pregnancy loss , only they impact much earlier.

I am quite honestly a little concerned at the fact that at 6+ weeks, no fetal pole or HB was observed. I am not overly concerned about your blood progesterone. Give it 1 week and repeat the ultrasound. At that time you will have conclusive evidence…one way or the other.

Quite frankly , it sounds to me as if something else might lie at the root of your poor reproductive experience: see below…

Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.

It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:

1. Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2. Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.

We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).

3. The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.

4. Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:

a. A“ thin uterine lining”
b. A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c. Immunologic implantation dysfunction (IID)
d. Endocrine/molecular endometrial receptivity issues
e. Ureaplasma Urealyticum (UU) Infection of cervical mucous and the endometrial lining of the uterus, can sometimes present as unexplained early pregnancy loss or unexplained failure following intrauterine insemination or IVF. The infection can also occur in the man, (prostatitis) and thus can go back and forth between partners, with sexual intercourse. This is the reason why both partners must be tested and if positive, should be treated contemporaneously.

Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
I strongly recommend that you visit http://www.DrGeoffreySherIVF.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
• Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
• 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?

___________________________________________________________
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

The information you

reply
Carol

Hi Dr. Sher,
I am very nervous awaiting an ultrasound in two weeks to confirm a viable pregnancy and wondered if you have any insight.
My HCG levels rose slowly then seem like they could be back on track, and I am wondering if I should have any hope.
Ovulated: 4/17
Confirmed pregnancy: 5/1
HCG Levels:
5/6: 1,505
5/8: 2,088
5/10: 4,126
Ultrasound on 5/8 showed a sac that looked normal but too early to be definitive.
Have you seen anything like this with a healthy viable pregnancy before?

reply
Dr. Geoffrey Sher

Frankly, these values are cause for guarded optimism.

Good luck!

Geoff Sher

reply
Lana Burton

I passed something on Sunday, then on Monday I had an ultrasound that couldn’t determine whether it was a viable pregnancy. My hCG level on Monday was 2900. Wednesday hCG= 3100 Friday hCG =4035 it’s also important to note that my Fallopian tubes were removed a few months back. Do I have a viable pregnancy?

reply
Dr. Geoffrey Sher

You should wait a week and repeat the ultrasound. It is impossible to predict authoritatively with the information you provided.

Geoff Sher

reply
Brenda

Hi Dr. Sher,
After a 5 day FET, I found out on April 26th that I was pregnant with an hcg level of 48.6. On April 29th it doubled to 96.5, and on May 2nd it went up to 324.5. I have a fourth beta check again this coming Sunday. At first they said they were worried about the lower numbers, but after the 324.5, they said things are looking good! I have an u/s on May 14th, and hoping that everything is where it should be. It’s taken us almost 16 years to get this positive result, so I was wondering your thoughts about my numbers and viability of this pregnancy? Thank you for your time!

reply
Dr. Geoffrey Sher

I would be “guardedly optimistic here.

Good luck!

___________________________________________________________
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

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