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.

1,989 Comments

Deo

Hi Dr Sher,
Hope you are doing well. In the first abdominal ultrasound scan it showed 5 1/2 weeks with gestational sac and no fetal pole, while as per LMP it should have been 3 weeks more. The doctor suggested HCG which came out to be 27400 and after 40 hours came out to be 23900 IU/L. Since then there was a black brown discharge 2 times with a gap of 2 days but no pain or bleeding. We are really worried what is happening, we have another scan scheduled after 4 days. Based on what we read on the blog as per point 1 related to HCG level, believe you mentioned HCG level can drop sometime and increase sometime later, and it can still be normal viable pregnancy. Hoping to hear from you soon. Doctor has concluded based on HCG levels that its going to be miscarriage.

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Dr. Geoffrey Sher

It is hard to say until the US result is available.

Please keep me in the loop!

Geoff Sher

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Deo

In general does it make a difference if HCG levels are measured at 40 hours instead of 48 or for that matter everywhere i read.. they recommend 48-72 hours. what happens if someone measures 30 hours later… would they still show some increase? Did we do an error by measuring earlier than 48 hours ? One more thing would want to share these additional details from 1st Ultrasound scan-, if it may change your earlier answer
GA on 28th April by LMP- 10w 3d
GA by Ultrasound on that day- Mean Sac diameter 8.7mm which coorelates with approx GA 5w5d +/- 1w3d
Adrexal review is normal with no free fluid, No embryonic pole with cardiac activity is detected at this this,
Conclusion- Early intrauterine pregnancy, No embryonic pole is visible due to early stage of pregnancy, A further ultrasound is recommended after 2 weeks in order to verify viability and accurate dates
Blood test 30 April- 27400, Blood test 2 May after 40 hours approx- 23900
Thanks again for all your help! I really appreciate it.

Dr. Geoffrey Sher

The level of hCG usually doubles every 40-50h in the early stage of pregnancy. However when it rises above 5,000, it usually increases more slowly or not at all , over such a short time span.

I agree with your RE that another US 1-2 weeks from now should be absolutely definitive.

Good luck and be safe!

Geoff Sher

Deo

Update from previous –
We did scan again today and no embryo was detected in both abdominal and vaginal ultrasound. so no more hopes I believe. thanks again for your help

Dr. Geoffrey Sher

Understood! If your hCG level is well elevated, be sure to exclude an ectopic (tubal) pregnancy. Discuss with your RE,

Geoff Sher

Kayla

I have left 2 different comments and they are not appearing on here?

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Dr. Geoffrey Sher

That is most unusual Kayla as I ALWAYS respond to posts! Please re-post them and I will mrespond…I promise!

Geoff Sher

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Linda

Hi Dr. Sher – I wrote to you 2 days ago about my niece – she is now 6 1/2 weeks pregnant. Her first HCG test was done on 5/2 and was 26,000, second HCG test done 48 hours later on 5/4 and was 37,000. I think I misled you – with the virus issue going on – my niece has not spoken to her doctor. It is my niece who is concerned that the level did not double, whereas in her last successful pregnancy the HCG tests taken around the same time as this pregnancy they doubled.
She is 6 1/2 weeks pregnant – are these levels good? Should there be cause for concern that they did not double in the 48 hour period? She had another HCG test done today (4 hours after the last one on 5/4). Should we no longer expect a doubling since she is way over the 6,000 mark? What type of increase should she expect to see on this latest test?
She is extremely anxious ridden but I seem to feel with all that I have read – her HCG levels and the rate they are increasing is good? I value your thoughts and opinions on this.
Thank you for your time.
Also she is scheduled for a US next week on the 12th.

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Dr. Geoffrey Sher

I would not be overly concerned. The rate of rise slows after the hCG rises above 4-5,000. Advise her to go in for an ultrasound evaluation

Good luck!

Geof=ff Sher

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Rachel

Hi. Here are my 4 most recent levels. How do they look to you?

4-27-2020 (HCG 4602)
5-1-2020 (HCG 16,876)
5-4-2020 (HCG 24,789)
5-6-2020 (HCG 47,131)

Thank you in advance.

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Janine Quigley

I’m about 5w3d pregnant. These are my HCG readings:
27/4 – 149
29/4 – 311
3/5 – 824
6/5 – 1336
I fear my levels aren’t rising quick enough for pregnancy to be viable. Please can you advise.
I did have 2 miscarriages last year. Thank you

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Dr. Geoffrey Sher

This is a nail biter. Only time and an US done in 10-14 days will provide an answer. However, please read below:

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

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

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

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

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

TREATMENT OF RPL
Treatment for Anatomic Abnormalities of the Uterus: This involves restoration through removal of local lesions such as fibroids, scar tissue, and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.
Treatment of Thin Uterine Lining: A thin uterine lining has been shown to correlate with compromised pregnancy outcome. Often this will be associated with reduced blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil and possibly aspirin.
Sildenafil (Viagra) Therapy. Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
Use of Aspirin: This is an anti-prostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81 mg orally, daily from the beginning of the cycle until ovulation.

Treating Immunologic Implantation Dysfunction with Selective Immunotherapy: Modalities such as IL/IVIg, heparinoids (Lovenox/Clexane), and corticosteroids (dexamethasone, prednisone, prednisolone) can be used in select cases depending on autoimmune or alloimmune dysfunction.
The Use of IVF in the Treatment of RPL
In the following circumstances, IVF is the preferred option:
1. When in addition to a history of RPL, another standard indication for IVF (e.g., tubal factor, endometriosis, and male factor infertility) is superimposed.
2. In cases where selective immunotherapy is needed to treat an immunologic implantation dysfunction.
The reason for IVF being a preferred approach in such cases is that in order to be effective, the immunotherapy needs to be initiated well before spontaneous or induced ovulation. Given the fact that the anticipated birthrate per cycle of COS with or without IUI is at best about 15%, it follows that short of IVF, to have even a reasonable chance of a live birth, most women with immunologic causes of RPL would need to undergo immunotherapy repeatedly, over consecutive cycles. Conversely, with IVF, the chance of a successful outcome in a single cycle of treatment is several times greater and, because of the attenuated and concentrated time period required for treatment, IVF is far safer and thus represents a more practicable alternative
Since embryo aneuploidy is a common cause of miscarriage, the use of preimplantation genetic diagnosis (PGD), with tests such as CGH, can provide a valuable diagnostic and therapeutic advantage in cases of RPL. PGD requires IVF to provide access to embryos for testing.
There are a few cases of intractable alloimmune dysfunction due to absolute DQ alpha matching where Gestational Surrogacy or use of donor sperm could represent the only viable recourse, other than abandoning treatment altogether and/or resorting to adoption. Other non-immunologic factors such as an intractably thin uterine lining or severe uterine pathology might also warrant that last resort consideration be given to gestational surrogacy.
The good news is that if a couple with RPL is open to all of the diagnostic and treatment options referred to above, a live birthrate of 70%–80% is ultimately achievable.
I strongly recommend that you visit http://www.SherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
• The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
• The Fundamental Requirements For Achieving Optimal IVF Success
• Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
• Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
• The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
• Blastocyst Embryo Transfers Should be the Standard of Care in IVF
• IVF: How Many Attempts should be considered before Stopping?
• “Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
• IVF Failure and Implantation Dysfunction:
• The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
• Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
• Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
• Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
• Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
• Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
• Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
• Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
• Endometrial Thickness, Uterine Pathology and Immunologic Factors
• Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF

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ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Founded in April 2019, Sher Fertility Solutions (SFS) offers online (Skype/FaceTime) consultations to patients from > 40 different countries. All consultations are followed by a detailed written report presenting my personal recommendations for treatment of what often constitute complex Reproductive Issues.

If you wish to schedule an online consultation with me, please contact my assistant (Patti Converse) by phone (800-780-7437/702-533-2691), email (concierge@SherIVF.com) or, enroll online on then home-page of my website (www.SherIVF.com).

PLEASE SPREAD THE WORD ABOUT SFS!

Geoff Sher

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helloworld2020

Hi Doctor Sher,

I had my second scan today and we couldn’t see the fetal pole, i have completed 7 weeks yesterday. Sac size has increased from 3.5 mm to 6.7 mm today. Doctor has stopped my progesterone and she is asking to wait for natural miscarriage. Is there any hope?

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Dr. Geoffrey Sher

Unfortunately, it sounds as if this pregnancy is not going to be viable.

Sorry!

Geoff Sher

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Linda

Hi Dr. Sher
I don’t mean to sound stupid, but my neice is concerned about her HCG levels – and I am not quite sure how to interpret them. She is approximately 6 1/2 weeks pregnant. She had her first blood test 4 days ago and the reading was 26. Does this mean 26,000??? 48 hours later her reading was 37 (here again does this mean 37,000)? She did not seem upset with the first reading as she said this was in line with her last pregnancy, except she expected to see it double?

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Dr. Geoffrey Sher

If the Dr was not concerned, all I can assume is tht she as talking about “thousands”. Call and inquire!

Good luck!

Geoff Sher

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Elle

My HCG levels were 64,000 and 48 hours later were 92,000. I am 6 weeks. Are these too high? I am worried about molar pregnancy.

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Dr. Geoffrey Sher

I think all will be fine, but I suggest ban ultrasound to confirm the viability of the pregnancy.

Geoff Sher

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Lotje

Goeienavond,
Ik volg een fertiliteitsbehandeling met Femara en vorige week zondag vond de ovulatie plaats. Maandag heeft de gynaecologe een HCG bloedtest gedaan (dag 22 dus in de cyclus). Ze vertelde me vandaag dat het resultaat negatief was en de kans op zwangerschap daardoor heel erg klein is. Wat ik niet goed begrijp, ik lees overal dat de innesteling gemiddeld 9 dagen na de ovulatie plaats vindt en dat er dan pas Hcg geproduceerd wordt. Hoe kan het dan dat men toch al na een week met bijna 100% zekerheid ahv een bloedtest een zwangerschap kan bepalen?

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Lotje

Ok er gebeurt iets raar: mannen zou ‘m-e-n’ moeten zijn. Er leeft hier blijkbaar een autocorrect die Engels in Nederlands wil vertalen 🙂

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Dr. Geoffrey Sher

The 1st blood pregnancy test should be done about b12 days post-ovulation. Yours seems to have been done too early. The urine pregnancy test is much less sensitive. Accordingly, the 1st one should be done about 3-4 days later.

Good luck!

Geoff Sher

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Sheetal

At 5w0days my hcg was 2335 mIU/ml and Progesterone was 10.83 ng/ml.
At 5w2days my hcg is and 4320 mIU/ml Progesterone is 9.13 ng/ml. Is there any risk or chance of miscarriage in my pregnancy?

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Dr. Geoffrey Sher

This seems to me to be a reasonable rise in hCG. The risk of miscarriage is the same as normal…i.e, probably around 10%.

Geoff Sher

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Caroline

Dr. Sher,

My husband and I found out we were pregnant on March 28th. We were together on March 13th & March 21st. I cramped for three days (March 25-27) and the took the test on the 28th and got a positive. This Tuesday was our first appointment and the US nurse couldn’t find a heartbeat. After further investigation, the US showed the gestational sac in the correct place, but no fetal pole or heartbeat. The US was measuring 7 weeks. I don’t know if this matters, but I have a tilted uterus. The first doctor explained my options and declared it a miscarriage. She did bloodwork before I left and wanted to repeat it in 48 hours. However, the next morning, my primary doctor called and said that she wanted to do another US in a week and will repeat bloodwork there. She is not 100% that I am miscarrying, but pretty sure. She said there is a very slim chance that something could develop in a week, but to prepare for the worst. They aren’t sure if I ovulated late, or something else. The bloodwork from Tuesday showed my hCG at 23,000. When it was first tested on March 31st it was at 305.

What is your experience with this? Have you seen this situation turn into a viable pregnancy? The agony of waiting for the next appointment is killing us. Especially since we were settled after the first appointment that it was over.

Thank you for taking the time to read this.

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Dr. Geoffrey Sher

I agree with your 2nd doctor. Give it a week and repeat!

Geoff Sher

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Elysa

Hi Dr. Sher,

I have the following HCG levels:

11 DPO: 45
13 DPO: 141
15 DPO: 378
17 DPO: 1191
19 DPO: 3,025

Is seeing a normal progression like this an indication of a viable pregnancy? They stopped testing and I have an ultrasound scheduled for 24 DPO. Do you think it would be too early to see a heart beat at that point? By then I’m guessing my levels should be around 15,000. Thanks!

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Dr. Geoffrey Sher

That would be a 6 week US and yes, it should reveal a HB by then. Personally, I prefer to do the US t 7 weeks by which time findings would be more definitive.

Geoff Sher

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Crystal Chavez

Hi my LMP was on 3/15… i had an trans-vaginal sonogram on 4/29 there was a yolk sac but no fetal pole is this normal?

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crystal chavez

Also on 4/17 my hcg numbers were at 497 my pcp said i was about 3-4 weeks

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Dr. Geoffrey Sher

You need to wait about 10-14 days and repeat the US. It is too early!

Geoff Sher

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Sunset

Has anyone here ever had a low beta number of 8? Then dropping to 5

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Dr. Geoffrey Sher

Regrettably, this is very likely a failing implantation… a chemical pregnancy!

Sorry!

Geoff Sher

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Susan

Last thursday 31.04.20 my hcg came back as 15. On monday – 4.05.20 when i retested it came back as 16. I guess this is a miscarriage.

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Dr. Geoffrey Sher

Sadly, this looks like a failing implantation.

Sorry!

Geoff Sher

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helloworld2020

Hi Doctor Sher,

I posted earlier as well on 16th April, my HCG started doubling properly, and my doctor did a scan at end of 6th week, we could see the sac but it shows 5W1D, my doctor is concerned. But I have never heard anything positive from her, she always tries to scare us, this is what we feel. Do you think this is a viable pregnancy?
I don’t have any bleeding, very less cramps, and other usual pregnancy symptoms. Please let me know if I should be hopeful. I have one more scan planned next week.

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Dr. Geoffrey Sher

I would do another US in 1 week. That should provide a more definitive diagnosis.

Geoff Sher

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helloworld2020

Thanks Doctor for a positive reply. Shall I keep my hopes up as my doctor was very negative yesterday?

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Dr. Geoffrey Sher

Yes, there is hope but manage your expectations.

Good luck!

Geoff Sher

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Robinson

Hello! I had my last period April 7th! Usual 5 days long… I ovulated about the 21st or 22nd.. I got multiple positive test from home. Went to the urgent care today and the urine test was negative (but my at home was positive) anyways they did a blood test and my HCG level was 37… is this normal? I have been freaking out! I think I should be around the 3 week mark.

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Robinson

Also I have to go back in 2/3 days to see if they have risen.. but is this level normal for where I am currently?

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Dr. Geoffrey Sher

It is on the lowish side but could still be fine!

Geoff Sher

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Dr. Geoffrey Sher

It is certainly not a good sign. This pregnancy is probably lost!

Geoff Sher

Robinson

I also haven’t had any bleeding, or cramping!

Kathy

Hello.
Hello.
My HCG levels have been:

10 DPO – 31
17 DPO – 756
19 DPO -1743
I wasn’t sure why dr wanted me to come back for the 3rd test. Could this be indicative of multiples or do you think they may have been concerned about something else.
Thank you.

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Dr. Geoffrey Sher

I think it is likely a singleton …but I could be wrong!

Good luck, G-d bless and please BE SAFE!

Geoff Sher

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Leah Axelrod

Hi there,
I want to begin by saying that I took an ovulation test and can almost certainly say I ovulated on 04/10(CD19),
Found out I was pregnant 04/23 and did my first HCG on 04/24 which came back at 125, my dr said it was low, so i did another HCG blood test about 72 hours later and it came back at 274…. does this seem normal to you?

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Aliya

Hello,

I ovulate late usually at CD22, so ovulated on April 9-10 and my cycles are 35-36 days. my hcg yesterday was 59. This seems quite low. Is this a pending miscarriage?

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Dr. Geoffrey Sher

You will need to re-post your original question this one…for context.

Geoff Sher

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Aliya

Sorry I didn’t mention that this was first bloodwork result, I go in for a repeat on Friday. I was concerned that this is on the very low side

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Em

Hi there Doc!
I had a MC at 5w6d on Friday 3/4/20.
My HCG On 3/4 was 590.
On Monday 6/4 HCG was 460.
I bled for 7 days.
On Saturday 25/4 I had a mild cramp which I thought was either period coming (cycle length is always 23-25days) or possibly implantation? Sunday last week, 26/4 I took a test and it was positive for pregnancy.
I had Beta HCG Monday and still awaiting results. Another positive home pregnancy test today 30/4, however now have some light spotting and mild cramp.
Is it possible that Hcg has remained in my blood for four weeks when levels were so low at the start April? Or is it another possible miscarriage.. I’m having a second Hcg beta tomorrow. I’m thinking you will tell me to wait and see!

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Dr. Geoffrey Sher

You are correct. You need to see a continued downward trend. If serial hCG blood tests dont show this happening, you could have retained products and your doctor might have to do a repeat US followed by a D&C.

Good luck!

Geoff Sher

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Emily

Dear Dr Sher,
I had a beta HCG test at roughly 16 days post ovulation on 4/24/2020 and it was 140. The doctor said this seemed low. I have had this test re-done today 4/27/2020 and my level was 681. I wondered if in your opinion, this is a good improvement and could still be a viable pregnancy?
thank you!

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Dr. Geoffrey Sher

I respectfully disagree. A beta hCG level of 140 16 days post-ovulation and the subsequent level of 681…3 days later are both are very encouraging!

Good luck and please be safe!

Geoff Sher

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Jocelyn

I am so anxious. We had our 2nd IUI cycle in March. 15dpo (or days past iui more accurately) I had a negative test. Went off progesterone. 24dpo I had a faint positive, but a lot of bleeding 25dpo. I assumed it was a chemical.

31dpo I was laid up with a very sharp pain in my lower right abdomen.

Monday (32dpo) I had a very solid line and got bloodwork done. My progesterone was low and my hcg was 879. Th hat seems really low for how far along I should be.

Covid means I’ll be getting my next test Friday (37dpo) but I’m having a hard time having hope.

Your article has let me see a potential story of the embryo almost miscarrying when I went off progesterone but then rallied and is just a little behind.

I know I don’t have enough information until I get my Friday results. But is that story something that could actually happen? What should I consider a hopeful lower limit from my test on Friday?

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Dr. Geoffrey Sher

No!,

I think you did a urine test too early on and that is why it was -ve at first. Do an US in 10 days from now to see if the pregnancy is viable!

IMPORTANT: If you have sudden severe pain, go straight to the ER to assess for a possible tubal (ectopic) pregnancy!

Good luck!

Geoff Sher

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Jocelyn

Thank you so much for responding!

Could the bleeding have been normal? or more likely problematic?My normal periods are very very light, so I marked it as a medium-heavy flow day

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Dr. Geoffrey Sher

Really hard to say…but yes, it could be inconsequential. Only time can tell!

Geoff Sher

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Anonymous

I received a positive pregnancy test 2 weeks ago and started bleeding around the time I would have had my cycle. On 04/14 I had a hcg of 462 and the another Friday of 332 which to me I lost the pregnancy. Since I was early I am thinking chemical pregnancy and since 04/13 I bleed up until now. Now I have just brown discharge and pink yet still have a strong pregnancy test. I will wait next week to do another test to allow 2 weeks yet I sometimes feel the pregnancy symptoms yet dont get my Hope’s up.

Dr. Geoffrey Sher

This sounds like a chemical pregnancy, I am afraid!

Geoff Sher

Jocelyn

The mystery continues. My levels on Friday were in the 1900s, up from 879 on Monday.

Worried about ectopic, I had a sonogram Friday afternoon and there was a 3mm gestational sac in the uterus.

FINDINGS:

The uterus measures 7.4 x 3.6 x 3.3 cm. The cervix is 2.9 cm in length. The endometrium overall measures up to 8 mm in thickness. Within the endometrial canal there is a 3 mm anechoic focus which may represent a very early gestational sac. Based on mean sac diameter the estimated gestational age is 5 weeks 0 days.

There is no evidence for a yolk sac. The fetal pole is not visualized. No fetal heart motion was detected.

The right ovary is 2.8 x 2.7 x 2.2 cm and contains a 1.8 x 1.8 x 1.5 cm cyst. The left ovary is 2.7 x 1.3 x 1.2 cm.

There is no free fluid

So…could my IUI on March 18 have failed to trigger and we actually conceived 2 weeks later? (LMP Mar 6, first faint positive April 11) Or am I looking at a probable miscarriage? My gut is leaning towards miscarriage, but maybe there’s other explanations that feel less fantastical.

I’m having more bloodwork tomorrow and another sonogram wednesday. No cramping or spotting since 2 weeks ago

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Dr. Geoffrey Sher

It sounds quite possible that this pregnnacy occurred after a failed IUI cycle. Only time can confirm this.

Geoff Sher

Emma

Hi Dr Sher,

I had my mirena removed on 25th of March, bleeding from 27th-1st of April.

I had a blood test at
6 dpo (16th of April) – it was 16
10dpo (20th of April) – it was 251

Is that a normal rise? Everyone keeps saying multiples but I’m not sure what to think.

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Dr. Geoffrey Sher

It is suggestive of an implanting pregnancy…probably a singleton.

Good luck and please be safe!

Geoff Sher

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Cecelia

Hi,
At 5w4d~ my HCG was 2017. Then 6 days later at 6w3d~ it was 6290. Is this an appropriate increase or is it too slow?

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Kelly

Hi there I have a repeat HCG and progesterone and am slightly anxious as my first blood test showed my HCG as 44.5 and progesterone as 96.9 which is a confirmed pregnancy do you think there is anything wrong with my first blood results?

Thanks

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Dr. Geoffrey Sher

No I do not. However what is more important is whether the level at least doubles every 48h in the 1st part of the 1st trimester.

Geoff Sher

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Tiffany

I am 15 dpo. HCG level of 604.2- am wondering if that seems high to you or normal? Could this indicate a twin pregnancy or do you think maybe I need to keep my eyes open to the possibility of something being wrong?

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Dr. Geoffrey Sher

Looks promising to me…..Could be a multiple?.

Good luck!

Geoff Sher

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Amanda

4/17 HCG 129.15 DPO 17
4/20 HCG 174.63 DPO 20

DR wants me back on 4/22

Is this probably not a viable pregnancy?

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Kristen

My lmp was exactly 4 weeks ago. I track ovulation so I know it was taken at 17 dpo. My hcg levels are 1,626. Could this indicate a pregnancy with multiples? I go back for another blood draw tomorrow.

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Erin

Hi there, your interaction with your readers is phenomenal.
My hcg readings are:
22/4 57
24/4 183
29/4 356
I had some light bleeding on 24/4 and spotting for a couple days after which has now stopped.
Do you think this pregnancy is not viable?

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Dr. Geoffrey Sher

Thanks Erin!

I would repeat the beta in 2 days. It needs to be above 700 to be satisfactory!

Good luck, G-d bless and BE SAFE!!

Geoff Sher

Erin

Thanks so much Dr. Sher. It was only 619 2 days later. But I had an ultrasound a few days after that which showed a gestational sac in the uterus, measuring 5w 2 days (meant to be 5+5). I’m not doing any more hcg bloods but will have another scan in 2 weeks. Would you say this isn’t looking promising? And if not viable how long does it usually take to miscarry?

Dr. Geoffrey Sher

I cannot answer either question authoritatively. You need to have the US and then regroup.

Good luck!

Geoff Sher

Angela

Sorry Doctor it’s Angela again, I was talking about progesterone on my previous comment, pardon me, I’m writing in a rush as I’m a little bit nervous right now. Thanks.

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Dr. Geoffrey Sher

I know you were, but I honestly do not believe that progesterone therapy will cure the problem. If you take it, 200mg/day should suffice.

Geoff Sher

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Jamie

Hello! I am currently pregnant with my 4th baby and having some slow rising HCg levels that my doctor says it “evident” this will end in miscarriage.
My LMP was 3/5, but cycles were 36 days so I don’t have a clue of any other dates. I went into the doctor on 4/27 and was told I was measuring at 4w6d, saw the gestational sac and had a baseline HCg of 20,000. 4/29 I went back in for more blood work and another scan. Gestational sac was there as well as the yolk sac and measuring 5w3d. New HCg level came in at 23,000. Went in on 5/1 for another scan and blood work. US tech said she could see the yolk sac so much better, but was now measuring at 5w1d with an HCg of 25,131. My doctor is telling me that the measurements aren’t normal. I should already hear a fetal heartbeat and miscarriage will be soon. I’ve asked her to keep my upcoming appointments on 5/5 and 5/11 to continue to watch and monitor. I’ve read so many success stories even with slow rising HCg numbers. What’s your experience with this? Looking for hope!!

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Dr. Geoffrey Sher

Jamie,

This looks concerning but only time will tell! I wish I could be more encouraging.

Good luck and G-d bless!

Geoff Sher

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Jamie

Hi Doctor. Thanks for your quick response. Your response was 100 times better than what I got from my OBGYN.
I have a couple more questions:
1. My doctor swears up and down with my baseline HCg of 20,000 I should have a fetal pole with a heartbeat even though I was measuring 5w3d. Is this always the case with a HCg that high even though I’m so early?
2. Should we even consider getting more blood draws with the numbers I’ve already gotten that are slowing rising?
– baseline 20,000
– 48 hours later 23,000
– 48 hours later 25,131
With my 3 other pregnancies, I’ve never known my HCg levels, so I’m thinking this could maybe be my normal and never knew. ( at least that’s my hopes). This is also the earliest I’ve ever gotten an ultrasound with any of my pregnancies as well.

I look forward to your response.

Dr. Geoffrey Sher

I would not do more hCG testing. Instead, ! wait 10 days and do another US.

Good luck!

Geoff Sher

Afraid

I have been visiting my boyfriend from overseas since March 5th until present April 18. I wasn’t on birth control pill when we had unprotected sex from March 5th – 8th.I took the Plan B on the 8th around 09:30pm. on April 10th I started bleed to what I thought was my period but it ended the next day, I only discovered this when I took off my shorts.

So took some pregnancy tests on March 12, 13, 14, and 15 which all came back negative except the test taken on the 15th. However, on the 17th I got what I thought was my period. I would described it as Heavy for the 3 days than lightened to the end of the 23rd. So I assumed the test (taken on the 15th) was a false positive. I immediately started on my Birth control (Harmonet) and continued to have sex (no condom though). I took my last pill on Apr 8 and started the “rest week” which was when my period was supposed to come. I did continue having sex during the “rest week” (as far as I know the pill still gives you protection during the “rest week”) but he would pull out to ejaculate.

I was starting to “feel different” so I took additional pregnancy tests on 13th and 14th which results came mixed positive and negative. I went to a pregnancy clinic and had a HCG blood draw on April 15th and it showed that I had a 6 HCG level. I did another blood test two days later to confirm with the doctor, I’m currently awaiting the results.

I am trying to better understand the situation. Any help or advice is appreciated. I’m worried sick.

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Dr. Geoffrey Sher

Repeat the blood pregnancy test in 2 days to see if it rises and get back to me with the result. When you do, be sure to re-post the original one for reference.

Geoff Sher

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Natalie

I should be 5 weeks pregnant and hcg this morning showed 21. I did have quite a bleed for 2 days a week ago. Is this definitely a miscarriage or could there be a chance of a viable pregnancy

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Dr. Geoffrey Sher

I am afraid, this does not look good! I am afraid that the implantation has faileRepeat rthe hCG test in 2 days, in the hope that I am wrong!

Sorry!

Geoff Sher

Geoff Sher

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Aggie

Hi Dr. Sher,
I have a history of an ectopic pregnancy with the need to remove one of my tubes. Half a year later I had a miscarriage at 6 weeks. A day before my missed period this time, I tested and had a very faint positive. Had an hcg the day of my missed period and my level was 38 and progesterone of 10.6. I’m scheduled to take another test tomorrow (48hrs after my prior test). However I’m super anxious and just want an honest opinion. Do you think the chances of this being a non-viable pregnancy are high? Thank you for your time.

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Dr. Geoffrey Sher

It looks promising but you need an US at 6-7 weeks to confirm and exclude another ectopic. If you have any sudden acute pain or bleeding, go straight to the ER for evaluation.

Geoff Sher

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Aggie

Hi Dr Sher,
I found my post! Excuse me if I posted this earlier in the wrong forum. So 48hrs later my hcg has only risen to 51 and progesterone went down to 9.6 (previously hcg 38 and progesterone was 10.1). My OB isn’t concerned yet and is placing me on progesterone. I wanted to know what your thoughts were. Thank you!

Dr. Geoffrey Sher

That is discouraging. Repeat the test 2 -4 days later . If the level does not double in 2 days, that is a negative.

Geoff Sher

KRB

Hi, would value opinion.
Right sided pain and around 5+3 – 1st scan showed ?sac in uterus and nil else
BHCG 727 and repeat 40hours later 947. repeat scan enlarged sac 3.7mm and ?yolk 1.7mm, nill visible in tubes. Is only outcome miscarriage?

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Dr. Geoffrey Sher

This is likely, not an ectopic. Repeat the US in 10 days for a definitive result!

Geoff Sher

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Aliya

Hi! my HCG level yesterday was only 59..

I ovulate late, possibly CD22-23 this cycle (April 9-10) and my cycle is on the longer side as well (35-36 days). I’m supposed to be 4-5 weeks according to calculations.

I have never had HCG levels this low and I am freaking out. I go in for repeat bloodwork on Friday but I am just stressing out. Any input is appreciated!!

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Dr. Geoffrey Sher

Unfortunately, only time will tell. Follow-up blood hCG tests will help but the most important will be an ultrasound examination in 10-14 days from now!

Good luck!

Geoff Sher

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helloworld2020

HI Doctor Sher,

My IUI was done on 30th March 2020, and I had my first betaHCG on 13th March which was 31.2 then second on 15th March which came as 46. Can I hope for a viable pregnancy?

Also note that my mensuration cycle is 30-32 days, and my last period was on 17th March 2020. Also I have no bleeding though have mild cramps. I get my periods regularly, don’t have any issues. Reason for doing IUI was infertility issues with my husband.

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Dr. Geoffrey Sher

Only time will tell. Repeat the hCG test in 4 days. It should be around 200! An US in about 2 weeks should be definitive.

Good luck!

Geoff Sher

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helloworld2020

I have one more beta test today, is my gynae doing too frequent beta tests?

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Dr. Geoffrey Sher

I couldn’t say. They should be done at least 2 days apart!

Geoff Sher

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Jade

Hi there.
Needing opinions!

LMP 2/24 however, we feel I’ve ovulated late and am actually around 4-5 weeks instead (as at 4/22).
It took until day 12 of my missed period to show a faint positive line and 27 HCG. Followed up on 11th as 73 prog 48.6. 14th as 206. 16th as 488. 20th as 965 prog dropped to 15. Doc is concerned it’s a blighted ovum and having US on the 24th. Is there still hope?

Dr. Geoffrey Sher

It would be impossible to say this is a blighted ovum until an US is done in about 2 weeks or so.

Good luck!

Geoff Sher

Michelle

Hello,

I had an IVF-ICSI fresh transfer on March 16th. I was supposed to be 6+5 this past scan but my doctor only measured me at 6+0 due to the heartbeat being around 100 and the CRL only 3.46. My hcg was 1,217 at 18dp5dt and over 14,000 at 28dp5dt. Should I be preparing myself to miscarry? Everything I read tells me that the embryo is way too small for the dates. Thanks for reading.

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Dr. Geoffrey Sher

While there is no need for panicking at this stage, there is some reason for a little concern. A repeat evaluation in 1 week could show a reversion to norm
Good luck!

Geoff Sher

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Erika B

Hi doctor,

I had an IUI (using letrozole 5 MG and Pregnyl trigger) on March 13th. My first HCG level at 15 days DPO was 347. My second HCG level at 19 days DPO was 3463. And my last HCG level at 21 DPO was 11,385. I also had an ultrasound at 21 DPO and the gestational sac was visible. With the HCG levels doubling every 27 hours and being so high, is it possible that I have twins, or just a rapidly progressing level of HCG?

No history of twins in family. I had one succesful pregnancy and delivery 12 years ago. I am 34 with diagnosis of premature menopause.

Thank you!

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Dr. Geoffrey Sher

This looks promising, and yes, a multiple could be possible.

G-d bless!

Geoff Sher

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Trisha Ghosh

Hello doctor i had ICSi treatment and had a 3 Day transfer. I had 3 embryos transferred on 20/03/2020.On 04/04/2020(15dp3dt) beta was 3370 and on 07/04/2020(18dp3dt) beta was 11186 .What do you make of the result? My scan is on 20/04/2020

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Christan

Hello! I took a test last Saturday the 4th and got a positive test. Took a blood test the 6th and my miu was 43. Repeated test on 8th and it was 67. How far along could I be?

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Dr. Geoffrey Sher

This is a slow rise. Repeat the hCG test in 2 days time. Hopefullly it will pick up and double, Sounds like you are very early on still (4-5w)..

Geoff Sher

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Hayley

Hi i dont know how far aling i am as my cycles was all over ovulation never same my hcg was 56 retesting again in 48gr which is tomorrow

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Dr. Geoffrey Sher

Hard to say, but you are probably about 4 weeks along.

Geoff Sher

Anna

Hi Dr!
I had an IUI on March 23. I had blood drawn yesterday – 9 dp-iui and the result is 1… My doctor is willing to repeat the test again on Saturday at 12 dp-iui if I would like, but I am feeling very defeated… Is it possible I could still be pregnant or would SOMETHING have shown up by 9 days on the labs??

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Dr. Geoffrey Sher

Frankly Anna, you can be surprised. Yes! I would do the schweduled repeat beta.

Miracles do happen!!

Stay safe.

G-d bless!

Geoff Sher

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Juliette

So I’m slightly anxious due to this being a new pregnancy after a recent mc and I got pregnant before I had my period. My levels went from 22, 55, and then 126 (all 48 hour intervals). Is this progressing in a healthy manner?

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Trisha

Hi i had beta hcg on 14dp3dt and it came out as 3373 miu/ml .Is this normal?!? I have a scan scheduled 15 days later

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Dr. Geoffrey Sher

That is high and you should be evaluated for a molar pregnancy!

Good luck!

Geoff Sher

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Katie Joseph

I had an vaginal ultrasound in 3/31 of which showed an 8mm gestational sac but no yolk sac or fetal pole. My doctor said that I should prepare for a miscarriage since my HGC level was at 5900 I go back tomorrow morning (49 hours after my last blood test) for another ultrasound but he was already talking about a D&C. I’m devastated and keep reading that the fetal pole and yolk sac can be visible at hgc level 7200. What are your thoughts?

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Dr. Geoffrey Sher

Unfortunately, only time can tell!

Stay strong and stay safe!

Geoff Sher

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Samantha Brown

Hi! I went on 3/30 for my first ultrasound appt and there was a gestational sac and little tiny yolk sac and I was measuring 5 weeks. My HCG levels on that day were 811. On April 1st I got my blood drawn again but they had fallen to around 622ish. I also had a progesterone level of 6.2 and the OB put me on progesterone pills right away. Could they go back up?

Backstory: In November 2019 I went into preterm labor with my husband and Is first at 21 weeks. They ruled that I had an incompetent cervix and that’s why we lost him. Not sure if that has anything to do with it or not.

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Dr. Geoffrey Sher

I am afraid this does not look very promising!

Please consider the following!

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 15y 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)
Founded in April 2019, Sher Fertility Solutions (SFS) offers online (Skype/FaceTime) consultations to patients from > 40 different countries. All consultations are followed by a detailed written report presenting my personal recommendations for treatment of what often constitute complex Reproductive Issues.

If you wish to schedule an online consultation with me, please contact my assistant (Patti Converse) by phone (800-780-7437/702-533-2691), email (concierge@SherIVF.com) or, enroll online on then home-page of my website (www.SherIVF.com).

PLEASE SPREAD THE WORD ABOUT SFS!

Geoff Sher

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Trisha Ghosh

Hello doctor i had an ICSI treatment and 3 day embryo transfer on 20/03/2020.Three embryos were transfered.On 15dp3dt my beta was 3370miu/ml and on 18dp3dt it was 11186 miu/ml .You said it might be molar pregnancy but is molar pregnancy possible in ICSI treatments?

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Dr. Geoffrey Sher

Yes! It is possible, but it could also be a multiple pregnancy. Do an US in 10 days!

Good luck and G-d bless!

Geoff Sher

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Allie

At 7w the heartbeat was 147 bpm and at 11w it’s still 147 bpm. HCG is fine, but I thought the heart was supposed to speed up?

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lizett torres

I went in for sono and they said 6 week 2 day but they took a progesterone and hcg I was at 23,600 and it fell 500 points in two days. Is that normal? Ive had 2 miscarriages already

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Dr. Geoffrey Sher

At this stage and with that high an hCG level, it is not really sinister. What matters now is another US in 5 days from today.

Good luck!

Geoff Sher

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mH

Hi Dr. Sher, my betas were tripling nicely but suddenly, they are taking much longer.
At 5w2d (23dpo)- 4100
5w5d (26 dpo) – 7450
Is this an impending problem, do you think? Thank you and bless you

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Mh

I forgot to add – I had an ultrasound on 5w5d and gestational sac and yolk sac were seen, but fetal pole was not.

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Ashleigh

Hi Dr Sher, my first 3 hcg’s taken 2 days apart during my 4th week did not double appropriately (224, 323, 463) but 1 week later they were 4000, which right on track. I saw heartbeat 6weeks and am now 9 weeks but I can’t stop thinking something will go wrong. In your experience, can levels ‘catch up’ and result in healthy pregnancies? Thank you

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Dr. Geoffrey Sher

If US showed a HB and appropriate size of conceptus and sac, my bet is that all is well. However, your OB should be scrutinizing development and growth from here on out and if there are concerns, then further additional prenatal testing might be indicated.

Good luck!

Geoff Sher

Geoff DSher

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Jamie

Hello. I had two positive pregnancy tests on 04/18. Went in for hcg test on 04/20 and it was 273, went back 48 hours and was only 398. Is this normal and/or okay?

Dr. Geoffrey Sher

That is a slowish rise. It could be fine though!

Repeat the beta hCG test 2 days after the last one. It should be well over 500.

Good luck!

Geoff Sher

Dr. Geoffrey Sher

It is not unusual to see the betas slowing down with regard to increase, once the level reaches 5,oo! This alone is not very concerning to me.

Geoff Sher

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Mangostree

Hello Sir,
I was on just one round of clomid 100 mg last month and I got positive on 18th march.
My hcg level on:
19th march was 225,
24th march was 2972,
and 28th march is 12414.
.
I know hcg levels in itself aren’t definite indicative of twins, multiples, but still just curious to know your expert opinion whether it could be twins/multiples?
My US is not until next two weeks due to lockdown. Just anxious and seeking your opinion. Please oblige.

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mangostree

Also, 19th march was
15th dpo, when I got hcg level as 225.
Thereafter, 20th dpo and 24th dpo respectively.

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Vishu

In my 10 week but no pregnancy symptoms, im on progesterone pills and shot…i had a miscarriage in past so im paranoid that baby is not growing and because of progesterone im not even bleeding, what are the chances that progesterone can mask a miscarriage from happening…my clinic is closed for indefinite period coz of this virus thing so my scan is also cancelled

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Dr. Geoffrey Sher

Hi Vishu,

I previously responded to this post, stating that the the progesterone is unlikely to mask an inevitable miscarriage.

Geoff Sher

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Lauren Tabloff

Had a 5d FET March 30. Had Beta today (10d) and was 5.51. Doc wants me to continue meds andcome back Monday for another beat but says to be cautiously optimistic. Progesterone levels good.
What do you think? Any hope?

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Dr. Geoffrey Sher

This is a rather low 1st beta, but only time will tell Lauren. Hang in there!

Geoff Sher

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Dr. Geoffrey Sher

So sorry!

Trisomy 9 is an extremely rare chromosomal developmental defect . I have never seen this before. I would wait another 3-4 weeks and do an amniocentesis before acting…but of course that would be up to you to decide.

Geoff Sher

Geoff Sher

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Victoria Tumolo

Hello doc! I had my hcg drawn at 12DPO (March 25, 2020). My level was 77. I’m concerned that is too low. Any opinion? Thank you!

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Dr. Geoffrey Sher

This is still acceptable. I suggest you repeat this in 2 days to see if it will double.

Geoff Sher

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Lauren Andrade

Complete molar pregnancy 8 months ago. Got okay to try again 6months after molar which was Janurary 2020
Positive pregnancy test march 14th
Hcg at 10dpo =10
Hcg at 13dpo =101
Hcg at 19dpo=1545
19dpo progesterone 9.69ng/lm

What do you think do you think based off those numbers my pregnancy is viable?

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Robyn

I am 9 weeks pregnant accordingly to the date of my last period – I had my HCG levels tested on Friday 20th March and again on Monday 23rd March and the level had only risen from 150,000 to the early 160,000 – I am having another blood test tomorrow Thursday 26th March so hopefully it has risen more – are these results normal or something to worry about as I am completely unsure.

I would appreciate a response.

thank you!

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Dr. Geoffrey Sher

That could well still be acceptable. The rise in hCG levels tend to slow down after 5-6 weeks and then tail off. US serial assessments are far more reliable.

Good luck!

Geoff Sher

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Marissa H

Hello Dr Sher! Hope you are well. I somehow got a positive beta doing a natural cycle. I ovulated on cd7, so super early, and didn’t have much hope. My Hcg has been tripling nicely every 48 hours. betas: 156 – 600 – 1500 – 4100. My only problem is my estrogen has been very low. It was 25 with no estrace. Now taking 4 mg of estrace a day, and it’s 125. Do you think this points to an unviable pregnancy given the estrogen? I am on oral and vaginal progesterone and it’s around 45.
Thank you for your time!

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Dr. Geoffrey Sher

I suggest you do a beta hCG test and then repeat in 2 days to see if the levels are increasing appropriately.

Geoff Sher

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Marissa

thank you! My beta hcg is doubling, but estrogen remains low. What is your opinion on the importance of estrogen in regards to viability? Thank you!

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Dr. Geoffrey Sher

In my opinion, as long as the hCG keeps rising appropriately, progesterone is >10ng/ml, you still are in the running for a favorable outcome.

Geoff Sher

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Allie

I’m almost 11w and progesterone has been consistently in the 80s, and now they want to take me off progesterone supplements (200mg/day). Do you think that’s safe?

Mel

Hi there. My beta came back today it is 689 and I am 11dp5dt. Can you tell me if that is in the normal range?

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Dr. Geoffrey Sher

It is on the high side…Could be a multiple?

Good luck and G-d bless!

Geoff Sher

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Renee Smokovich

I had a beta test today at 6dpt5dt. Hcg was at 0.5 which went down from my first beta test at 4dpt5dt from 1.5. Is this drop due to The trIgger shot wearing off? Or is it not a good outcome?

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Dr. Geoffrey Sher

Hi Renee,
I regret to have to tell you that this is unfortunately a failed implantation!

So sorry!

Geoff Sher

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Chels

Hi Dr Sher,
I live in a small rural town and do not have my first obs/gyn appt until end of April,2020. I am 10 weeks 3 days today (23/3) have had some brown discharge with pelvic pain for the past 5 days, my HCG on 20/3 was 92,000 and dropped to 75,000 on 21/3. I had an ultrasound on 20/3 and bubs was right size with heartbeat of 160bpm. My GP has said that dropping HCG is a sign for impending miscarriage. Are they correct in this diagnosis?

Thank you so much for your time and expertise.

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Dr. Geoffrey Sher

At this stage of pregnancy, hCG levels can fluctuate. You cannot go by the hCG alone. Ultrasound will be more reliable at this stage….in my opinion.

Geoff Sher

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Chels

This has given me a glimmer of hope and fingers crossed all is still well, as it was at last scan 3 days ago. My GP is organising another ultrasound for this week and i’m pending a 3rd HCG BT results from today. We’ll take every day as it comes. Thanks Dr Sher, really appreciate your time.

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Jodie

Dr Sher,
I was seen on 04/07 where my hcg levels were at 2200 then seen again 30 hours later on the 9th and my hcg levels rose to nearly 2700. My ultrasound showed a sac but no visible yolk yet. The doctor thinks I’m no more than 4- 5 weeks. Is the slow rise in hcg level a sign of miscarriage or could those numbers be okay? I have no history of miscarriage.

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Mabel

Hi Dr. Sher,

I had a 5 day blastocyst transfer on 10 March, and the hcg test only showed a level of 10 on March 20. Will do another test in 48 hours. Can i ask if the hcg level is the only criteria? Shall i request for a progesterone test as well? When shall i make decision to give up? Can i start a new IVF cycle immediately?

Many thanks,
Mabel

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Dr. Geoffrey Sher

I do not personally believe that measuring progesterone will matter. I would however, not give up until repeated hCG tests and/or subsequent US done 2-3 weeks from now, discounts a pregnancy. Thereafter, my advice is to take a break for one full cycle before re-engaging.

Good luck and G-d bless!

Geoff Sher

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Kk

My first beta for my iui was 14 today later it was 16 , my number didn’t go down so what do this mean?

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Sreeja Pradeep

Hi Doctor,
I am Sreeja, since 2 days i am waiting for your valuable answer. 2012 underwent open ovarian cystectomy, 2016 got married and after 2month ectopic salphinjectomy left done because there is adhesion of the open surgery. Tried 2 years ovulation induction and IUI, but failed, HSG done, and my doctor told that tube filled with dye but only some spillage is present to the peritoneum, there may be a distal block and he adviced 2 options, HLS to assess tube or IVF. Which is suitable for me. Will HLS help to remove distal block? I am eagerly waiting for your reply.

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Dr. Geoffrey Sher

You need IVF but if you have a hydrosalpinx, this should be addressed beforehand. Talk to your RE.

Geoff Sher

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Janelle

My hcg was 256 on March 5th. On March 17th at 3pm it was 2566 and on March 20th at 11 am it was 2839. Is there something wrong? Can I still have a healthy pregnancy. My last period was feb 5th

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Dr. Geoffrey Sher

This is a slow rise. Only time and ongoing testing can determine if this is a viable or non-viabl3e implantation.

Good luck!

Geoff Sher

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Destiny L.

Hi!. My IUI was 2/29/20.
3/16 was 212
3/18 was 590
Are those good numbers? What’s the likelyhood of twins with the numbers almost tripling in right at 48-49 hours.

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Jenny

Hello!

I had a single, 5 day transfer on 3/11/20. Beta HCG on 3/20 was 131, and repeat done on 3/24 was >1000. Im wondering your thoughts on this rise, is it a fast rise in your opinion?

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Dr. Geoffrey Sher

I suspect this is a healthy pregnancy on the make!

Good luck!~

Geoff Sher

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Priya

Hi Dr. Sher,
This is my first IVF cycle. 2 embryos were transferred at 5th day on Feb 26. I am now at 5 weeks and 5 days after LMP.
I had my first beta 7 days later. Progesterone was 29 on March 16. HCG levels were:
March 4 – 45
March 12 – 744
March 16 – 1300
March 18 – 1669

My RE initially said she was happy with the numbers and now says she is concerned that the number from March 18th isn’t higher and that I need to have an US to check. What are the chances this is still a viable pregnancy? What do you think is happening?

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Shara

Hi Dr,
My IUI was done on 02/29/2020. My hCG:
03/13 — 27
03/16 — 31
03/18 — 88
Do you think it is a viable pregnancy?

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Dr. Geoffrey Sher

It is too early. Repeat the hCG in 4 days , it should quadruple if OK. Then do an US in 2.5 weeks from now for a definitive answer.

Geoff Sher

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Shara

Thanks for your reply. I was curious to know even if this ends up as a viable pregnancy, does the low hCG mean that the fetus may have disabilities? Or there is no such connection?

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Dr. Geoffrey Sher

There is not necessarily a connection. However, a lot will depend on measurable, progressive developmental parameters. Discuss with your RE and Perinatologist..
Geoff Sher

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Christe Anastopoulos

Hi Dr. Sher,
I am officially freaking out! Any success stories with HCG not fully doubling? Or similar numbers?

10dpo (3 weeks 3 days)
Beta HCG: 37

13dpo (3 weeks 6 days)
Beta HCG: 140

17dpo (4 weeks 3 days)
Beta: 292

My last beta reflected HCG doubling every 3 days & 18 hours
(2 days increase 44%)

Going in for another beta tomorrow…
I have gone off the deep end reading studies….I have found 3 different opinions. Some studies say 60% increase in 48 hours, some say 50% and I saw another that said the threshold should be lowered to 35% increase in 48 hours. What are your thoughts on this being a viable pregnancy with the numbers above?

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Dr. Geoffrey Sher

I wish I could assure you that all is well Christe, but that is not possible. You will have to wait another 2 weeks and do an ultrasound. In the meanwhile ask your doctor to keep an eye out for a tubal (ectopic) pregnancy. I am not suggesting that this is what is happening but rather be safe than sorry. Report any pain, light headedness or bleeding to your doctor.

My thoughts and prayers are with you.

Geoff Sher

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Christe

Thanks! I’ll keep you posted. Just so anxious and sad regarding the last beta…. I had a MC in Sept and a second MC on Thanksgiving 2019. This is now my third pregnancy and no baby yet. I really hope the Beta’s make a turn for the positive.

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S e lew

Hi I had beta hcg reading of 58000 at 9 weeks (or 8 depending on accurate dates- discrepancy on scan at 6 weeks due to spotting). At 9 weeks 3 days I had beta hcg of 57000.

Also, I have spotted every day since 16/3 with some episodes of heavier bleeding and clots. The sonographer warned of a risk of miscarriage as the foetus was in the lower third of my uterus just above cervical os.

I’m unable to get in for a scan due to the virus but they are going to test hcg again in 6 days. On the last test it was noted that by b12 is low and requires injections.

I have got my head round all outcomes I just need someone’s opinion as I’m not really getting answers- could you help?

Thank you x

Dr. Geoffrey Sher

The position of the fetus at this stage is NOT relevant. Your bleeding is most likely due to a retrochoionic bleed. This is not uncommon and more than likely will stop over the next few week. Most of these do clear up.

I think there is reason for guarded optimism as I am hopeful will be revealed by your next US a few weeks from now.

Good luck!

Geoff Sher

Christe

Got my results back. It went from 292 on 3/16 to 526 on 3/18
2 Day change = 80.1 % increase.
Doubling time =2.4 days or 56.53 hours

Hopeful?

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Zee

My betas have started slowing down. I’m 6w2d today and they’ve gone like this:
25dpo: 4689
27dpo: 7024
30dpo: 11732
The last two readings have a doubling time of 97hours. Does this look like it’s failing? A sac was seen in uterus at 5w5d
Thanks

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Dr. Geoffrey Sher

Not at all! At this stage of pregnancy the rise in beta hCG level slows down.

I think all is well!

Good luck and G-d bless!

Geoff Sher

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Lily

Hi,

I had two miscarriages before, now had a positive pregnancy test with 66 hcg 13dpo. I haven’t done a second test but just concerned that 66 is low. What do you think?

Thanks!

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Dr. Geoffrey Sher

Do a second test in 2 days to see if it doubles.

Good luck!

Geoff Sher

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Ali

Hello Dr Sher

Transferred two Embryos on 2/23/20

My Betas are

3/2/20 370 8DPT
3/6/20 2205 12DPT
3/9/20 6478 15DPT (Two weeks)

Is this a normal progression? Could it be multiples ?

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Heather

Hello Dr. Sher,
I’m pretty sure I ovulated around March 14th. Had a very faint positive at home pregnancy test on March 26th. Went for beta on March 30th was at 57. Went in again today April 1st and it was 99. Doctor said to do an US in 3 weeks but didnt say to repeat beta. I’m feeling uneasy about these numbers.

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Dr. Geoffrey Sher

I am afraid that only time will tell!

My hunch is that all will be fine!

Geoff Sher

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Angela

Hi Dr. Sher, I’m 7 weeks 1 day pregnant, I’ve been told I’m having a subchorionic hematoma, I’m bleeding since last night and something like liver came out my vagina this morning, I went for an ultrasound and was told that these are common and I should do bed rest, lots of fluids and go back for another ultrasound in a week. Also was told to inject 100 mcg im instead of 50 mcg, and also to continue 50 mcg suppositories. I have another suppositories at home too that are 200 mcg, I know you are not going to prescribe me through here but wanted to know your opinion on how bad does this looks and also what’s your opinion on what would be better: using 200 mcg suppositories + 100 mcg im injections or 50 mcg suppositories + 100 mcg im injection. Thanks in advance for taking the time to reply.

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Dr. Geoffrey Sher

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

Good luck!

Geoff Sher

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