Is there any hope?

We are often asked the difficult question of whether there is any hope when the beta levels are not rising appropriately. The short answer is that there is always hope and yet I wish that I could know the outcome as soon as possible so that I could spare patients that roller coster ride of emotions when things are not going according to the textbooks. However, I have become very cautious about writing off pregnancies too early. There are several patients who love to write at the bottom of their Christmas cards little reminders like “The little boy in the reindeer sweater is the pregnancy that you thought was never going to end well.”

Hey, I am only human and you can only take so much abuse from your patients before you learn to keep your mouth shut and just let it ride…

So given today’s question on the INCIID bulletin board here is the Question of the Day from 100 Questions and Answers about Infertility, the book that has not yet been featured on MSNBC unlike that other book 100 Questions and Answers about Cancer and Fertility…Oh well, that is a good book too.


80. My beta­HCG levels are as follows: 260 mIU/mL 14 days after a day­3 embryo transfer, 500 mIU/mL 16 days post transfer, 900 mIU/mL 18 days post transfer, and 1900 mIU/mL 20 days post transfer. Is there any hope for this pregnancy?

In a normal early pregnancy, regardless of the method of conception, the woman’s blood beta-HCG levels will roughly double every 48 hours. Failure of the beta-HCG levels to double suggests an abnormal intrauterine pregnancy or an ectopic pregnancy. Given that biologic variation can occur in both normal and abnormal pregnancies, however, we cannot assume that a pregnancy is in jeopardy simply because the beta-HCG levels fail to perfectly double. In the case described in the question, the woman’s beta-HCG levels did not double, but she could have either a normal intrauterine pregnancy, an abnormal intrauterine pregnancy, or an ectopic pregnancy. This determination can be made only by performing a transvaginal ultrasound examination. Even then, the results may be inconclusive. In our practice, we have seen several cases in which patients had dramatically abnormal beta-HCG levels associated with a first sonogram, suggesting an early blighted ovum pregnancy, only to discover later that the pregnancy was completely normal. Another common cause for abnormal increases in the beta- HCG level is multiple pregnancy. When patients undergo transfer of two or more embryos, a multiple gestational pregnancy may occur. In roughly 40% of these pregnancies, spontaneous fetal reduction of the extra implanted sacs occurs, resulting in a sudden drop in the beta-HCG level. Initially this decrease might be falsely interpreted as an apparent problem with the pregnancy when, in fact, one surviving embryo is completely healthy. For all these reasons, the blood beta- HCG doubling effect must be viewed as a guide, and not as absolute proof of the woman’s condition and future outcome of her pregnancy.