My IVF Cycle Failed – What Went Wrong? Question #16: Why did my hCG levels stop rising properly?

22 Aug
Ask Dr. Sher A Question

Learn why your Beta hCG level stop rising

This is the 16th in a series of answers to common questions about failed IVF.

Immediately following implantation, the root system (trophoblast) of the embryo begins to release the pregnancyhormone, human chorionic gonadotropin (hCG) into the surrounding uterine lining (decidua) from where it enters her blood circulation and spills over into the urine. It is only after several days of implantation that the hCG blood level reaches a measurable concentration and only several days later that it becomes detectable in the urine.

Each implanting day-3 (cleaved embryo) should, within 7-9 days of being transferred to the uterus, contribute about 5mIU/ml to the blood hCG concentration and within 5-7 days following the transfer of an implanting day 5-6 blastocyst. Thereupon the blood hCG concentration should double approximately every 48 hours during early normal pregnancy, peaking at about 60,000 mIU/ml at about 10 weeks (but there is a substantial variation with the extremes of normal levels ranging between 10,000 to 250,000 mIU/ml). From the 10th to 20 weeks of gestation, hCG levels decline, reaching an average concentration of about 15,000 mIU/ml. Again, there are considerable variations with hCG concentrations ranging from 3,000 to 115,000 mIU/ml where the blood concentrations remain from 20 to 40 weeks (term).

Pregnancy (weeks)

 

Days post-ET

Approx. hCG concentration

single conceptus (mIU/ml)

3

5-9

0 to 5

4

14

5 to 450

5

21

180 to 7500

6

28

1,100 to 56,500

7 – 8

35 to 42

7,600 to 230,000

9 – 12

49 to 70

25,300 to 300,000

13 – 16

77 to 100

14,000 to 250,000

17 – 24

4,000 to 170,000

25 -40

3,000 to 115,000

4 – 6 wks after birth

< 5

It is true that some normal pregnancies progress normally in spite of low blood beta hCG levels. The best way to confirm if an early pregnancy is progressing is to repeat with a blood test in 2 days time, and perhaps again 2 days later to determine whether the hCG level is rising adequately. In cases where during the 1st 1-2 weeks of pregnancy the blood hCG concentration fails to double every 2-3 days on a consecutive basis, it often (although not invariably) spells trouble for the pregnancy.

It could mean the following:

  • A failing intrauterine pregnancy that will ultimately miscarry
  • A tubal ectopic pregnancy
  • Multiple pregnancy where one or more (but not all) of the concepti are failing (being absorbed)

Ultimately, discrimination between a normally progressing early intrauterine pregnancy and one that is failing or is ectopic gestation requires careful correlation between the trend in blood hCG levels and findings at one or serial ultrasound examinations.

350 Comments

  • Davis ronaldo says:

    Hi doc,my wife done 2 embroy transfer on Day 3 but her menses came on the 10th day with blood test beta count less than 1.2…pls help to advise whether any problem with the embroy transfer procedure…thank you

    • Geoffrey Sher says:

      My website has changed. The new site is at http://www.sherIVF.com where I host and populate new and updated blog articles . The blog can also be accessed directly by going to http://goo.gl/4hvjoP. I now only respond to posts on this new site.

      To find and follow updated and new blog articles and to post questions or comments, please use this new venue. I promise to respond promptly.

      In the interim, please re-post this question or comment on my new website-blog.

      Geoff Sher

  • Jayson canson says:

    Hi there, my wife had her b hcg test today (day 7 post transfer of 5 day blastocyst, unassisted hatching) her hcg was 2.2, very low accdng to RE, advised us to come back after 5 days for repeat hcg blood test, is there still hope for a pregnancy?

    • Geoffrey Sher says:

      Thank you for connecting! I am updating my entire blog, so kindly-go to http://goo.gl/4hvjoP and re-post your question/comment there, and I will respond promptly. Henceforth I will be responding on that site.

      Thank you.

Leave a Reply

Your email address will not be published.