Our Los Angeles based fertility center, the Center for Fertility and Gynecology, utilizes a vast array of methods and technologies to assist our patients to conceive. However, we know that optimal care does not stop with the positive pregnancy test. The first few weeks following a positive pregnancy test can sometimes be as stressful and confusing as trying to get pregnant. The following is a description of the normal steps taken during early pregnancy and what to expect from early testing.
Pregnancy test timing:
A pregnancy test is always scheduled for 14 days after “ovulation”. For patients who have undergone controlled ovarian stimulation (COH) or ovulation induction with IUI, this is usually 14 days after the insemination. For patients who have undergone IVF, this is 14 days after follicle aspiration. In patients who have undergone frozen embryo transfer (FET), this is the equivalent day to when the embryos are 14 days old (11 days after a day 3 transfer, or 9 days after a day 5 transfer).
Type of pregnancy test:
We perform both a urine and blood test for pregnancy. The urine test is available immediately. If it is positive, there is essentially no chance that the blood test could be negative. On occasion however, the urine test can be negative while the blood test is positive.
What number are we looking for?
The blood test quantifies the concentration of beta HCG (the pregnancy hormone) in the body. On the day of the first pregnancy test, we normally like to see the beta at around 100mIU/ml (60-150). It is important to know however, that there is a wide range of possible normal beta levels at this point. I have personally seen levels as low as 12 mIU/ml that have gone on to be beautiful, perfect babies.
Rate of rise:
More important than the initial absolute value of the HCG, is the rate at which the HCG increases. The rule of thumb is that the HCG should double every 48 hours. Importantly, this is only a rule of thumb and there are exceptions, but in general we are reassured when the number doubles every 2 days.
What if the number doesn’t rise properly?
If the beta HCG does not rise as expected, we will continue to follow it every 2 days until we know what is going on, this may take 6-14 more days. There are 3 possible outcomes with an abnormal rise:
1. Normal pregnancy
2. Abnormal pregnancy (one that will eventually cause a miscarriage) within the uterus
3. Abnormal pregnancy outside the uterus, this is known as an ectopic pregnancy.
Distinguishing between the above 3 possibilities requires a significant amount of skill, experience and perseverance.
If are struggling with fertility or have any questions about early pregnancy, feel free to contact us, we are happy to speak with you.