Sunday, January 31, 2010

IVF Patient's Early BetaHCG Levels Show Drop In Estrogen


On January 12th, I discovered I was pregnant following IVF. My HCG numbers have been excellent. However, on January 21st I learned that my estrogen levels had dropped to 259 (from 400 on Jan 15). My progesterone and HCG continued to do well (HCG 569 on Jan 15, 3616 on Jan 21st). My Doctor has indicated that I should plan a D&C imminently as the pregnancy is unlikely to be viable.
Would you share this view? How significant is an estrogen drop? Thank you.


Thank you for your question.

In the early pregnancy, less than 6 weeks gestational age, estrogen is derived almost completely from the ovary. Placental estrogen production has not started. Based on your first BHCG, I estimated that you are less than 6 weeks gestational age (assuming your BHCG was drawn at 8-10 weeks post transfer). If that is the case, and you are not taking exogenous estrogen (from another source), then the drop is concerning because it is an essential hormone of pregnancy.

Your doctor might want to consider adding estrogen in some form. Estrogen alone is not sufficient to diagnose an impending miscarriage. If all three hormones are dropping, then that would be significant. I would continue to follow the BHCG levels, which is the most sensitive to make that diagnosis.

In such an early pregnancy, a D&C is generally not required. Good luck and hang in there!

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program


  1. I am mid 40s and doing a donor egg IVF cycle, scheduled for March 22nd.

    On March 8th, I went for my E2 and lining check. My E2 was 1,296 and my lining was at 7.6mm. I am currently taking .2ml of Estradiol Valerate IM injection 2x week (Tuesdays and Saturdays).

    Because my E2 level "looked great," the clinic said I didn't need any more blood drawn, but to come back for a lining check.

    Today, March 11th, the ultrasound technician commented that my lining was starting to mature - tri-layer - and that my lining was at 7.4mm. This is a drop of .2mm since Monday. I am very concerned.

    I am waiting on a call back from my clinic to advise me of my situation and whether there would be an adjustment in my Estradiol. I would assume so, since my E2 dropped!

    At my suppression check on Feb. 19th, my E2 was less than 9 and my lining was a 3.1. I've did a few .1ml Estradiol shots, and then they increased it to .2ml at the beginning of March.

    I am very worried. Does the fact that my lining dropped/isn't rising a sign of a problem? Is there enough time to increase my lining before my estimated transfer date of March 22nd or 23rd?

    Why does this happen?

    Thank you.

  2. Hello, an endometrial lining of 7.4-7.6 is definitely not adequate. The lining should be 9 mms or greater. If it is inadequate, it would necessitate some type of treatment to try to increase the lining. Some clinics will just increase the dose of the injection, whereas others will add a vaginal estrogen (since that gets to the lining more directly). If the lining is not adequate by the time of the start of progesterone, and definintely by the time of the transfer, then most clinics will NOT transfer the embryos but will elect to freeze them and transfer in another cycle when the lining is better.

    I know my note is late, but there is enough time between the 11th and 22nd or 23rd for the lining to reach appropriate levels. Hopefully it has!

  3. I am 10 weeks ivf still on estrogen and progesteron support. My estrogen has been dropping steadily since 8 weeks and is now at 225. My progesterone is doing great though. Does this indicate an impending miscarriage? I have to wait a few more days for an ultrasound.

    1. No. After 8 weeks the placenta has taking over production of the essential hormones to support a pregnancy. We keep them longer only for peace of mind. You needn't worry.

  4. I am currently 5 weeks pregnant from a 3dat FET. MY LEVELS 6 days ago were hcg 300, p4 11.1 and estrogen 1700. I have been on endometrin 3x a day since 3 days before transfer and estrace 1/2 tab 2x a day. My first blood work 6 days ago was taken in the morning. I had my levels rechecked today my hcg was 6,000 and estrogen dropped to 215. I also had an u/s and my gestational sac measured 5 weeks exactly. Does this look bad?

    1. Congratulations. You can't really measure a pregnancy by the numbers at this point. The ultrasound is the primary means of evaluation and yours is looking good. However, the definitive ultrasound exam to determine that a pregnancy is viable is an 8 week ultrasound that shows a well developed fetus of appropriate size, good strong heartbeat (120-180) and normal anatomic findings. Congratulations.

  5. I am 6 days post embryo transfer. My estrogen level was 79 and progesterone was 13.4. My dr is starting me on patches and progesterone oil today. Is it even worth doing? Im so confused, please help

    1. I know that this is probably too late to you help you, but the answer to your question for the audience is that following the doctor's recommendations/orders is always the best choice. No one can predict an outcome so you have to do everything you can to try to make it successful.

  6. Hello, I had FET on 12/09 and found out couple of days ago that it was successful. My beta at 9dp5dt was 340 and 11dp5dt was 710. P4 level is 60. However my Estrogen level is only 110. Prior to transfer it was 180. Is this level considered low? What is the expected level of Estrogen in early pregnancy following FET?
    Thank you



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