Saturday, October 15, 2011

IVF Patient Has False Negative On Pregnancy Test: Late Implantation? What Went Wrong?


Question:

Dr.Ramirez,

I have written to you in the past and you have always been such a great sounding board. I need help and closure and I am hoping that you can help.

In September I went through IVF (in vitro fertilization). On 9/7 I transferred 2 embryos- 1 7cell grade AF and a 4cell grade BF. On 9/16 I had some light spotting and cramping. My beta was on 9/19 (12dp3dt)was negative & my RE instructed me to stop taking the PIO & Estrace. A few days later, what I thought was my period arrived. It was a medium flow w/some small clotting & lasted about 4 days & stopped. A couple of days later, I started bleeding very heavily & passing large clots. I went in to see my RE. She conducted an Ultrasound & some blood work to make sure I wasn't anemic. At that time I asked her to run a pregnancy test. She said that there was no way that I could have been pregnant but did it anyway. The next day she called to tell me my beta was 512!

I am absolutely devastated. I can't believe that I was pregnant the whole time. My RE is calling it a biochemical pregnancy and is saying that it probably wasn’t a healthy pregnancy but I am getting the feeling that they are trying to place blame elsewhere. I feel like I need some questions answered by a neutral party. I am having a hard time moving on so maybe you may be able to offer me some closure.

1.Should something have shown up on the beta 12dp3dt? If not, do you think it was a lab error?

2.Could it have shown as negative because of late implantation? If the cramping/spotting on the evening of the 16th was implantation, would HCG have shown up on the morning of the 19th?

3.I have a luteal phase defect. What effect/impact would stopping the PIO and Estrace have on the pregnancy? Do you think that stopping meds was the reason for the miscarriage?

4.My beta was 512 after bleeding for over a week (heavily). I would think it was much higher to start. Do you think that this would have been a healthy pregnancy?

5.Should the clinic have done a 2nd beta?

6.Any suggestions on where to go from here? Any help would be greatly appreciated.

D. from Boston, MA

Answer:

Hello D. from the U.S. (Boston),

Certainly what you have gone through is very unusual and unfortunate. It shows that late implantation exists. I usually do my first bHCG at 8-9 days post embryo transfer. I do two bHCG's, one at that time and another 48 hrs after. I have had a successful pregnancy case where the first bHCG was negative (<1) and the second positive (14) that went on to deliver a beautiful baby. Keep in mind, however, that there are no specific protocols regarding how many bHCG's to do and it is totally up to the medical director of your clinic.
I cannot answer the question about the cramping and spotting on the 16th. If you have a luteal phase defect, then yes, stopping the supplemental hormones can lead to a miscarriage. There is no way to know if this was the reason for your loss because there are many other possibilities as well, such as an abnormal embryo. I cannot answer your question about whether or not this pregnancy would have been healthy. The number was certainly a good and high number.

What is important to keep in mind at this point: This experience showed that you can achieve pregnancy. IVF only has the capability of giving you the opportunity to become pregnant. It cannot force a pregnancy on you. Keep in mind that the last two steps required to achieve pregnancy, embryo hatching and exiting the shell and implantation are natural steps. We don't have the technology to make these happen. That is why I say that IVF can only give you the opportunity. The last steps are in God's hands. The fact that implantation occurred (positive bHCG) shows that the last two steps took place and you can do it again.

Now you just have to maintain your hope, diligence and savvy. You've gotten this close. After all that you have been through, why would you not keep trying? Hopefully, the next one will be a "home run" or "touchdown" depending on which sport you prefer. If you don't try, you certainly won't be any closer to success, so don't give up!

Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

249 comments:

  1. Hi I am about to undergo IVF but have been told that they will only do a urine pregnancy test 13 days past transfer and if it's negative they will stop the meds. II had a natural pregnancy 10 years ago and did not get positive pregnancy test until 7.5 week's pregnant eventho I was testing every couple of days had 2 urine tests at family planning clinics and one at a doctor's. I have decided that I'm going to get a bloodtest done privately because I really do think it's wrong that clinics do not appreciate that there are women out there that dont show up on a urine pregnancy test the same as this poor lady above and then told by the professionals to stop the meds at such a crucial time. IVF costs enough I think it's a disgrace.

    ReplyDelete
    Replies
    1. You and I are in complete agreement but that is the price of socialized medicine.

      Delete
  2. Dear sir, do you agree that a lady late 40's early 50's should undergo fertility treatment and is it safe?

    ReplyDelete
    Replies
    1. Yes. That is the standard recommendation because the natural chances of pregnancy are almost zero. IVF is the only option that can increase that chance, although it is still low.

      Delete
  3. I am on 15day post embryo transfer..Did pregnancy test confirmed negative

    ReplyDelete
    Replies
    1. I'm sorry to hear that. You need to keep trying. IVF is not a perfect technology but your chances are good as long as you don't give up.

      Delete
  4. Dr I am in such confusion...im 10dpt it was 6dt (icsi)...mybeta hcg is on 30th but I did it today out of curiosity and I turned out to be negative giving result of 0.9...but since last 3 days im getting positive in my hpt...is it possible tht um pregnant and lab has done some error or shud I give up hope...waiting anxiously for ur reply

    ReplyDelete
    Replies
    1. A blood pregnancy test is more sensitive than a home pregnancy test. Also, since you are 10 days post transfer, if you were actually pregnant, it should have been a positive test. I'm afraid it's not good news.

      Delete
  5. Im 9dpt it was 5dt (icsi)...im gettin postive results on hpt since 3 days and my blood test is due on 30th...but I cudnt wait and did my bhcg today it came out negative with 0.9 value...can labs do error or shud I give up hope

    ReplyDelete
    Replies
    1. I just answered the question you posted 4 minutes prior to this one. Evan at 9 days the test should have been positive. I usually test my 3dt patients at 8 days post transfer and my 5dt patients at 6 days post transfer.

      Sorry.

      Delete
  6. I am on 7th day after transfer of two "very good embryos" according to doctor. Who selected these two embryos out of ten. I was tested today and result was negative :( Do you recommend retesting maybe by Monday? I have no spotting, some cramping and tenderness on my breast which reminds me of my two previous pregnancies.

    ReplyDelete
    Replies
    1. Seven days post transfer is a little early if it is a D#3 transfer, but not if it is a D#5 transfer. I always repeat the test two days later just to get a confirmation. I have had patients that initially test negative but then turn up positive due to a late implantation. Some of these have ended up as chemical pregnancies but some have progressed. I always do two tests.

      Delete
  7. Dear sir, I had my fet of 3 embryos (two 8 cell and 1 compaction) on 27th may. 14dpt had my beta tested negative. I was asked to stop medicines. Now even on 18dpt did not get my periods. Is there any chance that am pregnant? Should I test beta and if so when? Eager to know you reply. My fresh ivf akso turned up negative.

    ReplyDelete
    Replies
    1. If you did a blood pregnancy test and it has been 18 days since your transfer. It is unlikely that you are pregnant if the test was negative.

      Delete
  8. I just took my bHCG it was ver low so I was informed that I am not pregnant. But they also informed me that there could be exceptional cases and ask me to go back to hospital if my period didnt come in two weeks after I stop sll my meds. So is it wise to stop the meds since there is still a possibility that I am pregnant. Thanks and appreciate your guidance.

    ReplyDelete
    Replies
    1. What did your doctor mean by "low"? Is that negative or a low positive? If it was a low positive, then the usual protocol is to repeat the test every 48 hrs to check the progress of the pregnancy, and in that case, the medications should not be stopped.

      Delete
  9. Hi,

    Today is her 15 days. We do the HPT last night and this morning and it turns negative. Schedule tomorrow for blood pregnancy test. Ist possible that my wife is still preganant. Thanks.

    ReplyDelete
    Replies
    1. A home pregnancy test (HPT) can only detect the bHCG hormone if it is above a certain threshold level, whereas a blood pregnancy test can detect it down to zero. So, there is still the possibility of a positive bHCG.

      Delete
  10. hi doctor.tady is my day 10 after day3 embryo tnasfer.had serum beta hcg value of 0.6.what should i expect> should i do it again.please help me

    ReplyDelete
    Replies
    1. My usual protocol is to do two tests in order to verify that the first is not a false negative. I have had patients have a negative test on the first bHCG and then turn positive. I would therefore repeat the test in 48 hrs. If it is negative then that is the final result. If it is positive with a number above 1, then I keep testing every 48 hrs.

      Delete
  11. Looking for answers.....I just did my 2nd IVF cycle and second FET. I'm on an RPL protocol which consist of heparin and intralipids. My embryos had the 23 micro array done, so I know they were normal. Today is 6dp5dt and I'm getting a negative on hpt. Any idea why my normal embryos didn't make it? I'm absolutely devastated.

    ReplyDelete
    Replies
    1. I'm sorry to hear your result. There is not way for me to answer your question. Remember that the success of pregnancy after embryo development depend on four very important factors: transfer technique and three NATURAL steps - egg hatching out of the shell, attachment to the endometrial lining and the lining growing over the embryo. These last three steps have to occur on their own. They are in God's hands. The transfer technique is what makes RE's different.

      I have a post on recurrent pregnancy loss and the protocol that I use. I would recommend that you review it and if your doctor is not using some of these medications, you might want to discuss that.

      Delete
  12. hi doctor,
    i had got my second ivf done, first one was fertilisation failure. but second time 3 grade 1 embryos were transfered. My hcg test after 16 days revealed it was negative. our Dr has told us to get an ultrasound to confirm...is there any possibility that ultrasound shows some positive result?

    ReplyDelete
    Replies
    1. You have a stupid doctor. There will be nothing to see by ultrasound if the bHCG is negative. It is a very sensitive blood test. The bHCG level has to be above 2500 in order to see any thing by ultrasound. I wonder if you doctor wants this just to make money?

      Delete
  13. Hi Dr Ramirez, I had a 3 day transfer, rested at home for three days then on day 6 post transfer I went for accupuncture. 20 mins into accupuncture I had a muscle spasm in my abdomen it shocked me and woke me up it was very strong. The next day all my pregnancy symptoms I was having, dizziness, acne, cramping stopped. That was also the day my hcg trigger left my body. I am now day 13 and pregnancy test negative and I have three more days until my blood test. I have two questions: 1 could the spasm have effected any potential pregnancy (I am told it was my stomach point the needles were in) and 2. I had a nine day period this month due to a polyp removal and dc. I am normally 26 days (and on the 26th day of my cycle I started getting cramping but no period ( I am on progesterone) should I therefore factor in another 3 days for my period this month given it was a 9 day period instead of my usual 5-6 days? I am asking so I know when to time my home pregnancy test from. Many thanks.

    ReplyDelete
    Replies
    1. I am not an expert in acupuncture but doubt that the stomach cramping would affect implantation or a pregnancy. I don't understand the second question at all. You are far enough post transfer to have a blood pregnancy test and that is what you should do. I usually check my patients 8 days after the transfer.

      Delete
  14. Hi Doctor,
    I had 3day frozen embroy trnasfer.Today is 12day post tranfer.I did
    hpt today came out negative .My blood test is scheduled after
    2 days.Does it means cycle is failed?

    ReplyDelete
    Replies
    1. Yes. This means that you are not pregnant.

      Sorry.

      Delete
  15. Me and my husband did our first ivf. My husband had a fnac report that says he had obstructive azoospermia.we started ivf nd i was told that my ovaries are suppressed i am 31 yrs totaly normal bt a bit high fsh. They gave me lupride nd gonal and menopur that too 150unts each a total of 300 every day till egg retreival.then they said i am low responder.nd on tesa day my husband didnt showed any live sperms that came like a shock.sadly i had to go with donour sperms.i just had one embryo a quality transfer nd on day of hcg blood test it was negative.are those high doses responsible for non impla.tation nd lowering my egg quality.i have no period its 5 day pass that negative test.plz help sir m too sad with all these bad things happening to me m too depressed to move furter in life.

    ReplyDelete
    Replies
    1. There are three steps that your body has to go through on their own before a pregnancy will occur when doing IVF. These three steps are natural steps and we do not have the technology to make them happen. For that reason, IVF is not a perfect technology. Failure of any of these steps would lead to a failed IVF cycle.

      Just like a woman trying naturally, it can take several attempts with IVF before a pregnancy can occur. I would recommend a high dose protocol to try to get more eggs. However, if you are going to have to use donor sperm, your alternative would be to try IUI instead.

      Good Luck

      Delete
  16. Hi doctor
    Hope you are doing well. I got my first ivf done and I am 14 days past embryo transfer. The 2 week wait was the worst bit but I did take care and avoided any strenuous activity. I did one hpt 12dpt and one today but both came negative.i am devastated because I was feeling very positive and had some symptoms like more trips to the toilet, more thirsty, cramping on day 4 and day 9, the latter was painful and also more gases in my stomach (sorry about too much info) and a bit of change in my diet like less tea/coffee and craving of spicy food. My hospital does not do blood tests for some odd reason so I have to go to my Gp for s hcg blood test. I just wanted to know is there even a slight chance the Hpt test was a false positive? The nurse said to me that the Hpt are always accurate :( but I was not entirely sure. We have been TTC since last 3 years and both of us are perfectly healthy. I would love some advice.thanks z.

    ReplyDelete
    Replies
    1. By two weeks out, even a HPT will show a pregnancy if you are pregnancy, however, I don't rely on them. I would certainly recommend a blood pregnancy test to make sure.

      Good Luck

      Delete
    2. Hi doctor my ivf transfer on 30th sep n I went for blood test on 14th oct it was negative I was v upset n then I got periods on 17 little stil shal I hope

      Delete
  17. Hi dr I am 8dpt 3dt and my beta says <1.20 is there any chance of being pregnant? This is our 2nd ivf cycle and we are really hoping that this one will work but now seeing my beta made me depressed... They scheduled my beta on sept 25 though.. We was on sept 7 and et was on sept 10

    ReplyDelete
  18. I do a hpt this morning on day9 came negetive do I still have some chances of posive results

    ReplyDelete
    Replies
    1. HPT is not a sensitive enough test this early in the cycle. You need to wait at least 14 days post transfer/ovulation or do a blood pregnancy test.

      Good Luck

      Delete
  19. Dear doctor,
    I had 5 day blast FET on 14 th sep'13. As my doctors protocol i did b hcg on 27 th sep'13 & it came negative. After that i stopped all medicine but my periods not started yet. When would my period may come. I had not bleeding no spotting and no major cramping.
    Thanks

    ReplyDelete
    Replies
    1. Hello,

      You have to allow yourself at least 7 days to have a period after stopping the medication.

      Delete
  20. hi my name is diana i'm 27 years old i have endometriose in the fallopian tube i did my first ivf in june it was a negative result,i did my second ivf in 26 sept it was the day 16 after my period,i did my beta hcg test in 10/10 and it is negative.My doctor told me to stop all the medicaments but in the laboratory wher i did my blood test they told me to continue and retest after 5 days.What should i do?could it change to positive?

    ReplyDelete
    Replies
    1. I can't advise you on this because you haven't given me specific enough information. However, if you want to be absolutely sure it is negative, then repeat the test. You don't need to wait 5 days. You can do it two days later.

      Delete
  21. FET of two 5d blasts (1 hatching & 1 expanded) with no degradation during thaw.
    +HPT began 5 days after FET.
    bHCG 10dp5dt 147; 13dp5dt 145; 15dp5dt 166; 17dp5dt 277.
    RE indicates he truly believes 2nd blast implanted & is progressing.
    Has ordered repeat bHCG tomorrow (4 days past last test).
    I'm cautiously optimistic, but also realistic.
    Have you seen this in clinical practice & what are chances of success?
    I have 3 grown children w/no issues but tubal ligation done after 3rd child so did IVF w/current husband. The youngest is 20 y/o.
    Thank you.

    ReplyDelete
    Replies
    1. The bHCG numbers started on the high side which can potentially mean that there was an implantation of two, but the fact that the numbers are not doubling may mean that one is not progressing well. Since the numbers are going up, I would agree that you should follow the results. There is still hope.

      Delete
  22. Hello Dr. Ramirez,
    I am 8 days past a 5day transfer of male embryos, using donor eggs. Both were quality blasts, no spotting during or after ET, but HPT is negative. My lining was 11.5 and except for current age,no issues getting or staying pregnant. I have a beta in two days, but shouldn't a HPT at least show a slight line?

    ReplyDelete
    Replies
    1. I know this answer is after the fact and apologize for delay (but this site is not intended to give immediate responses). But for your future information, a home pregnancy test will only term positive after the bHCG hormone has reached a certain level. It is meant to be done after a period is missed, which is over 14 days. For that reason, it often will not show as early as when a blood pregnancy test is done following IVF.

      I hope this response finds you newly pregnant. Good luck.

      Delete
  23. Hi,
    I'm 11dp3dt. They transferred 2, 5 cell embryos. This entire IVF process I've been 2-3 days behind what the RE's expected me to be at primarily b/c I'm 30. I tested at home on day 10 and it was negative. I have a blood beta on day 14. Could I still be pregnant and if so, is it possible that I've got a late bloomer?
    Thank you

    ReplyDelete
    Replies
    1. If the embryos were only 5 cells on day#3, then the prognosis for getting pregnant is not good due to poor quality. However, there is always a chance and I have had pregnancies with 4-cell embryos. Most likely, however, the pregnancy test is correct and you are not pregnant.

      Delete
  24. Hi...
    Today I'm 14dpt. We implanted two 5day blasts. Today I had a hcg beta done..which in turn was negative. Which was upsetting. But my question lies in this..in the intial papers describing the transfer it stated the steps of the procedure including having your bladder 2/3 full. When we arrived for the transfer I was asked to empty my bladder, before the procedure began. I asked, don't you need my bladder somewhat full to have a guided ultra sound for the transfer. The Nurse Practitioner that works along with my Dr. States she will be doing thr transfer, due to the Dr. leaving for a cubscout retreat. No guided ultrsound was used. My thought was this..when the Dr. Intially examined me he did a mock transfer with a ultrasound, I felt the entire thing. When the NP did the actual transfer, I barely felt anything. Nothing like the mock procedure, no feeling of the cath. at all. I'm I just being over sensitive about the whole thing?

    ReplyDelete
    Replies
    1. Hello. If you have followed my blog, you will have seen that I believe that the transfer is the most important step of the IVF process because even if you have the absolute best embryos, if the transfer is not done well, it will fail. Experience with embryo transfers is key to finding a good doctor.

      I am greatly disappointed to hear that this important step would be relegated to a nurse practitioner. I think that is a disservice to you as a patient who chose this doctor and expected him to provide the treatment for you. In addition, the mock embryo transfer is one to practice the transfer so that there are no surprises at the time of transfer that might compromise it.

      With mock embryo transfers, I use a rigid catheter so that I can feel the entire cervical canal and thereby know how it goes. At the time of the real embryo transfer, I use a very soft catheter that I cannot feel as well. As a result, patients often feel the MET but don't feel anything with the real transfer.

      Finally, ultrasound guidance is a new technique that helps to know where the tip of the catheter is so that one can be sure it is placed in the correct position. In the old days we did not use the ultrasound, but studies have shown that this improves results. The ultrasound is not absolutely needed, but not doing so is "old school technique".

      You might want to consider if this is the clinic you want to spend a lot of money at and entrust your fertility.

      Delete
  25. Hi
    I had 5 day one Frozen embryo transfer on OCt 25th. Nov 5th bHCG was <1. After reading your comments I did not stop Med. I decided to go with med until 14th day and see it's results using HPT. I really appreciate your thought on this matter.If this turn out negative, how long should I wait to start next FET?

    ReplyDelete
    Replies
    1. Hello. Your bHCG was done 11 days after transfer of a blastocyst and therefore, if you were pregnant, it would have been positive. Although delayed implantations can occur, they are not delayed that much. Sorry.

      Delete
  26. Hi dr. Ramirez.
    I am on my 15th day post 3day embryo transfer..the hpt was negative on day 14 and 15..but i have pregnancy symptoms.strange taste in mouth..weakness. back acke. Sore breasts. Is there a slight chance of pregnancy..
    Patient in destress

    ReplyDelete
    Replies
    1. Usually by 2 weeks from ovulation, a home pregnancy test would be positive, but because it is not as sensitive as a blood pregnancy test, I do not use nor trust them. So, the most likely answer is that you are no longer pregnant but in order to be absolutely sure, you should have a blood pregnancy test done.

      Delete
  27. Hi
    This is my 7th IVF treatment (from nb 4 I have my son who is 2.5years old)

    I had 3blasto transferred on day 5 (dr said they r A+) Im on ET +7 and pregnancy test is really really negative...although I know what you think about pregnancy test (I read this last page) when I had my son I had 3embyo transferred on day 3 8 cells and I almost had twins...my pregnancy test was positive I mean nice positive on ET+9

    1. My question is is it possible if there is really not even a slight line on my test?
    2. My Bhcg test will be on ET+10 (in 3 days) what should I expect if im pregnant? Is there any min bhcg for it? I'm really disappointed and I think this one its just not happening. I just feel it. (I hope im wrong)

    Thank you for taking the time and answering my questions. Have a nice week.

    ReplyDelete
    Replies
    1. Ok I got my blood test done on ET+10 it was 2 which is negative but they did the test after 2days (today which i'm glad for coz they really making sure) Today ET+12 was under 2 so next week we will meet the dr and talk about what's next.

      I always had ET on day 2 or 3 coz I never had more then 5embryo and they don't wanna risk it. After ET they always try to freeze the rest on day 5 but that never happened, This last IVF I had 5embryo and they took the risk and went till day 5. 3of them made it and yes I was happy but it didn't happened this time so i'm really thinking :

      1. if it's make since to wait and risk the embryos? I rather have transfer on day 3 and froze some (so I have 5) then just gamble. What do you think? I'm mean this is gonna be the 8th IVF.I know nobody can tell what better but it worked ones and now we tried the other option, I rather to be safe then sorry.(maybe i'm just having this thoughts coz my son happened with 3day embryo, almost twins as I mention before)

      Let me know what do you think.
      Thank You!

      Delete
    2. If I don't have enough embryos, I don't take them to D#5 mainly because of the risk of losing them. Although the technology has gotten very good, and most good embryos will make it, it is not perfect and many good embryos may not make it. Also, going to blastocyst (D#5) does not guarantee that the embryo is a good quality embryo. For example, I recently had a young patient (<35) do genetic testing for sex selection. Out of 10 embryos, 4 made it to blastocyst and underwent biopsy. Of the four, only one was chromosomally normal. So, as you can see, going to blastocyst is not a perfect solution and studies have shown that there is not an increase in pregnancy rates. For that reason, I would transfer at D#3 and let the uterus be the incubator.

      If you've failed 8 IVF cycles, then there is some other problem going on that must be checked. Failing 8 times is neither normal nor usual.

      Good Luck

      Delete
  28. Hi Dr Ramirez.
    my husband 33 years of age has low morphology less than 1 % no mortility. I had 9 eggs retrieved and only 2 made it to blastocyte stage whiche werent a good quality eggs either one one ok second wasnt even developed into a blastocyte but DR said it might next 12 hours. I started cheking pregnancy tests after 5 days post transfer and they were getiing darker and darker until day 10 i started getting whiter and whiter which completetly disappeared on the day 11 i fell very sad now we didnt even have anything to freeze. Is that a chemichal pregnancy I am 29 years old Dr was positive 50% that i would get pregnant however tests became 1 line

    ReplyDelete
    Replies
    1. Hello, I had trouble following your comment so I hope that I answer the question correctly for you. If in fact you had a positive pregnancy test (by the way I don't necessarily trust home pregnancy tests for this purpose. I recommend blood pregnancy tests) initally and then became negative, that would be consisten with a chemical pregnancy. Considering that your embryo quality was not that good, it is not surprising that the pregnancy did not continue. The most likely cause of poor embryo quality in your case is due to poor sperm quality, but that is difficult to know for sure.

      Delete
    2. Hi Dr Ramirez,

      I did have a chemical pregnancy my blood test was negative. However I did send my clinic a picture of my home pregnancy tests they stopped showing 2 lines on the day 11th. So my clinic replied back to me saying thanks for letting us know you had an earlier unfortunately yo u had an early miscarriage. My other question is why clinics offer IVF and ICSI procedures if it fails to work. My doctor was swearing that this cycle would be successful however I failed it and now I have to go thought the whole thing again. I am 29 years old absolutely healthy. My protocol was birth control 14 days than I got my periods and they didn’t start me until day 5 because my estrogen levels were 5000. I took gonal F 150 plus luveris 75 and on the 3 I started blocking with certrocide until day 5 and on the 5 I took a ovidrell shot and on day 7 I had my egg retrieval of 9 excellent eggs only 8 fertilized next day and only 2 made it to day 4 and 2 made it to day 5. So I have nothing to freeze. Does TESE procedure would work better for us than ICSI I also heard about IMSI but however it doesn’t offer in north America for some reason. Thank you

      Delete
    3. Hi. I don't think that Dr's offer IVF and ICSI if it fails to work. Most reproductive specialists are trying their best to get patients pregnant and this is the best technology that exists. In addition, we can't predict when it will or will not work. The last three steps in the reproductive process are still left to God or Nature (embryo hatching and exiting the shell, attachment to the lining and the lining growing around the embryo).

      TESE is used mainly when you can't get sperm any other way. Since your husband produces sperm, TESE would not be necessary. In terms of your question regarding IMSI (intracytospamic morphologically selected sperm injection) is what almost all IVF clinics use in the U.S.. I don't know of any reputable IVF center that chooses non-morphologically normal (normal formed) sperm for injection.

      Delete
  29. Dear doctor,
    I had a 5 days blastocyst graded 3ba transferred 8 days ago. I did a hpt and got a negative, does it mean this cycle didn't work? My blood test is schedule to be this coming Friday, two days from today... Is there any hope?

    ReplyDelete
    Replies
    1. I don't rely on home pregnancy tests because they cannot pick up a pregnancy unless the bHCG reaches a certain minimal threshhold. I would advise that you not give up until you get the blood pregnancy test result.

      Delete
  30. Hi Dr Ramirez,I had my embryo transfer on the 16th of november,I was told to come for my test today which I did and it came out negative.I had my spotting on sunday the 24th.I was asked to come for another test on wednesday 4th dec for another pregnancy test,I am really scarred what of it it comes out negative again

    ReplyDelete
    Replies
    1. I'm afraid that if your blood pregnancy test was negative then you are not pregnant. 14 days is more than enough time to pick up a positive pregnancy with the blood test. I generally test at 8 days post transfer.

      Delete
  31. I got transferred 3 embryos with assisted laser hatching as my zona was thick after ET there was some cramping inside me for few days after that I don't feel anything and finally my pregnancy blood test result for my first IVF cycle got negative. So please could you suggest me with the expected problem.

    ReplyDelete
    Replies
    1. I'm afraid you are asking for something that is not possible to give ("could you suggest me with the expected problem"). There are three steps that the body still has to go through on its own (embryo hatching and leaving the shell, attachment to the lining, and lining growing around the embryo) because we do not have the technology to make these happen. I believe these are in God's hands. So the failure can occur at any of these last steps. Since you had cramping it is possible that the transfer technique was not good as well. In addition, IVF does not offer a 100% pregnancy rate. So, it does not work every time and no one can know why at this point in time.

      Delete
  32. Hi Doctor,

    I had 2 grade 4AA blastocyst transferred on 11/5/13. My uterine lining was 10.5. My progesterone level was >40 4 days after transfer. I took a home pregnancy test (First Response 6 Day Early Result) this morning (8 day post transfer) and got a negative. :( My BETA is scheduled for tomorrow, is there a possibility that I'll get a positive result tomorrow?

    ReplyDelete
    Replies
    1. Urine pregnancies tests are generally not reliable if it is too early after transfer, so if you do a home pregnancy test and it is negative, you could still be pregnant in a blood bHCG.

      Delete
  33. Can you help? did i have a chemical?
    5dp3dt bfn
    6dp3dt bfn
    7dp3dt bfp
    8dp3dt bfp started spotting
    9dp3dt bfp getting fainter, still spotting
    10dp3dt bfp very faint spotting
    11dp3dt bfn spotting slowing
    12dp3dt bfn spotting vitually stopped
    My clinic dont do betas just told me to poas at 14dp3dt, could it have been a chemical?, i tested out the trigger shot and the first bfp was 13 days after the trigger. appreciate your advice on what happened. we have a history of rpl and this was our 1st try at ivf after 2 years of ttc. I was on a neupogen, steroids, progesterone, intralipids and clexane. Many thanks

    ReplyDelete
    Replies
    1. Hi. I have a whole blog post dedicated to bleeding after embryo transfer so would recommend that you look at that. I do not consider spotting to necessarily indicate something bad. In fact, it seems to be very common with my IVF patients and I think it is due to vaginal progesterone. I have NEVER heard of an IVF clinic that does not do blood pregancy tests. There is a LOT of information that can be gathered by doing serial blood pregnancy tests such as detecting a chemical pregnancy. This is important to know because that then tells you than implantation occurred, which means that your body can do the last three natural steps. If I were you, I would DEMAND a blood pregnancy test and this should be repeated every 48 hours for at least four times.

      Good Luck

      Delete
  34. Hi Dr Ramirez. I recently completed my 3rd IVF trial which failed. I was taking Gynera at the instruction of my doctor to rid my ovary of a cyst. I was spotting despite the fact that I was taking Gynera, and thus my doctor instructed me to stop taking the pill around Oct 27. On October 30, I began my period which only lasted for 2 days. On November 13, my doctor performed the egg retrieval and on November 16, the ET was done. This seems like a very extended period. Would it still have been possible for me to get pregnant despite the fact that I was already on the 18th day of my cycle. My cycle is typically 26 days in length. Thanks for the 2nd opinion....

    ReplyDelete
    Replies
    1. IVF is an artificial cycle and timing is determined based on specific points in the process, NOT based on your cycle days. You had a D#3 embryo transfer which is appropriate. The transfer date is going to be dependent on the retrieval date and the retrieval date is going to be dependent on the follicular sizes.

      Delete
  35. Dr. Ramirez, We did a 5dt of 2 great looking embryos. I tested out the trigger. The hpt never showed negative. I am now 7dp5dt. The lines on the hpt the last 4 days have been identical, faint but there within minutes. Is this indicative of anything? Anxiously awaiting beta in 2 days (9dp5dt). Thanks for any insight.

    ReplyDelete
    Replies
    1. I think your question is best directed to the manufacturer of the HPT. I don't have that information so can't give you an answer. I only rely on the blood pregnancy test for proof of pregnancy.

      Delete
  36. Hi my first IVF cycle failed and I have stopped all medicines. My cycle has started but I keep feeling pressure on my upper right side just wondering is there any possibility that I should request another HCG test.

    ReplyDelete
    Replies
    1. If you want to be sure, a repeat bHCG is not unreasonable.

      Delete
  37. Hi Dr. Ramirez. We were instructed we were transferring an early blastocyst maybe 6 hours behind from our first cycle blastocyst which was transferred last year and ultimately we miscarried shy of 8 weeks. We are 9dp5dt and the beta was 16. I am now feeling nauseous and choosing to remain cautiously optimistic. We retest Friday. Am I right to hold out hope?

    ReplyDelete
    Replies
    1. Hello Bobbi. You have a positive so at this point all you can do is wait and hope for the best. Don't give up just because of the bHCG level.

      Delete
  38. I had a 6 day FET 1/25, beta on 2/3 was 24. Realistically, what is the likely outcome here?

    ReplyDelete
    Replies
    1. It was only 9 days post transfer so there is certainly the possibility that the pregnancy can continue normally. I would not give up yet.

      Delete
  39. Dear Dr Ramirez, I had my 5day et on Dec 28 overseas. On Jan 10, had a positive pt result but betahcg is just 65. The day after bhcg decreased to 63. Dr told me to stop all meds and that I will miscarry in 2 weeks, that I should go to a hospital in our country. He said no need for another blood test as nothing can be done. Jan 18, we went to a clinic and told what my ivf Dr overseas told me. Had ultrasound, just corpus lutea and thickened endometrium. Local Dr told to wait for my menstrual period and come back. Or I can even have bhcg test. Unexpectedly, it increased to 491.4. After almost 3 days, it increased to 1273, and after 3 days to 2535. A day aft I had u/s and a gestational sac of .31cm was seen. After 7 days, the g.sac's size became 1.03 cm. But still, there was no yolk sac and heartbeat. Local Dr told me I can have d&c then, or wait for another week.

    Dr Ramirez, did any of your patients experience something like this? I am hoping gnat things will turn out okay but I am also afraid.

    ReplyDelete
    Replies
    1. I can't say that any of my patients have experienced this, but since the pregnancy is continuing, you need to have it followed until it can be determined whether or not is is normal. That may require that you repeat the ultrasound in two weeks to see if a fetus develops. If none is seen at that time, then we call that a blighted ovum, which is an abnormal pregnancy. At that point you can either wait for a natural miscarriage, have the miscarriage induced by medication or undergo D&C. I would recommend that you have the miscarriage induced by medication. Unfortunately, things don't sound like they are proceeding normally.

      Delete
    2. Thank you very much, Dr Ramirez. Your response was very comforting.

      Delete
    3. Dr Ramirez, I had an ultrasound yesterday at a different clinic. The g sac grew only by 2mm in one week but a yolk sac of 4.4 mm was seen,but still no fetus. Could the slow in growth of the gsac was caused by the stop of my progesterone suppository as ordered by local Dr . She told me duphaston is sufficient, or by the stress that I went through? Or is it an indication something is really going wrong? Thank you very much again. -daisy fr phils

      Delete
  40. Hello Dr. Ramirez

    I had a 3 day frozen embryo transfer on weds 1/29 of a morala and a 10 cell grade A embryo they checked my beta on fri 2/7 which would have been 9 days post they said it was negative and to stop my meds could it be to early for the beta or am i out this round or should i have my hcg tested again on Monday 2/10 just to me safe?

    ReplyDelete
    Replies
    1. I usually do my first bHCG's 8 days after transfer so your timing is not too early. However, to make absolutely sure that patients don't have a late or delayed implantation, I repeat the test two days later.

      Delete
  41. hi dr. I had my hcg test done friday feb 8. my day 3 fet on Jan 28. the test came back +3. did I do my blood test to early?

    ReplyDelete
    Replies
    1. No. +3 is a low positive and should be repeated after 48 hrs to confirm that it is rising. If it rises, I would recommend that it continues to be followed every two days until it is confirmed that it is rising normally. At that point an ultrasound can be scheduled for 6-1/2 weeks gestational age.

      Delete
  42. I triggered on feb 20th, o'd feb 22nd, had what I think was implantation bleeding on March 4th(10dpo) and beta blood test march 6th(12dpo) level was 1.6.... Any possibility if I retest this outcome could change? Recommendations on levels or when to blood test?

    ReplyDelete
    Replies
    1. Hi Ashley,

      The level is very low for 10 days post ovulation and I would expect that his will end as a chemical pregnancy (in my lab this is a positive). I usually repeat the test 48 hours later to see what the trend is. If it continues going up in a normal fashion then you just continue to follow it. If it goes down then that's it.

      Good Luck

      Delete
  43. Dear doctor,

    my husband and i have been trying for 7 years for a baby, we have just had our 3rd and final icsi treatment which was a fail. The first 2 times it failed i had bad cramps and heavy bleeding this time no cramps and very light bleeding but it still failed.

    we had a 3 day transfer on feb 14th 2014 and had to wait two weeks, on day 10 of those two weeks is when i started 2 bleed very lightly with no cramps.

    It is now march 11 and i have been experiencing pains in my left overie and the pains shoot down my leg it only occurs every now and then and last 10 mins each time.

    I usually have constant overy pain and very very heavy cycles should i see my doctor about this?

    ReplyDelete
  44. I had a 5 day blasto FET on 14 March. The hcg blood test, 10 days later, on 24 March was just 13 and deemed "equivocal". I had a further hcg blood test on 26 March and the level had doubled to 30. I am booked to have a further blood test on Monday (31 March). Is there hope that this could still turn out to be a viable pregnancy? I haven't experienced any cramps, pains or bleeding.

    ReplyDelete
    Replies
    1. As long as the bHCG is rising in a normal pattern, I always look at the bright side, which is that the pregnancy is developing and will be successful. There is no sense worrying about the downside unless there is evidence to support that. ALWAYS hope for the best no matter what the outcome! Besides, it is out of your hands. Congratulations.

      Delete
    2. Many, many thanks for your response and advise. It really helped and is greatly appreciated.
      I had another blood test today and the beta hcg level has risen to 442, which is encouraging. What happens now is, as you so rightly say, out of my hands so I'll follow your advice, hope for the best - and enjoy it! :o) Thank you again for your kindness.

      Delete
  45. Hello Doctor,
    Question:
    I had 3 day 3 embryo transfer on 18th March. Out of them 1 was 8 cell Geade I, other are 2 are 7 cell and 6 cell grade II embryos. I carried out Serum Beta HCG on 28th March which came out negative. Is there any chance of late implantation here? I do not have my periods started yet which were due on 28th March as per my cycle.

    ReplyDelete
    Replies
    1. There is always a chance until proven otherwise. A blood bHCG test is what is needed to answer the question.

      Good Luck

      Delete
  46. Dear Doctor . I took an hpt 9dp4dt and it was a faint positive and then two days later took one, used one from the Same package and a new one (both cheap brands)both still came out faint within the time frame. My beta test is tomorrow could I be pregnant or is it a chemical. It's with fet.

    ReplyDelete
    Replies
    1. Your blood pregnancy test will give you the definitive answer.

      Good Luck

      Delete
  47. Dear Dr, I am on 8dpt of a 5day blastocysts but the urine test is negative. Could it be I am not pregnant. Were I did my Ivf they dont do beta test.

    ReplyDelete
    Replies
    1. Blood pregnancy test is the Gold Standard so you need to find a BETTER IVF center if they are not doing blood pregnancy tests. By 8 days post blastocyst transfer, the pregnancy test should be positive, but might be too low for a urine pregnancy test. If you are only doing a urine, then I would wait until 12-14 days post transfer to be sure.

      Delete
  48. Dear Dr. Ramirez, I had my IVF-ET on 4/10 (One Grade A-5-day blasto). Overall 6 retrieved and all fertilized. (2 got arrested and 3 others are frozen). on 4/17 my progesterone was >60. Yesterday - 4/24 was my beta test day. bHCG came negative (0.1) and progesterone is 65. My doc says no pregnancy but is confused about consistent rise in progesterone (and suspects pregnancy). After ET, I had cramps, bloating, blue veins in chest and breast, bit of nausea (without vomit though), spells of dizziness every now and then. I had no bleeding or spotting. My cycle is usually 25 days - if I were not pregnant ideally I should have got my period on 20th April. I'm never late on my period, this is the first time ever. Yesterday, my doc has asked me to stop all meds since evening and asked me to come for another HCG test if my period doesn't show up till 4/30. She also said after stopping all meds, I may get AF within 2-7 days. Doctor, please advise on:
    (1) how I can have realistic expectations on this IVF process
    (2) Is this progesterone level with negative HCG normal at all? what's really going on with my body?
    (3) Can late implantation occur with 5-day blasto and could I get pregnant?

    Thanks in advance!

    ReplyDelete
    Replies
    1. 1. Cannot answer this question as there is no answer.
      2. If you are taking supplemental progesterone, which most IVF clinics give to support implantation, then you level would be elevated.
      3. Yes, late implantation can occur by a few days.

      Delete
  49. Hello dr!!
    I am 10 dp a morula transfer. I did hpt today and yesterday, both came negative. My blood test is after 6 days. Should I continue taking the medicines or stop them.? Is there any chance.?
    Also, this will be my 3rd failed ivf implantation. What could I do to improve chances next time. I was on heparin for this cycle.

    ReplyDelete
    Replies
    1. Hello. Hopefully by now you have a more definite answer by blood pregnancy test. If it is negative then you would stop your medications. If it was positive then continue.

      In terms of your questions regarding what you might do next, having failed 3 IVF cycles, I cannot give you a specific answer without review of your medical records to see what has been done.

      Delete
  50. Dear doctor;

    I have been admitted by my GP into my local ER twice over the past couple of days, because of intense abdominal pain in the right iliac fossa and just below my diaphram, as well as a period that was 8 days late on the 1/5/2014, breast tenderness, shooting pains, nausea and dizziness. They thought it might have been either an ectopic pregnancy or appendicitis, both of which were ruled out by blood tests and an ultrasound. I feel pregnant. I'm very bloated, starting to get constipated, the nausea is getting progressively worse, and I've started getting temperatures. (The after-hours GP temped me at 37.9 last night 2/5/2014).

    When I left the hospital after being discharged on the 1/5/2014, I got my period. It was extremely heavy, and then the next evening virtually stopped completely. It is a very dark red, almost black, with clotting. I am in a huge amount of pain and was prescribed panadeine forte every 4 hours.

    My period has virtually stopped, and if it wasn't actually my period, it means I'm now 10 days late!

    The first day of my last menstrual period was the 27/3/2014. It was a few days late and lasted for six days.

    Four urine HCG tests and two BHCG blood tests have all returned negative. The senior staff at the hospital told me it was period cramps causing the pain, and told me to go home. They are not convinced I am pregnant, but something feels very, very wrong!!

    Please help me understand what could be going on, because I am lost for answers.

    ReplyDelete
    Replies
    1. Hi. I wish I had an answer for you but without doing an exam and some tests, there is no way for me to answer this. For example, if your cervix were nearly closed, as could be seen on exam, it could be that you are retaining the blood within your uterine cavity because it cannot escape. That would cause uterus dilation and pain. An ultrasound should be able to detect this and the treatment would be to do a cervical dilation. This is not to say what is going on with you but an example of why examination is required.

      Delete
  51. Whats a hcg result of 0-6 after 14 days of embryo transfer ..and today 17 day spotting light pink only like 4 times, back pain, nauseous,

    ReplyDelete
    Replies
    1. Hi. I'm not sure how to interpret a 0-6 range for a bHCG since in my lab and the outside labs I use, a negative is <1 or <5. In my lab, anything over 1 is a positive. In the outside labs, anything over 5 is a positive. By 14 days out, the bHCG should be strongly positive so the spotting is likely to be the start of a period.

      Delete
  52. hi.today is my cd31. i had ovulation induction with fsh injection and finally a hcg trigger with 5000iu done 17days ago. yesterday which was my 14dpo i took a qualitative blood pregnancy test at the clinic wich turned up positive after 3minutes. sample for quantitative was sent to the lab n hcg level came up as less than 0.1. am so confused.

    ReplyDelete
    Replies
    1. The QUALITATIVE pregnancy result was probably a false positive. The QUANTITATIVE blood pregnancy test is more sensitive and definitive. Sorry.

      Delete
  53. Hello,
    I did a 5 day transfer on April 15, 9 days later (April 24) I took a blood test and it was 5, so I was instructed to stop my progesterone injections. I did I waited for what I think was my period to start my birthcontrol. April 27 I had cycle day 1, and April 29th I started my birth control. And then May 17 I started Lupron for my FET. Well I started feeling nautious May 15 on and off an then for the past 2 weeks I have been so sick. I thought it was bug or somthing, wellI have been having weird cravings and my friends and husband convinced me I should buy an at home pregnancy test. I called my RE and they said to as well. Well the at home came back positive instantly. No one knows how this is even possible. thoughts? I go in for blood work and us tomorrow.

    ReplyDelete
    Replies
    1. Hi. In both my office lab and the outside labs I use at the local hospital, Quest labs and Lab One, the bHCG value of 5 is a positive. If you had been my patient, I would have repeated a second test, which is what I do on all my IVF patients, just to be sure. Probably a second test would have showed a rise. At this point, all you can do is hope for the best. I have seen patients in the past, from other doctors, that were pregnant after being give a dose of Lupron depot and continue with a successful uneventful pregnancy, so hopefully, it will not have affected yours. Congratulations and Good Luck.

      Delete
  54. Hello, I had a 5 day transfer and 9 days later did a blood test with a result of 0.50, i was told to come back for another test. Should i be hopeful

    ReplyDelete
    Replies
    1. I'm sure your question has been answered since you posted this comment, but 9 days post D5 ET would be enough time for implantation to occur so it is likely to be negative. Sorry.

      Delete
  55. This comment has been removed by the author.

    ReplyDelete
  56. hello dr did et with donor eggs on the 19th may,had home pt on the 2nd june which turned out negative.my dr has told me to stop all medications.still having most pregnancy symtoms.Do I still need to do blood test

    ReplyDelete
    Replies
    1. I never trust a home pregnancy test as my only confirmation of a positive or negative pregnancy. I ALWAYS use a blood pregnancy test.

      Delete
  57. Hi Doctor, I had a son in 2012 from my first attempt at IVF. This was after surgery for 'mild' endometriosis. Since then I managed to get pregnant naturally, but this resulted in ectopic pregnancy and my left tube was removed at 7 weeks. The next month I did a natural FET which was unsuccessful. Then I got pregnant naturally again (miraculous!) but lost at 5 weeks. I just used my final frozen embryo, another natural cycle, also unsuccessful. I am now 37.5 and confused about my next move. I have just moved back to my home country where IVF is $10000 or a 1 year waiting list for free treatment. Can I afford to wait at my age? Also what do you think about natural FET's I just did progesterone pessaries twice a day from day of transfer and 2xinjections. Thanks for any help, I am so confused!

    ReplyDelete
    Replies
    1. Hello. I don't think you have time to waste based on your age. Even with IVF your pregnancy chances are decreased and decreasing every year.

      I am not a big fan of "natural cycle" FET's because it is harder to hit the implantation window (which is only about 2 days. If you are off by even one day, the treatment will not work. That is why I only do programmed FET cycles. In a programmed FET cycle, progesterone is started before the scheduled transfer day which is based on the day of the embryo age. For instance, if using D#3 embryos (cleaved) then we would start the progesterone 4 days before the transfer whereas if D#5 (blastocyst) embryos are used, then we would start the progesterone 6 days before the transfer. Timing is absolutely critical for FET's to work!

      The reason this is important is that the estrogen is used to form the lining but progesterone is required to change the architecture of the lining to form the structures required for implantation to occur. Nature is very specific in this regard.

      Good Luck

      Delete
  58. Negative bHCG on day 8 of one 5 day blastocyst. Is this a forsure negative?

    ReplyDelete
    Replies
    1. There is a possibility of a late implantation so I would repeat the test in 48 hrs. If it is still negative, then its negative.

      Delete
  59. Hi! I am now 9 days 5 day transfer. We did a donor cycle and had 9 fertilized and none to freeze. My question is that I have been on estrogen and progesterone injections and my estrogen level has increased by 307 but my dosage of
    0.28 has remained the same. Does that mean that my body is producing it because of a developing embryo? Or is that typical from the meds. My progesterone is at 41 and went
    Down from 45. I was told my numbers looked good. Also on day 8 yesterday I did a hot but it was negative. I go and do
    My beta on
    Monday . I decided to toss
    The hpt out as it
    Can make a
    Person
    Crazy! I look forward to
    Hearing
    Back from
    You!

    ReplyDelete
    Replies
    1. These blood tests are no reliable for interpretation if you are taking estrogen and progesterone medication. The blood pregnancy test (bHCG) is the only reliable test this early in the pregnancy/process.

      Delete
  60. Dear doctor, I had my beta yesterday 12dp3dt of 4 quality 2 embryos 8,11,14,16 cells and it turned out 7. Dr said to stop medications and retest 3 days later. My questions are:
    -would you consider my embryos fast cleaving and probably abnormal as such?
    -is there a chance of late implantation ?

    ReplyDelete
    Replies
    1. Sorry for the delay in getting back to you, but I don't answer the blog on a daily basis. I'm not sure about the situation and question you are presenting so if you could clarify that, I'll be able to give you a better answer. When you say "it turned out 7" do you mean the bHCG was 7 at 12 days post delivery? If that is the case, the number is a little low but I wouldn't give up on it until it declares itself, i.e. is clearly abnormal by not rising or decreasing.

      Delete
  61. hello i m from Nepal 1 year ago i had ivf it turned to blighted ovum at 8 weeks of ges.
    after a year i had 2nd ivf the result was negative. but those whom i donated my eggs had positive result both on 1st and 2nd cycle . doc said i have a good quality eggs but why i could not sucess my pregnancy?
    how many times can i try ivf?
    what could b my lacking points ?
    how can i help myself?

    ReplyDelete
    Replies
    1. Hi,
      The blighted ovum on the first cycle was probably due to an abnormal embryo and so the fetus did not develop completely. The second pregnancy just may not have worked, for many unknown possible reasons, but since IVF is not a perfect technology, this can happen. If you donated eggs and the donor was successful, then I would expect that you will eventually be successful as well. You just need to keep trying.

      You can do IVF as many times as you want. There is no limitation, but most women will be successfully pregnant by 3 attempts.

      There are no answers to the last two questions. You are probably doing all that you can personally do.

      Good Luck

      Delete
  62. Hi, I had a 3dt 8 days ago. I had a normal amount of eggs retrieved but end up with lower than normal mature eggs. My doctor said I was ready to trigger after my first ultrasound. She said this was not the norm but seemed excited for me so I thought I was a good sign. Is it possible the doctor triggered me to soon causing a less than optimal number of mature

    ReplyDelete
    Replies
    1. Hello,

      It is possible that you may have been triggered too early but without reviewing the actual record, I cannot say for sure. Determining the time to trigger is what makes doctors and clinics different and is the art part of the IVF cycle.

      Delete
  63. Hello Dr. Ramirez,

    I am 39 years old. I have one 6 year old son that I conceived naturally. I am dealing with unexplained 2nd infertility. My first IVF was a 4-3daytransfer. I got pregnant but miscarried at 7 weeks.
    This is my second IVF. I am now 8days passed a 5day transfer and my HCG is negative. My BETA test is not for another 4 days. I have a few questions
    1- Is there any hope I can be pregnant?
    2- the one embryo that was transferred was genetically perfect (it was tested). Why would I not end up pregnant? My lining and all other numbers where great at the time of transfer.
    3- Due to my age do you think I can still get pregnant with my own eggs? Last transfer I had 10 eggs, 7 fertilized, 4 made it to day 5 blast and only 1 was normal

    Thank you

    ReplyDelete
    Replies
    1. Hello,

      There is certainly a chance of being pregnant until you have a blood pregnancy test to confirm otherwise. I usually test at 8 days post 3d transfer or 6 days post 5d transfer.

      Once the embryos are transferred, there are still three natural steps that have to occur for a pregnancy to ensue. These are the embryo hatching and exiting from its shell, attachment to the endometrial lining and the lining growing around the embryo. These are steps that we do not have the technology to influence at this point. As such, an IVF cycle can progress completely perfectly with perfect embryos but fail.

      With advanced age, the hope is that there are still good eggs left within the ovaries. As long as your ovaries respond well to stimulation, as yours do, then you can certainly keep trying and get pregnant. You have to be patients, be willing to bear the emotional stress, be willing to bear the financial stress and pray that God will bless you with another child. Never give up!

      Good Luck

      Delete
  64. Hi.
    I got a blood hcg test done after 15 days post a 3d fet. 3 grade 1 embryo were transferred. The hcg level is 6. Are there any chances of getting a positive if I test again.

    ReplyDelete
    Replies
    1. Hello,

      I consider a 6 as a positive. If the next level, done at 48 hrs, continues going up, then there is hope. If it goes down, then it is an indication that you had a chemical pregnancy, which is probably what is happening since you are 15 days out from transfer.

      Delete
  65. This comment has been removed by a blog administrator.

    ReplyDelete
  66. Sir, please what is the most effective and less traumatic way (step-by-step process) to disclose negative pregnancy test results to patients? Thank you

    ReplyDelete
  67. August 21, 2014 at 1:30pm transfer 2 blast on day 5... I am soo confuse and need your advice.. On August 26th at 2ish I started spotting on and off and still on this day , I took a pregnancy test today August 30th in the morning and it came out neg.. I am not cramping I feel good but got the neg and still spotting I don't fill a panty liner not even half in a whole day.. But I am scared confuse and don't know what to think. Please help me and tell me what you think . My beta is not until Tuesday September 2nd

    ReplyDelete
    Replies
    1. Hi Mary,

      I'm sorry for the delay in responding to your question, but hopefully by now, you know the answer to your question. Bleeding without cramping is not necessarily and indication of anything, but the question of whether or not you are pregnant can easily be answered by a blood pregnancy test.

      Good Luck

      Delete
  68. Hello Dr Ramirez,
    I had a 6 day transfer of 3 blasts. On the 8th day my blood hcg was negative , had a short period but not as heavy as it normally is.Showing some signs of pregnancy. Could I still be pregnant and should I do another blood hcg test.

    ReplyDelete
    Replies
    1. If I am understanding you correctly and your bHCG was done 8 days post transfer, then that would be a pretty sure result and you are not pregnant. To be absolutely sure I would repeat it because of your symptoms.

      On the other hand, if you had the transfer on D#6 and the pregnancy test on D#8 then that would be too soon for a pregnancy test since implantation would not have occurred yet.

      Good Luck

      Delete
  69. I did a day 3 embryo transfer on 26 Aug 2014, and I did a HCG blood test on 10 sept 2014 (day 16), the result is 17. My doctor asks me to do another blood test on 13 sept 2014.
    Is there any chance of late implantation in IVF????
    And HCG level 17 does it means it is not a viable pregnancy even the index rise?

    ReplyDelete
    Replies
    1. Hi,

      A bHCG of 17 indicates that you have an early pregnancy. There is no way to evaluate if it is viable or not at this time, but by following the bHCG's every 48 hrs, one can evaluate the trend and get an idea of its progress.

      Good Luck

      Delete
  70. I am 10 days post ivf results today hcg 3.52 and progesterone levels 171. Nurse said I was neg for pregnancy should I get re tested and stop meds as I was told? Or continue meds until I get retested in 2 days . Also they said I should get my period in 2 days and they want to do a stim ultrasound to get ready to put hereunder on birth control again and start process over. Do you think this is too soon? O had a 5 day transfer with genetic testing which was really like day 6 implantation of hereunder.

    ReplyDelete
    Replies
    1. Hi,

      I cannot interpret the bHCG result since labs use different levels for positive or negative. In my lab, this result would be a positive and I would repeat it in 2 days. However, it is a very low number and may indicate a chemical pregnancy (nonviable) instead of a viable pregnancy.

      If this turns out to be negative then you would be ready to prepare for another IVF cycle. I would recommend that you just move ahead.

      Good Luck,

      Delete
  71. Dear Doc, PLEASE HELP Me-36 (unexplained, no found condition) ...Hubby 39 (male factor/motility,morphology)
    I am 11 days past a 5 day transfer of 4 grade BB embryos with ICSI/AH done on 9/2/14.... i had my beta done today 9/13/14.. which the nurse said is negative..... however my period due date really is 9/15 or latest 9/19... is it too early for a beta? Is it possible that i had a late implantation? It it possible that HCG was just very low. i have no period symptoms yet../but still have time to go before a missed period.... should i continue meds just incase? should i do another blood test/ HCG???? Please help me.. i want to continue meds in case (progesterone oil shot, estriadol, prenatal vitamins).

    ReplyDelete
    Replies
    1. A positive pregnancy test can be obtained as early as 4 days post a blastocyst transfer and definitely by 6 days. If you are 11 days post transfer and it is negative then it is probably negative.

      Sorry

      Delete
  72. I did a day 3 embryo transfer on 4 semptamber 2014, and I did a HCG blood test on 15 sept 2014 (day 11), the result is 4.02. i stop the treatment and i will do another blood test on 18 sept 2014.
    Is there any chance of late implantation in icsi .
    thanks in advance

    ReplyDelete
    Replies
    1. Hello,

      In my lab a bHCG of 4 would be a positive, although it is a low number and probably not going to be a viable pregnancy. My protocol is to repeat the bHCG two days later to confirm. If it goes down then you know it is negative. If it goes up then you are pregnant and should continue to be monitored with levels every 2 days. I would not stop the medications until you have that confirmation.

      Good Luck

      Delete
  73. Dear doctor, I just had my second ivf round. I had 2 grade B embryos transferred on day 3. I started spotting on 11dpt and it became stronger on day 12. I took a home pregnancy test 13 dpt and it came negative. I stopped the progesterone and the bleeding got stronger for 4 days. Then I continued having spotting. I usually have very short menstration and no spotting. So I took a new test at home 20 dpt and it came positive. I got concerned and I took a bHCG on 21 dpt ang it was 103. I repeated the test next day and it was 199. I talked to my doctor and they strongly suspect ectopic pregnancy. I am going to take a new test in couple of days to see how bHCG progress. I don't have any tubal disease. What are the chances that this is a ectopic pregnancy? Is there any chnace for a normal pregnancy?

    ReplyDelete
    Replies
    1. Hi. Well you are definitely pregnant but I wouldn't just to ectopic pregnancy as the diagnosis just yet. The bHCG should be followed every other day to see if it continues to rise in a normal fashion. If it's an ectopic pregnancy, it will either plateau or do a check mark where it drops then rises again. Once the level reaches 2500-3000, the pregnancy should be visible by ultrasound and that is how an ectopic is ruled out. If there is no uterine pregnancy on ultrasound then the conclusion is it is in the tube. Good Luck

      Delete
  74. Dear Doctor, I am 15 days past 3dt and I had a HPT that came back negative. My period was due a couple of days ago but it is late, which has never happened before, and my question is: Is it possible that my period is late due to the meds I am currently taking(progesterone & estrofem) and shall I stop taking them?
    Thanks in advance.

    ReplyDelete
    Replies
    1. Yes. That is the most likely explanation but I would not rule out pregnancy until a blood pregnancy test is done.

      Delete
  75. hi sir
    i m very upset, its my 1st ivf, day9 i have start bleeding, its dark black only for one day, day 14 i take home test it was negative, can i take blood test for conformation ?

    ReplyDelete
    Replies
    1. Yes. Dark blood does not mean anything. I only worry about bright red blood.

      Delete
  76. Hi just want to ask i had gonal f for ten days and on 11th day got hcg shot and now im on my13th days after my hcg shot and had a brown light red discharges homw pregnancy test negative ..is it possible im pregnant thats its an implantation or im just having my early period???

    ReplyDelete
    Replies
    1. It is too early to have gotten pregnant. Once the trigger is given, it takes 24-52 hours for ovulation occurs. It then will take 7-10 days for implantation to occur. Only after implantation will a pregnancy test turn positive. The red discharge may be due to hormonal influences.

      Delete
  77. Hi Dr
    I'm 31 years old and had a 2day FET of 3 embies. I tested with hot yesterday and today which were both negative. My beta is due 28 October. Do I have a chance to get a positive result?

    ReplyDelete
  78. Hi Dr
    I did my 2dt get of 3 embies on October 16. I did 2 hpt which both were negative I tested thurand fri. Could my blood beta show different results? I don't want to give up just yet. Please tell me I have a chance to get that BFP.

    ReplyDelete
    Replies
    1. A home pregnancy test is not sensitive enough that early. Only a blood test can detect a pregnancy within 10 days of the transfer. HPT's usually need 14 days or more.

      Delete
  79. Hello doctor,
    After FET of CCS tested normal 5 day hatching blast (grade 1) and history of previous full term pregnancy, my numbers are;
    5dp5dt: HPT negative
    9dp5dt: beta 37.5
    11dp5dt: 89
    13dp5dt: 169.1
    I'm wondering what percent chance you would give, based on your experiences of this being chemical vs ectopic vs potential normal pregnancy? I know we won't know for sure until US but would like your opinion on what is most likely. Thank you

    ReplyDelete
    Replies
    1. Your bHCG's are growing normally so I would expect that you will have a good outcome. Things are going well thus far. I recently had a patient whose 1st bHCG at 7 days post transfer was 14 and her ultrasound shows a successful intrauterine pregnancy with normal heart motion and size. A positive is a positive until proven otherwise.

      Delete
  80. As a follow up, My 4th beta 48 hours after the 3rd is 353.5

    ReplyDelete
  81. Dear Doctor
    I have been reading all your comments which are very helpful. I did 2 IVFs with ICSI. One was couple of years back and the latest is month before last month. Both failed and i got 1 frozen 6 days old blast and transferred it on 27th of November 2014. My clinic did a blood test yesterday (5 days after 6DT) and my HCG level came out 1.6 and nurse gave me a very negative feeling saying sorry to me. I was devastated and cried a lot with unbearable sadness. When I read your answers this morning I am hopeful again. Do you think it is too early to do the test on day 5 after 6 day transfer? My next test is tomorrow and yesterday I didn't want to go for that but after reading our answers I am hopeful.

    Thank you so much!. I am Buddhist and you do a very good Karma by clarifying our poor issues. Appreciate :)

    ReplyDelete
    Replies
    1. Hi, By now you have the answer, but a low initial bHCG does not necessarily mean a negative, but I would say that in the majority of cases, the pregnancy is not normal. I'm hoping that your outcome is good. Keep in mind that IVF is NOT a perfect technology and many factors affect the outcome. For this reason you should never give up hope and keep trying. Persistence will often be fruitful but quitting is a guarantee for failure. I'm reminded of this each year when I receive a card and huge gift from one of my patients. It took her 7 attempts, with a couple miscarriages along the way, for her to be successful and she now has a beautiful girl.

      Delete
  82. Hello Dr. I had my first ivf cycle that failed.....I had a 3day transfer 3 eggs were transfer I weren't told the quality of my eggs, I am 28. I did a blood test after 2weeks wait, my RE said failed. What could've cause this, and how long do I have to wait if I want to start another fresh cycle? Failed ivf just few days ago 04/12/14. Am now having my menses, horrible pain. Thank you awaiting your respond.

    ReplyDelete
    Replies
    1. I can't explain why it failed. That would require a review of your medical records to get an idea and even then sometimes we can't know. In general, you have to skip a month between IVF cycles to allow for ovarian rest after the stimulation.

      Delete
  83. dear doc..my beta 12 days post 2 day transfer is 8.6.Is it consider as positive.should I continue my meds?Im so confused

    ReplyDelete
    Replies
    1. Yes. This would be considered a positive. I hope all turns out well.

      Delete
  84. Hi doctor, I got my beta hcg done on sat (12/13/2014) and it was 12.6 and my doc asked me to stop all medication and wait for period. By seeing your replies I still have some hope of me being pregnant. Thinking to do beta hcg tomorrow again for confirmation.

    ReplyDelete
    Replies
    1. I would not consider this a negative. In fact, this is a positive result and the bHCG should be followed every other day for at least three more results. All is NOT lost yet! and although I usually do not recommend not following your doctor's recommendations, in this case, I would recommend that you continue all your medications.

      Delete
  85. Hi. I did a 5d FET on dec 8th and did my first blood hcg dec 15 which came back negative. Is there hope for a positive still? And if this cycle fails how soon can I proceed with the next. FET?

    ReplyDelete
    Replies
    1. Yes. I generally do a second bHCG to confirm. There is still a chance for a late implantation. If the second is negative, then that would be the result.

      You need to rest the ovaries for one cycle (one month) before starting stimulation again normally, but if you are doing FET's, you can try again right away in the next cycle/month.

      Delete
  86. hi doctor , im currently 7d 5dt i got bfn each day from d5 and still just wondering is there still a chance i could be pregnant? im a surrogate and all i know about the embryo is it was progressing well before transfer and embryo glue was used also stratch test (forgot actual name of that) was performed 2 weeks before.......hope all this makes sense , is there hope for a positive ? my last surrogacy pregnancy i got weak positive from d5 5dt cant help think its game over?
    many thanks

    ReplyDelete
    Replies
    1. By 7 days a Blastocyst (5dt) implantation has usually occurred and the test would be positive, but a late implantation is not unheard of so I would wait for the next pregnancy test at day#9. If the next one is negative then that is the result.

      Delete
  87. Hi Dr. Ramirez, I had my first beta test Monday following IVF. My beta test showed HCG value of 5. They retested today and the value was 3. Should I continue to take my progesterone gel in the hopes the my numbers will go back up?

    Thank you!

    ReplyDelete
    Replies
    1. Hi. Yes, I think that you could probably stop the supplemental medications that you are taking. This is consistent with a non-viable chemical pregnancy.

      Delete
  88. Thank you. Have a Happy New Year!

    ReplyDelete
    Replies
    1. You are very welcome. Thanks for dropping by.

      Delete
  89. Hi i had 5day blastocyst transfer on 14th jan'15.my bhcg scheduled for 29th jan. I did home hcg test on day 12 n it was negative. Later in the day i discovered dark spotting. Should i continue profesterone insertion. N wait untill bhcg at clinic. Also M planning to visit clinic on 27th jan only.

    ReplyDelete
    Replies
    1. Hi, I'm sorry for the delay in getting back to you. This blog is not a daily question and answer blog, unfortunately. By now, your outcome should be well established. But, for your future information, with Blastocyst transfers, usually the bHCG will be positive by 6 days after transfer. If it has been longer than that and the result is negative, then it it probably a negative result. In terms of stopping medications, I won't give advice on that because I don't want to intrude on some other doctor's protocol. That will have to come from your doctor.

      Delete
  90. Hi Dr Ramirez,
    I had a 5dt FET on 1/19. Took a HPT on 1/24 and 1/26 both negative. I have had two previous ivf transfers, the first was a miscarriage the second was ectopic and resulted in tubal removal. Both of my previous pregnancies showed up on HPT early and I felt very clear pregnancy signs before my Beta tests. Since the HPT showed negative on 1/26 and I was feeling no symptoms, I stopped taking meds. I started bleeding and cramping on 1/29. I assumed this was my regular period. To my shock, when I went for my official blood test on 1/30, the result was Positive (hcg 33). I'm horrified. Is it possible that the bleeding was caused by me stopping meds? Should I still hold out hope that this pregnancy could be viable? I'm going for a follow up beta on 2/2.

    ReplyDelete
    Replies
    1. Hi. You are a perfect example of why I don't rely on HPT's. Usually, the HPT requires a certainly bHCG level to show positive and this will not be the case with early pregnancy tests. They are meant to be done once a woman misses her menses. Stopping the meds could have lead to the bleed, but that is an unknown. Hopefully it will not affect your pregnancy, since the pregnancy usually creates its own hormonal support. If you haven't already, I would recommend you go right back on the meds you were taking.

      Delete
    2. First, thank you so much for your response. It gives me a measure of comfort hearing that stopping the meds might not have affected my pregnancy. Unfortunately, either way it seems the prognosis is not good. HCG today was 48 and the doctor's office is instructing me to stop taking everything at this point and go back for a recheck in a week. Do you think I should continue taking meds and schedule a follow up in 48hrs just to be sure?

      Delete
    3. A single bHCG of 48 is a positive test and does not indicate anything more than you are pregnant. You need to see what the trend is. I would recommend that you have another test at 48 hrs to see if the level is going up or down. Only if the values are going down should you stop the medications.

      Delete
  91. Dr. Ramirez,
    I had a 4 day transfer last Saturday 01/24/2015 and my beta was today. I was wondering two things: my HPT was negative yesterday is there still a possibility I could have a positive beta today. Secondly, is it too early to test since I had the transfer almost a week ago?
    Blessings,
    Jaime

    ReplyDelete
    Replies
    1. Hi. You should read the comment right above yours. She did a HPT and it was negative, and the blood test was then positive. The HPT is unreliable at this early stage. It is meant to be two weeks after, not 6 or 7 days. Only the blood test is reliable at this early stage.

      I usually test my patients at 8 and 10 days after transfer and that is reliable timing. It has been plenty of time for you to test if you want. The advantage of an early test is, even if the pregnancy turns out to be a chemical pregnancy (an initial positive then negative), it shows that implantation occurs and that is a good fact to know. Frankly,I don't know why clinics wait longer to do the test. They would miss out on this information.

      Delete
  92. Hello Dr.
    I have a day 5 transfer on 15 January 2015. 9 days later the beta was 0.1. 3 days later it was 1.0 and another 3 days was 2.2. I am so devastated. Should I stop all the medication?
    Thank you

    ReplyDelete
    Replies
    1. Since the numbers are going up, I would continue to test, but considering how low the numbers are, I don't think it will be likely that you will have a successful pregnancy. However, at this point it is in God's hands so all we can do is continue to monitor, wait and see.

      Delete
  93. Hi Dr. Ramirez,
    I had my 3 day ET on 22nd jan, had 5 embreyo (3of 8 cells nd 2 of 6 cells) transplanted, had chorrionic gonadotropin inj on 25th jan, i did beta hcg blood test yesterday (12th day after ET nd 9th day after inj of hcg) nd it ca,e only <1.20. Can it posible dat i might have late implantation? should i retest after 48 hrs? Is der any hope sir, i m very desperate nd now depressed.. thanx in advance.

    ReplyDelete
    Replies
    1. My protocol is always to to do two tests 48 hrs apart to confirm results. However, because so much time has passed since the embryo transfer, it is unlikely to be a good result. If a pregnancy were going to occur, it should be positive at this point.

      Delete
  94. Hi Dr.

    I had my first beta test done this morning at 8 am. They did a beta qualitative test instead of quantitative test, so there is no HCG level that was reported. I am realistic so if it’s negative I would like to know when I can try again with a frozen cycle and would like to go over my protocol and see what I can do proceeding further.

    Dr. Wang transferred two fresh embryos on Monday the 22nd at 4PM. I know you are the expert and have been doing this for years. The way I have felt the last 3 – 5 days, and with spotting, I really thought it took. Is there any way that the test was done too early since doing at 8am this morning, would make it day 8.5 since I had my day 4 transfer done? I would still like to go in and have another test done maybe tomorrow or Friday, but would like you honest opinion.

    ReplyDelete
    Replies
    1. My protyocol is to do two tests for definitive confirmation. Just this last cycle, I had a patient who had a negative 1st bHCG at 8 days and has gone on to have normally rising bHCG's since. Usually 8 days post transfer, regardless of the exact time of the transfer, should be sufficient time for implantation to occur, but you never know. I would recommend retesting to make sure.

      Delete
  95. I m on my 27th day post ivf... on 17th day I did blood test the result was 110... dr said its positive then after three four days I did urine test it turned to be negative isthere a chance I can be ppregnant. .. plz reply... thnks in bbefore hand

    ReplyDelete
    Replies
    1. It is highly unusual for a urine pregnancy test to be negative with a level above 20. I don't trust the result and advise that you disregard it and continue to follow with blood tests.

      Delete
  96. Plz advise me I had my ivf on 10th jan.... on 26th jan the hcg result is 110 but after 3 or 4 days when I did hpt it came negative... can I hope to be pregnant. ... I have no spotting but very cramps just as if I m going to have my mc plz helpme

    ReplyDelete
    Replies
    1. Hi. You posted this question twice so the answer is above. Only blood pregnancy tests are completely reliable. I would not draw any conclusions until you have confirmation with a blood pregnancy test.

      Delete
  97. Plz help me I got my hcg test 110 on 26 th jan but after sum days when I did hpt its negative can I still be pregnant

    ReplyDelete

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