10/03

2017

Infertility: The Waiting Game

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Tick-tock. Waiting may be the most nerve-wracking part of the infertility journey.

Whether you are undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF), an infertility treatment cycle consists of many steps. Everyone involved in the process–doctors, nurses, embryologists and patients–does their part to ensure the cycle will be as successful as possible. Then the waiting begins, euphemistically known in the “trying to conceive” world as the tortuous two-week wait.

At HRC Fertility we try to support our patients and their partners as much as possible during this emotionally turbulent time. The emotional roller coaster does not necessarily end with the announcement of the first test results, and, in fact, often continues throughout the several months before we discharge patients to their obstetricians.

For most infertility patients, a pregnancy test is not as simple as seeing two lines on a home pregnancy test (HPT). They will undergo several blood hormone tests as well as ultrasounds to confirm the health of their pregnancy.

Initial beta hCG blood test
We will administer the initial blood test, known as a beta hCG, 12-14 days after an IUI or embryo transfer. It will assess the presence of human chorionic gonadotropin (hCG), which is produced by placental cells that nourish the fertilized egg after it becomes attached to the uterine wall.

It takes about two weeks for the test to determine if the embryo is creating a sufficient amount of new hCG versus the hCG that can linger in your body after it was administered as the ovulation trigger shot. Because of this, we need to wait an adequate amount of time to ensure patients do not get a false positive.

Even though those weeks may seem like an eternity, blood tests can detect the presence of hCG earlier than commercially sold urine tests, which require you to wait until you’ve missed a period in order to obtain an accurate outcome. We advise patients to be patient and avoid taking a home pregnancy test.

Congratulations, you’re pregnant!
When the day finally arrives to learn your test results, you probably will be on pins and needles. A positive result is considered above 25mlIU/ml.

As your pregnancy progresses, hCG levels typically double every 72 hours, confirmed by blood tests over the next several days. Your hCG levels will reach their peak in the first eight to 11 weeks of pregnancy. Repeat blood tests should be performed by the same laboratory so results are consistent. After several positive hCG beta blood tests with increasing levels of between 1000-2000 mIU/ml, we will order one or two ultrasounds to look for the presence of an amniotic sac and a heartbeat. After eight to 10 weeks, we will feel confident to discharge you to the care of your obstetrician for further prenatal care.

This transition period can be equally stressful as the two-week wait, especially for those who have experienced previous IVF failures or miscarriages.

If your results are negative
Though we were hoping to tell you good news, this, unfortunately, is not always the case. Before you start a cycle or at the the embryo transfer, we try to be candid about your prognosis. If we find that you’re not pregnant, we’ll do our best to communicate this news to you in the most sensitive way possible, as well as be available to answer your questions. We will schedule you for a follow up appointment where we can discuss what we learned from this cycle and how we suggest you move forward. Though delivering bad news is never easy, we are committed to supporting you every step of the way.

Additionally, you could experience a chemical pregnancy, where beta hCG levels at first rise appropriately, but we cannot confirm the pregnancy at the ultrasound. This is devastating news, though hopefully we can glean some information about what caused the implantation failure, whether it’s a chromosomal abnormality or issues with the uterine lining, which can be used to fine-tune your next cycle.

We will also observe your results for indications of an ectopic or molar pregnancy.

Knowing what to expect in the testing process can be very empowering Though we cannot guarantee a positive outcome for every treatment cycle, we can assure you that we will provide all the information and support you need to survive the two-week wait, the results of your pregnancy tests and your transition to an OBGYN.

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