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We normally do a blood test for HCG 2 weeks after the embryo transfer to find out if the embryos have implanted and if the cycle has been successful or not.

This can be a very long 2 weeks , and many women will start doing pregnancy tests 5 days after the embryo transfer.

The problem is that even if the embryo has implanted and you are pregnant, the embryo produce such small quantities of HCG for the first few days after it implants ( remember that it's just a microscopic ball of about hundreds of cells or so at this time), that it's not possible to detect this HCG in the blood . To be able to detect the HCG in the urine will take even more time, which is why you need to be patient.

Of course, many patients will cheat :) - and this is an email I got from a patient today. A picture is worth a 1000 words, and this image clearly shows how her pregnancy tests have now become strongly positive ( C stands for Control and T stands for Test). The stripe on C means you have done the test properly. Once the stripe on T shows up ( is positive) , this means you are
pregnant !

She's now ready to start her baby album !

Both my husband and I, born in India but raised almost entirely abroad (he in US, myself all over the world), met purely by chance in 2007 and got married soon after. I'm a career woman who got married very young and had put off having children when I became single again at 25. My husband had also married young and had 4 children, and found himself suddenly single again. After a whirlwind courtship and traditional Indian wedding, I was overwhelmed by gaining an instant family, but also felt a deep longing to experience motherhood for myself. However, I also had a complicated gynecological history and age was not on my side (I am 47), so did not share my husband's hopes that I would ever become a mother (other than through adoption). My husband and I tried one (very expensive) IVF cycle in the US which our doctor advised us against as he knew I had poor ovarian reserve due to age. I was ready to move on with our lives, but my resourceful husband did a lot of research and found Dr. Malpani. We struggled with the many decisions we had to make, whether to proceed, whether we would be comfortable with an Indian clinic, how many times we were willing to try, whether we would be comfortable with going through the donor process and many other factors such as being an older mother, but my husband gave me the love, reassurance and support to move ahead.

From the first meeting, Dr. Malpani's optimism and the lack of judgmental attitude in his clinic put me at ease. I am not going to lie, physically IVF is very tough on a woman's body, even when you use donor eggs. The drug protocol is harsh, and the side effects can be very discouraging. I persisted through 2 cycles, one done with fresh specimens, the second with frozen embryos. Neither was successful and because each involved so much juggling of our work and personal schedules, not to mention the fact that I had moved from one city to another and taken a more senior and stressful position for work, I began to despair that we would ever succeed. Through it all, Dr. Malpani never expressed doubt, and merely advised me to take a break after the 2 back-to-back cycles. Then I started to have irregular cycles and thought this would be another strike against me. However, I took a break and approached the 3rd cycle almost with an attitude of "it's probably not going to work, but what the heck." I was consequently very relaxed throughout the cycle and my husband and I had a very short belated honeymoon in Goa before going to Dr. Malpani's clinic for the third, all fresh, cycle. After some discussion, Dr. Malpani transferred 4 embryos, 2 Grade A, 2 Grade B, and I flew back to the US 2and a half days later and returned to work almost immediately. After 7 days, I was dismayed to find some staining and though I could not possibly be pregnant. On day 16, I went to my ob/gyn for the HCG blood test. A day later, I was advised that the test result was POSITIVE. Because I could not wait until the end of the day to tell him the fantastic news, I called my husband with the test results and he thought I was joking!!! In the meantime, between days 7 and 16, poor Dr. Malpani was living through the tortuous wait with us. At one point he suggested we not wait for the HCG test but take a home pregnancy test on day 14 (in the US, day 14 fell on a Saturday when all medical facilities are closed for the weekend). I was so convinced that I was not pregnant that I did not take the home test.

So now, I am getting into my second trimester. Two ultrasounds have revealed a healthy baby and God willing, everything will continue to progress well. I am due in July 2011, and am feeling great. To all of you out there, I know God will work a miracle as he did for us. And without Dr. Malpani, Dr. Anjali and their caring staff, the miracle might never have happened. My husband and I wish you all the best of luck and a healthy and baby-filled 2011.

It's success stories like this which make being an IVF specialist so meaningful - the fact that we change people's lives for the better ! And the fact that we get so many blessings daily every time our patients see their children is an added bonus :)

While all IVF patients understand with their heads that not every IVF cycle results in success, in their heart of hearts, every patient expects to get pregnant every time they do IVF ! This is why the 2ww after the embryo transfer can be so nerve-wracking ! Am I pregnant or not ? Have the embryos implanted or not ? The suspense during the 2ww can be even worse than the pain of the IVF injections !

Most patients would love to have a test which will allow them to find out if they are pregnant immediately after the embryo transfer ! Have the embryos stuck or not ? Why can’t we do a pregnancy test and find out right now ? Even if I am not pregnant, at least it’s better to know than to be unsure.

To understand why patients ( and their doctors ) still have to suffer through a 2 week wait to find out the outcome of an IVF cycle, let’s look at the biological basis of pregnancy tests and how they work.

A pregnancy test measures the amount of beta hCG ( human chorionic gonadotropin) that is in your body. HCG is a hormone which is produced by the trophectoderm cells of the embryo. It is produced in detectable quantities only after the embryo implants. Since implantation occurs 3 - 8 days after the embryo transfer ( depending upon whether you have had a Day 3 transfer or a blastocyst transfer), this means that the HCG produced by your embryo will be first detectable in your bloodstream only after this time.

As your pregnancy progresses, the amount of hCG in your system will increase. At 10 days past ovulation ( DPO) , for example, the average woman has an hCG measurement of around 25 mIU. This amount doubles to 50 mIU at 12 days past ovulation, and then doubles again to 100 mIU at around two weeks past ovulation. Every woman’s body is different, and there’s a lot of variation in HCG levels from woman to woman !

Home pregnancy tests measure the level of HCG in urine. Different pregnancy tests have different levels of sensitivity which means if you use a home pregnancy test that is sensitive to 100 mIU, it will not tell you that you are pregnant if your level of hCG is only 75 mIU. These tests cannot measure a level lower than 25, so they do not become accurate until a few days after embryo implantation. A negative result before then is meaningless, since there would not be a high enough level of HCG to detect even if you were pregnant. If your test is negative, you should retest after 2 days. This is why taking a pregnancy test too early can lead to inaccurate results. I know it’s hard to wait those extra days and you may want to try much earlier. It’s fine to do this, but please don’t assume that a negative results means that you are not pregnant.
This is also why blood tests for HCG are much better than urine tests. Not only are they more reliable, accurate and sensitive, they also give the doctor a number which he can measure and monitor.

If blood tests are so sensitive, then why not do a blood test for HCG 1 week after the embryo transfer ? Unfortunately, doing a blood test for HCG so soon does not make any sense. This is because there will still be some HCG in your body as a result of the HCG trigger shot ( Choragon or Ovidrel) which the doctor gave you to trigger off ovulation 36 hours prior to egg collection. If you test too early, the test will always be positive, as this HCG will show up in the test and give rise to false hopes ! This is why the doctor needs to repeat the blood test for HCG after 48-72 hours. In a healthy pregnancy, the HCG levels will continue to rise. If they do not do so, this means this is not a viable pregnancy.

Finally, remember that you should do the test even if you bleed. Bleeding can sometimes occur during pregnancy as well – and just because you have had bleeding or spotting does not mean you are not pregnant !

Most patients find that one of the most difficult things to manage during an IVF cycle is the dreaded 2 week wait ( 2ww) after the embryo transfer. Time seems to come to a halt and you live in a state of suspended animation - a bit like Schroedinger's cat ! Am I pregnant ? Am I not pregnant ? Every ache and twinge sends you scurrying to the bathroom to check if your periods have started - and you over-interpret every signal your body sends you. Am I feeling nauseous ? Is this a good sign ? Do my breasts feel fuller than usual ? Is this just PMS ? You try to prevent your mind from playing games with you, but this is surprisingly hard to do. Every hour seems to stretch on like a day ! You obsessively compare notes with all your online IVF friends - and drive your husband batty with your interpretations and wild imaginings ! Every time he drives the car through a pot-hole, you go bonkers with the anxiety that the jolt has jarred your embryos out of their safe uterine haven and caused them to fall out !

Why do I have to wait 12 days after the embryo transfer to do a pregnancy test ? Can't I do it earlier ? After all, if I am pregnant, won't the test show this ? Aren't the new tests very sensitive ? Aren't they supposed to show a positive result even before the period is missed ?

You cheat and start doing pregnancy tests anyways - how can it hurt ? And every time it's negative, you still hope against hope ! Maybe I did it too early ? Maybe it will show up as positive if I wait another 2 days ? How can God be so unfair ? After all the shots I have taken and the pain I have suffered, I am sure he will not let me down and will give me my baby !

Remember that your embryos are safe in your uterus and that nothing you do can harm them ! If they are going to implant, they will and there's precious little you can do to influence the inefficient biological process of embryo implantation either way.

Continue taking all your medicines; leading a normal life; and please remember the Serenity Prayer.

God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.

Blood tests for checking the beta HCG level are better than home urine pregnancy tests for the following reasons.

1. They are more accurate , sensitive and reliable. A negative test ( HCG level of less than 10 mIU/ml) can reliably rule out a pregnancy with 100% accuracy. Urine tests are not as reliable or accurate. This is because they can have false negatives. A false negative is the situation when a woman is pregnant, but the urine pregnancy test comes back as negative. This can be because her HCG levels are low, so that they cannot be picked up by the urine test ( which becomes positive only after the blood HCG levels cross more than about 30-50 mIU/ml). Other reasons the urine test can be incorrectly negative is when it’s not done properly by the patient ( who is not an expert, after all, and can make errors !); and if the urine is too dilute ( so that the concentration of the HCG in the urine is too low for it to be picked up by the urine test). This is why an IVF clinic will never rely on a urine pregnancy test and will insist that the patient do a blood test to check their HCG level.

2. They are quantitative. The other major advantage of a blood test over a urine test is that a urine test is only qualitative – it just gives a yes or no ( positive or negative) result. The blood test, on the other hand, provides a number. This is especially useful when the doctor needs to do serial tests to monitor the health of the pregnancy. Thus, in a healthy pregnancy, the HCG level should double every 48 hours. If it fails to do so, this gives the doctor an idea that there maybe a problem with the pregnancy. Similarly, a very high level can help the doctor to suspect a multiple pregnancy !

If you need help in interpreting your HCG levels, please send me your medical details by filling in the free second opinion form at www.drmalpani.com/malpaniform.htm and I'll be happy to help !

Image via Wikipedia

For a patient going through an IVF cycle, the most important number is the HCG (human chorionic gonadotropin) level - also known as the beta. HCG is a chemical produced by the embryo, and is the embryo's signal to the mother that pregnancy has occurred.

In a non-pregnant woman, the HCG level is less than 10 mIU/ml. A level of more than 10 mIU/ml is considered to be positive, and means that the embryo has implanted.

Many IVF doctors are very creative in manipulating the HCG results and in interpreting them, because they want to inflate their success rates !

How do they fool their patients ?

1. They give HCG injections during the luteal phase, after the embryo transfer, claiming this is for "luteal phase support". This HCG is then detected in the blood when doing the HCG blood test ( or in the urine, when doing a pregnancy test). Since the HCG test is positive, they then proudly proclaim that the patient is pregnant and that their treatment was successful. The cruel tragedy is that this just creates false hope and patients are on top of the world for a few days ! To make a bad situation even worse, they continue giving the HCG injections to "support the pregnancy". This means that the HCG levels remain positive for another few days. However , because the patient is not really pregnant, the levels soon drop. The doctor then claims that the IVF pregnancy miscarried because of "bad luck" and that the patient's best option is to try again. Patients feel that since they did get pregnant, this is a good IVF doctor - and they keep on doing IVF treatment cycles with him repeatedly.

2. They are very liberal with interpreting what a positive HCG level is ! Technically, a level of less than 10 mIU/ml is negative. This means that anything more than 10 can be considered to be positive. Thus, when patients get levels of 14 or 16, they proudly declare that the IVF was successful and that the patient is pregnant. In reality, in a healthy pregnancy, the levels should be at least more than 30 mIU/ml 14 days after the transfer ( typically, they should be abut 100 mIU/ml or more at this time).

It's quite easy for doctors to "game the system" - and the sad truth is that some doctors will do so ! That's why it's so important for patients to be well informed !

Need help in interpreting your HCG results ?

Need help in making sense of your lab results ? Please enter your lab values and your clinical details in our Free Second Opinion form and I’ll help you interpret your results !

Image via Wikipedia

One of the most frustrating things an infertile woman can experience is having a late period and a negative pregnancy test! If you are trying-to-conceive , every time you miss your period, your hopes that you are now finally pregnant go up. You do the pregnancy test with a lot of hope - and lots of prayers. You are scared to do it, because you do not want to get your hopes up, and you are worried that it maybe negative once again . You finally screw up your courage - even if the news is bad, it's best to know the truth, you tell yourself - and then do the test.

When it's negative, you are depressed, disappointed and disheartened. But then you start hoping against hope ! Maybe I didn't do the test properly ? Maybe I drank too much water and the HCG is not showing up in the urine ? Maybe I did the test too early ? Maybe I ovulated late this cycle ? Maybe this brand is not reliable ? Aren't these tests fallible ? Maybe the test kits have expired ? Should I test again ? Should I use another brand ?

What happens if the test is repeatedly negative ? A late period and recurring negative pregnancy test results can lead to a great deal of stress, worry, confusion, and conjecture on what might be happening.... If I'm not pregnant, then where is my period?!? Have I stopped ovulating all together ? What's happened to my eggs ? Is my body going crazy ?

One possibility is that you are in fact pregnant , but the urine test result comes back negative. This is called a "false negative pregnancy test"? First, read all the instructions again and make sure you are doing the test properly. If you are, then a false negative result can occur if the test kit you are using is of low sensitivity. This means that the test is capable of detecting pregnancy only when the level of hCG reaches a certain threshold, and the test is simply not sensitive enough to yield the positive result.The best option is to do a blood test for checking your HCG level. This is very reliable ! If this is less than 10 mIU/ml, this confirms you are definitely not pregnant.If the test is negative , this means the reason you missed your periods is because you did not ovulate. This is called anovulation. You can read more about this at www.drmalpani.com/anovulation.htm !

Many factors can cause a missed period because they disrupt your hormonal balance. These include increased stress, anxiety, travel, jet-lag, weight loss, exercise and sleeplessness. The doctor may need to do an ultrasound scan to find out why you have missed your period. This vaginal ultrasound scan should check for the following.

a. ovarian volume
b. antral follicle count
c. uterus morphology
d. endometrial thickness and texture.

Based on these results, your doctor may prescribe medications for you to induce a period.