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IVF pregnancy and queries

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My wife has been doing IVF for the last 6 months. We had a 5 day transfer on 10/31. On 11/8 we tested negative for pregancy so we began the next cycle. On 11/12 she received a period. On 11/13 her IVF doc had her start birth control and 11/26 she stopped birth control and on 11/ 18 she started Lupron. Today she went for a regular ultrasound and she found out she is 6 weeks and 1 day pregnant. Her HCG levels are 2675. They heard a heart beat of 129.31 bpm. The doc said she should be measuring at 7 weeks based upon her period. She goes back next Friday for another blood test and ultrasound. Of course we have tons of questions and with it being the weekend no doctor is available and of we don't want to call the on call doctor. Here are the questions -

1. Should we be considered she is measuring at 6 wks and 1 day versus 7 weeks? Could the dates be wrong with her cycle?

2. Any concerns with her HCG levels being low? Everything we read they should be higher. Could Lupron caused issues?

Laslty, she had light stopping THanksgiving day. Very light -- no pad required. Today we heard a heart beat. With her hcg levels being low could there be a chance we are miscarrying?

Thanks for your help!

Category: OBGYN

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Category: Infertility Specialist
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Please let me know when was her last period BEFORE the transfer was done, that is her last period in October. It is obvious that she conceived from the transfer done on 31st of October. The period of pregnancy is calculated from the last menstrual period, and not day of conception / transfer. SO yes, technically she should be 7 weeks pregnant.

However, I would not worry, and read much into it, the reasons being -
1. First trimester ultrasound scans have an error margin of 5 to 7 days, you are within the margin of error , and hence 6 weeks 1 day is not considered abnormal or alarming, when she should have been 7 weeks as per LMP.
2. I hope the scan was done vaginally - abdominal scans are further unreliable.
3. Please let me know the date of the period in October, also, were you sexually active anytime AFTER the transfer ?
4. At 6 weeks of pregnancy, the HCG levels should be between 1080 - 56,500. As you can see, this range is enormous in variation, and your wife falls well within the normal range. There is no cause for concern.
5. HCG values in isolation are not of much use. When taken serially, they show if the pregnancy is growing well. This too becomes redundant once the cardiac activity in a fetus is documented. When cardiac activity is present, other variables fade away in importance - Presence of heartbeat in the baby is the SINGLE MOST IMPORTANT factor determining that the chances of abortion are now quite low. So please do not worry. Yes, Lupron does inhibit HCG values, but she is still having normal HCG levels for her period of gestation !
6. Every pregnancy carries risk of miscarriage, particularly IVF pregnancies due to inherent risks. With spotting observed in the first trimester, there is definitely a risk of miscarriage. Only time will tell if the pregnancy proceeds normally. Once she crosses the first trimester uneventfully, generally the risk is minimized.

Avoid any kind of stress / negative thinking / coitus / jerky travelling etc.
Take all the medications as advised.

Report to the ER in case of any bleeding / persistent spotting / severe crampy pain.

Have the ultrasound scan as scheduled, and hope for the best.
Congratulations once more on the pregnancy !
Take care, and all the best.

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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