Slow HCG Rise and Options

Hello-

I just had my first IVF cycle completed. Prior to starting treatments, my fertility tests had the following results:
-Progesterone (7 days past ovulation) - 5.7
- Estradol - 36 (Day 3 of cycle)
- Prolactin - 6.9 (Day 3 of cycle)
- FSH - 5.9 (Day 3 of cycle)
- LH - 4 (Day 3 of cycle)
- TSH 1.49 (Day 3 of cycle)

In the IVF cycle, I was not put on birth control pills or baby aspirin. I was given a Lupron protocol to shut down my ovaries. Then, I was given 150mg of Follistim and 150mg of Menopur. On my first monitoring appointment, I was at risk for hyperstimulation and they lowered my dose of Follistim to 75mg for 2 days. Finally, they decided to cut off my Follistim and just keep me on Menopur until my egg retrieval.

On my egg retrieval, they were able to get 27 eggs. Out of those, 22 fertilized. On day 3 we had several good quality embryos. However, by day 5 we only had 4 Grade 2 Blastocysts and 1 Grade 2 hatching Blastocyst.

We ended up transferring 2 of the Grade 2 Blastocysts and froze the rest for a potential future FET.

On my first pregnancy test (14 days after retrieval), we received the happy news that we were pregnant with an HCG of 57. But things became bad. 48 hours later, my HCG was only 70. 48 hours after that, the HCG was 115. They decided to wait 9 days to measure my HCG levels and they came in only at 268 (I received this news yesterday).

We are going in for an ultrasound on Thursday, but we've been told that we most likely will miscarry or that it is ectopic. I'm still on my progesterone medications, but I'm trying to do some research as to why this might have happened and what we could do to increase our success rates for next time.

Do you have any suggestions for questions that we could ask our doctor? Also, if we were at your clinic and I was your patient, how would you proceed with me?

[Elaine Brown, MD]

Hi!
Well, based upon your HCG results,  you probably won't have good news when you have your ultrasound.  It does sound like they have prepared you for that. In most cases in which the embryo quality is poor, or the pregnancy fails to continue, abnormal chromosomes are the culprit.  This sounds much worse than it actually is.  It happens all the time in nature--eggs or sperm don't divide properly and when they recombine to form an embryo the wrong number of chromosomes result and the embryo doesn't survive. Only about 20-25% of naturally occuring pregnancies result in a baby.
One option for you to consider ( this is controversial) would be PGD. ( pre-implantation genetic diagnosis.) A cell is removed from the embryo and analyzed to be certain that the chromosome number is normal.  Normal embryos are much more likely to result in babies--all though not even this is a guarantee.
Often the embryo quality is a good enough guide, but sometimes poor quality embies can grow into babies.
The fact that you have such a good response to the meds makes me think that you will eventually have success if you keep trying.
Good luck!
Dr B

[mbeliza]

Thanks so much for the detailed response.  Unfortunately, the ultrasound did confirm that the pregnancy was not viable.  So, we will be doing a Frozen Embryo Transfer in about a month and a half.  Thanks again for the information and the words of encouragement.

[A_Muse4u]

GL w/your FET.  Prayers for your BFP and HH pregnancy L& delivery.  O:-)