A Positive BHCG But Now Bleeding Two Weeks After Embryo Transfer: Am I Miscarrying?

Question:

Hello. I did an IVF transfer June 24th, was told it was a beautiful transfer of 3 beautiful embryos. This past Tuesday, July 6th, I got a positive result, however doc told me to be cautiously optimistic as it could be a chemical pregnancy because my level was 33. The next morning I woke up to cramps and started brown (old blood like) spotting, which is kind of weird for me to be honest. My cautious optimism diminishes to despair. Called doc, told me it was normal and had to wait. Retested 48 hrs later (yesterday) and it was 60, so it nearly doubled! Which was a big shocker...I was really expecting it to go down. But yeah, right?

This morning, July 10th, I woke up to heavier spotting and an actual clot like thing (which kind of looked like a massive amount of my Crinone gel). Mostly brown blood with a little red now, but mostly when I wipe after going to the bathroom (sorry TMI). They say it could be a number of things, irritation from the progesterone gel, passing of one of the embryos, or just normal pregnancy symptoms. I think they are miscarry symptoms. I go back for blood draw Monday and I am just beside myself. I am normally a pretty together person but this has turned me upside down as I feel like I'm on an emotional roller coaster. One day I think I am dealing with a m/c and then we get news that my hcg doubles. This bleeding after my embryo transfer worries me.

I guess what I'm asking is should I look at the doubling as good news or could it be my levels haven't caught up with what will happen? Could I be passing one or two embryos while one implants? Is a m/c imminent in your opinion? Any help would be most appreciated. Thank you in advance. D. from the U.S.

Answer:

Hello D. from the U.S.,

First, let me answer your last question. Based on your symptoms and bHCG levels, you CANNOT make a diagnosis of imminent miscarriage. It can go either way, but I tend to focus on the good side.

The bHCG levels doubled as they were supposed to. I generally follow them every 48 hrs for the first four levels, but your doctor has a different protocol. As long as they continue to rise and approximately double (they don't have to double exactly), then we wait and see how things go. There is only a limited amount of information that you can gather from this blood test. If they are going up, you are pregnant and things are looking good. If they plateau or drop then things are not good. One cannot necessarily predict the outcome based on the levels.

Second, I would totally disregard the spotting that you are having, and not worry unless it is bright red blood that flows like a period. Anything less than that can be "normal" at this point. Bleeding after embryo transfer is more common than you think. We see this very, very often. . . in almost 90% of our IVF patients using Crinone. In fact, there have been studies showing increased spotting with vaginal progesterones like Crinone. It is thought that the progesterone makes the cervix more prone to oozing from the surface. In any case, this type of spotting with Crinone is very common.

Not much can be known about the pregnancy at this very early point, except that you are pregnant! Now, despite the worry, you have to wait and see how things progress. Try to be optimistic and keep the stress level down. I would not assume that you are destined for a miscarriage or are miscarrying yet. It can still go either way. Whatever is destined to happen, will happen and we don't have the power to change that at this point. We can only hope and pray for the best. By the way, it is never "TMI" (too much information), rather, all the information you can provide is appreciated by a physician.

The very best of luck to you both, my thoughts are with you. Sincerely,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF

Monterey, California