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I answered your other post.

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I know that doctor. But i had other questions that is why i posted the 2nd one.

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Yes, very low progesterone can be a problem in early pregnancy, but if it wasn't measured, there's no way to know. If it was measured, and it was below 9 ng/ml, then it may be contributing to the problem. I still think it "vanishing twin" (which is more common than low progesterone).

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My hcg level (after ivf) is 7.8. This is 12 days post transfer. They said it should be at least 50, but usually over 100. My dr. said stop progesterone, I should get my period in a few days. I feel like he is giving up. Is there hope?

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You had a "chemical" pregnancy. The embryo implanted, but failed to develop. This is usually due to a genetic problem with the embryo. An alternative explanation is that your body rejected the developing embryo (i.e. an autoimmune problem). Discuss these posibilities with your doctor in your follow up.

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Sorry to be Dr Doom 'n' Gloom, but I think there is no hope in your case. The low hCG is indicative of a "chemical" pregnancy. The embryo attached to the endometrium and initiated implantation, but then failed to develop further. This is usually due to abnormalities in the genetics of the embryo (see previous post). It is a frequent occurrence for both fertile and infertile women. It is nature's way of preventing abnormal pregnancies from continuing to term.

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Dr. Smith, Thanks so much for your posting.

My next question is whether we should do another IVF.

I am 41 adn husband 44 with low count/motility problem.

We have had 6 failed IUI and this was the first IVF.

With more than double the follistom (250iu twice/day), they only got 3 eggs with one fair/2 poor conditions. All fertilized with ICSI. On day 3, one was 6 cells, one stll 4 and one with more/but irregular shapes.

In our case, do you think it worth to do more IVF with poor sperm and now egg quality? What options available?


Thanks again.

-Bo

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At 41, approximately 80-90% of your eggs are genetically abnormal. In order to have a reasonable chance of success, you would have to produce around 10 eggs on an IVF cycle (about 12 mature follicles developing at the time of retrieval) on your next cycle. Your last cycle would indicate that this is unlikely.

Using donated eggs would vastly improve your chances, even with the sperm problems (which can be overcome with ICSI).

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Dr. Smith, Thanks so much for the information...

With my current pregnancy (low HCG), Does it hurt to stay on progesterone till it fail? Reading on the internet I only found one case turning around . I know the chance is very very slim. My doctor wants to pull off Progesterone and extrace whcih will push the m/c. I wonder if it doesn't hurt to wait till m/c or 6/7 weeks when the HCg is high enough for ultrasound?

I don't have any spotting or abdorminal pain, just a bit fatig last few days.

Which way would you recommend? Thanks so much.

-Bo

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These are medical questions and outside my area of expertise. Usually, its prudent to follow your doctor's instructions in these matters.

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Hi there I am in the same boat and need some advice. I had an IVF ET and at 11DPT my HCG was 23, today 15DPT it was only 42... it's not looking good and I am so dissappointed. They want me to go back on the 19th of the month for another HCG... do I have any hope??? Amy

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Thanks for the info I will let you know how it turns out.. Amy

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well my numbers went down to 21 so after AF I am on to FET. Any ideas on this, I have 14 frozen embryos! What are the success rates fresh vs. frozen? Medicated or not? Thanks Amy

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In general, the pregnancy rates for medicated and unmediated cycles is the same. However, medicated cycles make things much more predictable for the patient, physicans and the lab.

The implantation rate for frozen-thawed cell stage embryos (i.e. frozen on Day 3) is about half that of frozen-thawed blastocyst stage embryos. I always recommend thawing Day 3 embryos and culturing the "surviving"embryos to the blastocyst stage (particularly when the patient has several Day 3 frozen embryos). That way you know which embryos have truly "survived" the freeze-thaw process and continued development to the point where they are capable of attachment and implantation (only blastocyst stage embryos can attach to the endometrium and initiate implantation).

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Hello Dr. Smith,

I guess I am adding myself to the failure list. I posted once a message where I explained that I had 2 embies transfer 1-7 cell and 2-6 cell. Well, we were happy for 5 days when we were told "congratulations" that was on 6/23. 2 days later I began spotting-had my hcg checked and had double to 61.7 and progesterone was 18.7 since then on 6/28 my hcg is at a low of 74.7 and progesterone 23.
My RE's nurse called me with the bad news and told me to stopped with all meds and most likely I will be getting my period and one more thing that if by Friday my hcg is still growing then I would have to take medication to abort.
I saw your post about autoimmune problem and i will be looking into it, but what else could of gone wrong? Never had a miscarriage before and I conceived once a healthy boy naturally ever since my tubes are obstructed and never again pregnat but this second time with IVF. Thanks for your advice.

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Nothing necessarily went "wrong", but I would suspect embryo quality (e.g. abnormal genetics). It is impossible to say for sure, but abnormal blastocyst stage embryos having very few stem cells produce "chemical" pregnancies such as yours. Chemical pregnancies are common, even amongst the "fertile" population. It is nature's way of terminating the abnormal pregnancy as early as possible, so that you can try again on the next cycle. It is natural to search for answers following a chemical pregnancy, but it may be just part of the natural process of reproduction.

That being said, I agree that you should be checked out for evelvated NK cells and/or abnormal NK cell activation (just to be on the safe side).

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