Question:
Dr.Ramirez,
I have written to you in the past and you have always been such a great sounding board. I need help and closure and I am hoping that you can help.
In September I went through IVF (in vitro fertilization). On 9/7 I transferred 2 embryos- 1 7cell grade AF and a 4cell grade BF. On 9/16 I had some light spotting and cramping. My beta was on 9/19 (12dp3dt)was negative & my RE instructed me to stop taking the PIO & Estrace. A few days later, what I thought was my period arrived. It was a medium flow w/some small clotting & lasted about 4 days & stopped. A couple of days later, I started bleeding very heavily & passing large clots. I went in to see my RE. She conducted an Ultrasound & some blood work to make sure I wasn't anemic. At that time I asked her to run a pregnancy test. She said that there was no way that I could have been pregnant but did it anyway. The next day she called to tell me my beta was 512!
I am absolutely devastated. I can't believe that I was pregnant the whole time. My RE is calling it a biochemical pregnancy and is saying that it probably wasn’t a healthy pregnancy but I am getting the feeling that they are trying to place blame elsewhere. I feel like I need some questions answered by a neutral party. I am having a hard time moving on so maybe you may be able to offer me some closure.
1.Should something have shown up on the beta 12dp3dt? If not, do you think it was a lab error?
2.Could it have shown as negative because of late implantation? If the cramping/spotting on the evening of the 16th was implantation, would HCG have shown up on the morning of the 19th?
3.I have a luteal phase defect. What effect/impact would stopping the PIO and Estrace have on the pregnancy? Do you think that stopping meds was the reason for the miscarriage?
4.My beta was 512 after bleeding for over a week (heavily). I would think it was much higher to start. Do you think that this would have been a healthy pregnancy?
5.Should the clinic have done a 2nd beta?
6.Any suggestions on where to go from here? Any help would be greatly appreciated.
D. from Boston, MA
Answer:
Hello D. from the U.S. (Boston),
Certainly what you have gone through is very unusual and unfortunate. It shows that late implantation exists. I usually do my first bHCG at 8-9 days post embryo transfer. I do two bHCG's, one at that time and another 48 hrs after. I have had a successful pregnancy case where the first bHCG was negative (<1) and the second positive (14) that went on to deliver a beautiful baby. Keep in mind, however, that there are no specific protocols regarding how many bHCG's to do and it is totally up to the medical director of your clinic.
I cannot answer the question about the cramping and spotting on the 16th. If you have a luteal phase defect, then yes, stopping the supplemental hormones can lead to a miscarriage. There is no way to know if this was the reason for your loss because there are many other possibilities as well, such as an abnormal embryo. I cannot answer your question about whether or not this pregnancy would have been healthy. The number was certainly a good and high number.
What is important to keep in mind at this point: This experience showed that you can achieve pregnancy. IVF only has the capability of giving you the opportunity to become pregnant. It cannot force a pregnancy on you. Keep in mind that the last two steps required to achieve pregnancy, embryo hatching and exiting the shell and implantation are natural steps. We don't have the technology to make these happen. That is why I say that IVF can only give you the opportunity. The last steps are in God's hands. The fact that implantation occurred (positive bHCG) shows that the last two steps took place and you can do it again.
Now you just have to maintain your hope, diligence and savvy. You've gotten this close. After all that you have been through, why would you not keep trying? Hopefully, the next one will be a "home run" or "touchdown" depending on which sport you prefer. If you don't try, you certainly won't be any closer to success, so don't give up!
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
