The patient continued hormonal supplementation throughout this time, and a repeat ultrasound at 7 weeks and 6 days gestation confirmed a viable intrauterine pregnancy. At that time, the patient’s hCG level was 2,778 mIU/mL, and an intrauterine gestational sac with yolk sac was visualized. A repeat hCG measurement and ultrasound were completed 1 week later, at approximately 5 weeks and 4 days gestation. Measurement of her hCG level was repeated 48 hours later, at which time it had risen to 225 mIU/mL, a 40.6% increase. Forty-eight hours later, her hCG level was 160 mIU/mL, a 22.1% increase. Nine days after the embryo transfer, her hCG level was 131 mIU/mL. On the day of transfer, a thawed single 5AA blastocyst, as defined by the Gardner blastocyst grading system, was transferred. This patient, 30 years old and G1P0 with a history significant for polycystic ovary syndrome with chronic anovulation, underwent four cycles of ovulation induction with intrauterine insemination and ultimately IVF with intracytoplasmic sperm injection (ICSI). Our case series reports even lower rates of rise than has been previously described in patients following embryo transfer. One previous study reported rates of rise as low as 30% measured 48 hours apart in 391 women who underwent in vitro fertilization (IVF) and were later found to have a viable intrauterine pregnancy ( 5). We described three cases of viable intrauterine pregnancy after embryo transfer with a lower hCG rate of rise than that seen in 99% of viable intrauterine pregnancies ( 3).Ĭurrently, the same hCG thresholds are often used to establish pregnancy viability regardless of the method of achieving pregnancy ( 4). These values depended on the initial hCG level 49% for hCG 3,000 mIU/mL ( 2). In March 2018, es presented, we recommend conservative management for patients found to have abnormally low ris ACOG Practice Bulletin 191 cited a multicenter retrospective study of 285 women that published revised and lower thresholds for the rate at which hCG increase could be considered consistent with possible viability ( 1, 2). To aid in diagnosis, clinicians use clinical signs and symptoms, serial human chorionic gonadotropin (hCG) levels, and ultrasound criteria. Misdiagnosis can lead to either interruption of a desired viable pregnancy or an untreated ectopic pregnancy at risk of rupture. Discuss: You can discuss this article with its authors and other readers at Īccurate diagnosis of an early intrauterine pregnancy, with or without viability, or an ectopic pregnancy is essential for appropriate management to maximize positive outcomes and minimize harm.