Very Low hCG Level After Cryotransfer – Seeking a Second Opinion

Dear EB1986,

To get a clear answer, it’s best to wait for the results of today’s blood test and then reassess the situation.

Best regards,

Dr. Miranda Sanz

Hi EB1986,

I’m so incredibly sorry that you’re stuck in this nerve-wracking waiting game right now. The hope and anxiety between blood tests are incredibly emotionally draining.

Unfortunately, based on the hCG levels, it’s medically entirely understandable that your clinic is ruling out a viable pregnancy. Even with today’s new value (202.0 IU/L), the curve doesn’t show the growth pattern you’d expect to see in a healthy, viable pregnancy. The levels are rising, but too slowly and too gradually for this stage (the typical doubling every 48–72 hours is missing).

The fact that you should stop taking progesterone and will now be monitored further is the standard procedure in such a situation for your own safety:

1. Why stop progesterone? If a pregnancy is not viable, the artificial administration of progesterone would only unnecessarily delay the natural process (the shedding of the endometrium). The body should now be given the chance to regulate this on its own.
2. Why are you still being monitored? Since your hCG level continues to rise steadily despite stopping the medication, the clinic needs to monitor the situation very closely. Unfortunately, a slow, steady rise without any drop is a very typical pattern for a pregnancy outside the uterus (e.g., ectopic pregnancies). The tissue there continues to produce hormones independently, even if the uterus is already bleeding slightly.

That’s why your appointment on Thursday (July 9) for an ultrasound and blood test is extremely important. With an hCG level of around 200, they probably won’t be able to see anything in the uterus yet (that’s usually only possible starting at around 1,000–1,500 IU/L), but the doctors need to check whether the level is finally leveling off or dropping, or whether there are any abnormalities outside the uterus. So this is no longer about “hoping for a miracle,” but purely a precautionary measure for your health.

Please take good care of yourself until Thursday: If you experience one-sided lower abdominal pain (including pulling or stabbing pain), circulatory problems, dizziness, or pain that radiates into your shoulder, please don’t wait until Thursday—go to the nearest hospital immediately. If an ectopic pregnancy is suspected, you have to be very vigilant.

I’m sending you a hug from afar and wish you lots of strength for Thursday and quick clarity on what to do next.

Warm regards

Dear EB1986

The HCG level seems to be continuing to rise—it’s doubling every two days. I wouldn’t stop taking the progesterone. And then you’ll need to give it some time before you can make a final assessment. You won’t be able to see much on the ultrasound. At this point, I wouldn’t be too worried about an ectopic pregnancy with an HCG level of 200. I recommend waiting and being patient.

Best regards

Dr. Miranda Sanz

Hi everyone, I’m on day 12 after an embryo transfer and I’m mentally at rock bottom—or rather, I’ve gone crazy.

Until Wednesday, I had real pregnancy symptoms. Starting Thursday afternoon, I suddenly had intense pulling sensations in my lower abdomen, along with slight twinges and cramps. By Friday, they had vanished—out of the blue, they’d eased from 1–2% to virtually no symptoms at all. But on Friday evening, the pulling sensation returned under my upper abdominal wall. Today—Saturday—it’s started again with pulling and pain in my lower abdomen. Not as bad as Thursday, but sometimes up top, sometimes down below, sometimes on the right, sometimes on the left. I’m going to lose my mind. Or maybe I already am Every now and then I get very mild waves of nausea—not as strong as on Wednesday, but just tiny waves. Today I’m not hungry at all; I have no idea why—I’m usually always hungry! By 11 a.m. at the latest, I want to eat. Today, nothing at all. I just don’t understand any of this.

Maybe writing all this down will help. Basically, I’m totally powerless, but the constant stomachaches since this morning are driving me crazy. They come one day and disappear the next What will tomorrow bring?

Quote from Clara44

Hi everyone, I’m on day 12 after an embryo transfer and I’m mentally at rock bottom—or rather, I’ve gone crazy.

Until Wednesday, I had real pregnancy symptoms. Starting Thursday afternoon, I suddenly had intense abdominal pulling, minor twinges, and cramps. By Friday, they had vanished—out of the blue, they’d eased from 1–2% to virtually no symptoms at all. But on Friday evening, the pulling sensation returned under my upper abdominal wall. Today—Saturday—it’s started again with pulling and pain in my lower abdomen. Not as bad as Thursday, but sometimes up top, sometimes down below, sometimes on the right, sometimes on the left. I’m going to lose my mind. Or maybe I already am Every now and then I get very mild waves of nausea—not as strong as on Wednesday, but just tiny waves. Today I’m not hungry at all; I have no idea why—I’m usually always hungry! By 11 a.m. at the latest, I usually want to eat. Today, nothing at all. I don’t understand any of this.

Maybe writing all this down will help. Basically, I’m totally powerless, but the constant stomachaches since this morning are driving me crazy. They come one day and disappear the next What will tomorrow bring?

Can’t you start your own thread? This one belongs to someone else—I think that’s really disrespectful and not cool.

Dear Clara44,

This roller coaster of emotions is completely normal after undergoing fertility treatment. You pay attention to every little detail, notice every symptom, and ask yourself a thousand questions.

My best advice would be to have your beta-hCG levels checked regularly through blood tests and to keep your clinic updated. A few weeks after an embryo transfer, it’s still too early to feel any symptoms at all, so only a blood test can give you clear information about what’s going on in your body.

I wish you the best of luck,

Best regards,

Dr. Alejandra García-Villalba.

Dear Ms. García-Villalba,

Some time has passed now, and I know for certain that the transfer was unsuccessful. Two negative pregnancy tests don’t lie. I had the impression that the embryo had stopped developing on day 10 after the transfer. Of course I’m disappointed, especially since we had two 3-day-old embryos of A and B quality. And that at my age—44 years old, AMH level 0.87

My partner has a poor semen analysis, which is why we decided to go with ICSI.

I just can’t get over the fact that the A-grade embryo didn’t take. We were praised so much for it at the clinic. What do you think? Does it even make sense to keep going?

Here are my questions:

- Could stress during the second week after the transfer have hindered development?

- Why would a Grade A embryo fail to implant?

Is it surprising, given my age, to have retrieved 5 eggs, 3 of which were successfully fertilized?

Best regards

Karla Kurz

Dear Clara44

Don’t worry about the stress you’ve been under—I don’t think that was a factor here. And it’s true that you still have a good egg reserve for your age. Still, I think the issue here is more about quality. The problem is that at age 44, most blastocysts are aneuploid—meaning they have chromosomal abnormalities, either one or more monosomies or trisomies. This is likely the case for you as well (though, of course, I don’t have access to your entire medical record).

That’s why in Spain—and especially at Vida Fertility —almost all of our patients with low ovarian reserve or who are over 40 undergo PGT-A testing of their embryos before transfer. Quality grades A or B refer to morphology and do not take into account what is happening inside the embryos. Thus, it is possible for a grade A embryo to be aneuploid, while grade B or C embryos may be euploid (chromosomally healthy).

You are already at an age where egg donation should be considered. However, if you’d like to try one more cycle with your own eggs, I would advise you to visit a clinic that offers PGT-A and wait to see if you can obtain at least one euploid embryo before making a decision about egg donation.

I hope this helps,

Best regards,

Dr. García-Villalba

Dear Dr. Dr. García-Villalba

That’s already helpful. Next time, I would definitely have PGT-A done before a transfer.

At my age, would you recommend multiple rounds of stimulation to obtain as many eggs as possible? Or just one round of stimulation?

Up to what age can treatment be performed using one’s own eggs?

Best regards

Karla Kurz

Dear Clara44

Both answers depend on your egg reserve and your overall medical history. Unfortunately, I can’t give you a clear-cut and honest answer.

It’s true that at age 44, while it’s not impossible, it is quite rare to give birth to a healthy baby using your own eggs. You should seek a medical evaluation as soon as possible from a clinic that can perform PGTA.

Best regards,

Dr. García-Villalba