I always say it’s never over ’til the fat lady sings….predicting a successful pregnancy outcome

fat_lady_singing

I always say it’s never over ’til the fat lady sings.  But that doesn’t mean I can’t see that fat lady getting ready to get on stage…I can also hear her warming up, running through a few scales too.

So, my suspicions were pretty much confirmed about why I didn’t get my results yesterday.  My results were not good.  And let me point out here that these are not my words, but the words of my nurse.

My hCG levels last Weds were 49 –  just a bit lower about where they should be, but were not overly worrisome…

My results from Tues this week, however, were 126.  They went up!!!! But those of you who are familiar with hCG levels and where they should be by now will know this is not a great number.  hCG levels should double every 2 to 3 days.  What does this mean?  Well my doctor wants me to keep taking my progesterone and estrogen, just in case – there is always a small chance this pregnancy is still viable!! But I have to go in for another beta test on Friday to double check that this pregnancy is, in fact, over.

I can safely say I am no longer feeling cautiously optimistic….I am feeling pessimistic as hell and sad.  If you would like to hold onto hope for us, I gratefully take your strength and thank you for helping to hold us up, but quite frankly when the nurse tells you it is not good, it’s not good.  I understand she is preparing us for the worst.

BUT!!!!! I decided to do a bit of research on what all this really means, what are MY chances?  You know I had to do it, as one of my colleagues told me today – GTS!  (Google That S#*% !!!).  OK, I’m going to get a bit technical here….hang in there if you have in interest in hCG levels (the beautiful pregnancy hormone!!)….

I found a very useful study* that looked at the predictive values of hCG levels for a viable pregnancy 13 days after a 3 day Embryo Transfer (I took my first beta test 14 days after my 3 day Embryo transfer).  My result of 49, according to their model, gives me the following chances of outcome: 45% successful singleton pregnancy, 31% miscarriage, 13% bio-chemical pregnancy, 9% ectopic pregnancy, 3% successful multiples pregnancy.  Well I am glad they didn’t tell me what my hCG levels were last week!

According to these researchers’ analysis, they decided that the cut-off level for predicting a viable pregnancy was an hCG level is 76 IU/I (80% sensitivity)….although this is considerably higher than some other researchers have reported (for example other studies have found the cut off at a similar sensitivity to be: 42 mIU/ml (Qasim et al., 1996); 55 IU/l (Bjercke et al., 1999); and 50 IU/l (Sugantha et al., 2000)).

Wow guys, 76 seems to be a whole lot higher than the others….so do they have credibility in their research?  Well from what I can ‘statistically understand’ and in understanding their research design, it looks solid; their sample size is excellent, some of the best I have seen in articles about artificial reproductive technologies….but I am not a medical professional, so I am totally relying on my knowledge of stats and may be there is something ‘medically awry’ that I cannot see.

If I use any of these models, and consider my hCG level of 49 from last week, these researchers would have told me my chances of a viable pregnancy were always going to be low.

However, there was one interesting point that came out from this study that caught my eye:

In subjects with unexplained infertility, ICSI may result in lower than expected HCG levels (Gold et al., 2000)….The explanation for this was not clear.  Although the early embryo cleavage is delayed in ICSI-derived embryos and the fragmentation of embryos is increased the implantation potential is comparable with IVF-derived embryos.

Even though my numbers have not multiplied nicely….in the back of my mind I am holding onto this slither of hope….holding on that we are the ones in that 5% extreme quantile who defy the norm, and it is because we are unexplained and our embryo was ‘ICSI-ed‘ that my hCG numbers are much lower.

Until Friday…………. :-s

*Pokkeus, P., Hiilesmaa, V. & Tiitinen, A. (2002) Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Human Reproduction 17(7):1901-1905. Available at: http://humrep.oxfordjournals.org/content/17/7/1901.full

18 thoughts on “I always say it’s never over ’til the fat lady sings….predicting a successful pregnancy outcome”

  1. Dee says:
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    Yes yes there is hope, lower hcg does not always mean what you think, it is why in other non medical pregnancies they ensure you don’t test too early!!!

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  2. EmilyMaine says:
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    Oh I am so sorry to hear this. It really throws you for a six when they wheel these comments out. They have to be realistic for you but damn the delivery can burn. I did so much research on low HCG and slow doubling in my recent pregnant and there are plenty of stories out there where the numbers start low and they go on to success so I am going to keep hoping for you. Hang in there. xxx

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  4. Nara says:
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    I’m holding onto hope for you Dani. Especially as it could be an ICSIosyncrasy (see what I did there?). It’s not over till that curvy lady gets on stage and opens her gob. I’m hoping and (atheistically) praying that you get the answer you’re hoping for. X

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  7. g2the4thpower says:
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    Interesting about the icsi finding. I too did icsi and always was surprised by my seemingly low betas relative to what other ivf’ers had reported. I’m keeping my hopes up for you sweetie! Xx

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  8. ashleykyleanderson says:
    Reply

    Oh, Dani and Chris… I am so sorry that you are going through this because even though I am hoping with EVERYTHING I have that this IS a viable pregnancy, I wish you were not dealing with this stress and worry. I am thinking of you guys and of the huckles and wishing I could give you a big hug right now. Sending you lots of love and waiting with you for Friday’s results. xx

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