11.06.2015

Non viable pregnancy after ivf

After having trouble getting pregnant, you’ve seen a fertility specialist, started IVF, and gotten through the first embryo transfer.
While all IVF patients understand with their heads that not every IVF cycle results in success, in their heart of hearts, every patient expects to get pregnant every time they do IVF.
Most patients would love to have a test that will allow them to find out if they are pregnant immediately. A pregnancy test measures the amount of beta hCG (human chorionic gonadotropin) that is in your body.
Share this articleIn a previous blog we discussed the expected ultrasound findings in a normal intrauterine pregnancy.
The criteria most often used to diagnose pregnancy failure are the absence of cardiac activity by the time the embryo has reached a certain length (crown–rump length), the absence of a visible embryo by the time the gestational sac has grown to a certain size (mean sac diameter), and the absence of a visible embryo by a certain point in time. A crown–rump length of 5 mm was widely recommended as a positivity criterion for diagnosing failed pregnancy when no cardiac activity is seen.
It is prudent to use a cutoff of 25 mm (rather than 16 mm) for the mean sac diameter with no visible embryo in diagnosing failed pregnancy (see figure above). Not all failed pregnancies ever develop a 7-mm embryo or a 25-mm gestational sac, so it is important to have other criteria for diagnosing pregnancy failure.
According to the Society of Radiologists in Ultrasound Multispecialty Consensus Conference on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, October 2012; the following are guidelines for Transvaginal Ultrasonographic diagnosis of Pregnancy Failure in a Woman with an Intrauterine Pregnancy of Uncertain Viability.
When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7 to 10 days to assess the pregnancy for viability is generally appropriate.
In younger women, the incidence of a clinical miscarriage (after ultrasound shows the presence of an intrauterine pregnancy) is around 15%.


If you include chemical pregnancy (blood pregnancy test is positive but the pregnancy does not progress till it is seen on ultrasound), the incidence of miscarriage is closer to 25%. It is unlikely this is a normal pregnancy — unless the ultrasound tech missed the pregnancy (or your dates are wrong)! I did an abdominal scan yesterday and it showed 6 week 1 day pregnant with gastational sac and yolk sac (20mm).
I would really appreciate your opinion on whether this pregnancy has any hope o being viable. After months or years of having trouble getting pregnant, the two weeks after the embryo transfer can seem like an eternity and can be very nerve-wracking.
Bleeding can sometimes occur during pregnancy as well – and just because you have had bleeding or spotting does not mean you are not pregnant!
Recent studies have shown that a 5-6 mm cutoff can result in a false positive diagnosis of pregnancy failure.
The most useful of such criteria involve non visualization of an embryo by a certain point in time.
Tagged in: abnormal pregnancy, crown-rump length, early pregnancy ultrasound, gestational sac, yolk sac.
To understand why patients (and their doctors) still have to suffer through a two-week wait to find out the outcome of an IVF cycle, let’s look at the biological basis of pregnancy tests and how they work. These tests cannot measure a level lower than 25, so they do not become accurate until a few days after embryo implantation.
It is now recommended that we use a 7 mm (rather than 5 mm) cut-off for diagnosing failed pregnancy.


An alternative approach to predicting pregnancy failure, based on subnormal growth of the gestational sac and embryo, has been shown to be unreliable.
I had an iui so I am sure of my dates… At 6 weeks 1 day had tvu showing just a gestational sac of 12 mm with no yolk after searching the curves of the sac. Since implantation occurs 3 – 8 days after the embryo transfer (depending upon whether you have had a Day 3 transfer or a blastocyst transfer), this means that the hCG produced by your embryo will be first detectable in your bloodstream only after this time.
A negative result before then is meaningless, since there would not be a high enough level of hCG to detect even if you were pregnant. Thus if the crown-rump length is 7 mm and there is no heart beat visible, it is suspicious for a failed pregnancy. For example, if the initial ultrasonogram shows a gestational sac with a yolk sac and a follow-up scan obtained at least 11 days later does not show an embryo with cardiac activity, the diagnosis of failed pregnancy is established. Dr advised me to repeat the US 10 days later, she suspects a pregnancy failure without embryo.
At 7 weeks another tv ultrasound was done, finding a sac of 2,5 cm, nothing else (corresponding to a 6 weeks pregnancy so I must have ovulated a week later).
It’s fine to do this, but please don’t assume that a negative results means that you are not pregnant.



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