Negative beta HCG after IVF

Dealing with a negative beta HCG result can be one of the hardest things to cope with during IVF treatment - especially if it's your first IVF (In Vitro Fertilization) cycle.

Before starting IVF treatment , patients need a lot of courage and conviction. They do IVF with high hopes and expectations , because they have read so much about this exciting new technology , which is so full of promise, and has created so many miracles. They feel that this is the solution for all their problems - after all, if the doctor is actually making an embryo in the IVF lab how can it possibly fail ? IVF promises new hope - especially when the cycle has gone well and you have seen your own embryos for yourself. Also, IVF is the final answer, which is why so much rides on the outcome of the IVF cycle. After all, if IVF fails, then there's nothing beyond IVF , is there ?

Every couple thinks in their heart of hearts that it's going to work this IVF cycle- otherwise they would never start an IVF treatment cycle. This is why the news of a negative beta HCG results can be so difficult to cope with - especially when the result comes after the 2 week wait ( 2ww) from hell. Your hopes were so high - and now they have been dashed into nothing !

A negative beta brings forth the outpouring of numerous emotions, no matter how strong you are, and how brave a front you put on for the rest of the world. The primary emotion is one of despair and frustration. All that money, time and energy gone down the drain - what a waste ! This is often tinged with a sense of guilt - did I do something wrong which prevented the embryos from implanting ? You often blame yourself, and feel you have let everyone around you down by failing to conceive - your husband, your family and even the IVF doctors ! Sometimes you are ashamed of your body - it was not good enough to hold on to my embryos.

A failed IVF cycle is like a double whammy - I couldn't get pregnant on my own, and now I can't even get pregnant after IVF - I am a loser ! This can be even more acute, if some of your IVF cycle buddies have conceived , because now you are jealous and envious of their success as well .

You need to pick yourself up and move on - you've been through worse !

The first thing you need to do is to talk to your doctor. It's a good idea to have a list of questions for your doctor, so you are better prepared for the future.

  1. What was the quality of the eggs ? sperm ? embryos ? uterus ( endometrium)? Why do you think the cycle failed ?
  2. Should we try again ? If we try again, will you change our protocol ? How ? Why ?
  3. Are there any additional tests we should do to troubleshoot for undiagnosed factors ? ( eg hysteroscopy ?)
  4. Are there any special therapies we should consider ? (eg, laparoscopic tubal occlusion if you have a hydrosalpinx)
  5. Should we do our next cycle now or wait ? Can we wait for a year ?

Please make sure you ask for a photocopy of your medical records - this is very valuable in case you need a second opinion ! If the second opinion confirms your doctor is doing a good job, that's fine. If not, then maybe you should be pursuing alternative options at another clinic !

Often your doctor may not be able to tell you why the cycle failed - and this is fine. After all, IVF is not a perfect science, and we are still a long way off from the holy grail where every embryo we transfer becomes a baby. Nevertheless, it's important to analyse the cycle carefully. What did we learn from this cycle ? What went right? What went wrong ?

Remember, that the quality of the doctor's answer depends upon the quality of your question. The question should NOT be - What went wrong ? or Why didn't I get pregnant ? or Why didn't the embryos stick ? After all, no one cares about problems - we are only interested in solutions ! Rather, the question should be - What should we do the next time to improve our chances ? Constructive questions get constructive answers ! The key question to ask should be - What, if anything, should we do differently the next time ?

There are usually three variables which you should look at carefully:

  1. the number and quality of embryos
  2. the endometrial thickness and texture
  3. the actual embryo transfer

If all these were fine, often the best option is just to repeat the exact same cycle again. It's like buying a lottery ticket - the more often you buy one, the better are your chances of winning !

Patients are often so disheartened with failure, that they often lose hope and give up. This can be a big mistake. For anyone making good embryos, often getting pregnant with IVF is just a matter of time till they hit the jackpot ! Just because you did not conceive in the first cycle does not reduce your chances of conceiving in the second cycle. After all, chance has no memory !

There are many things a doctor can change. For example, he may want to change the superovulation protocol; or use a higher dose of drugs; he may want to consider doing ICSI rather than IVF; or a ZIFT rather than an embryo transfer. He may also suggest using donor eggs; or doing assisted hatching or a blastocyst transfer or embryo biopsy. This is why it is so important that you go to a well-equipped full-service IVF clinic which has the facilities , expertise and experience to provide all these options.

For many patients, second cycles are often easier than the first. Because you've been there, done that , you know what to expect, and are familiar with the treatment details and the doctor. You know there's no pain and no surgery. It seems less daunting because you know what you are facing - and since you've been through the worst, there is little you have to fear. You have already survived a baptism by fire. It's also easier to keep perspective - after all, what's the worst thing which can happen in your second IVF cycle ? You may not get pregnant again - but you won't be any worse off than you are right now. However , for other patients, repeating another cycle is much more difficult . They find they cannot cope with the stress, and the uncertainty. They find it's more frightening, because they know more about all the things which can go wrong; they know how demanding the treatment is; they know there are no guarantees; and they know what's at stake.

No matter what the final outcome, you should have peace of mind you tried your best

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.