When is the beta hCG test?
Your pregnancy test is a blood test, called a beta hCG, taken 9 to 11 days after a day-5 embryo transfer. It measures human chorionic gonadotropin, the hormone a pregnancy starts making once the embryo implants.
The blood is drawn at a lab or clinic near your home, not at the intended parents' fertility clinic. The result goes to the fertility clinic the same day, and the clinic's nurses read it and call with the number.
The days between transfer and that test are the two-week wait. Here is what is happening, day by day.
| Day after transfer | What is happening biologically | What you do | What the clinic does |
|---|---|---|---|
| 0 | The embryo is placed in the uterus | Rest as the clinic instructs; continue medications | Records the transfer |
| 1 to 2 | The embryo begins to hatch from its outer shell | Continue estrogen and progesterone | Nothing scheduled |
| 3 to 5 | The embryo attaches to the lining and begins to implant | Normal light activity; continue medications | Nothing scheduled |
| 6 to 8 | Implantation completes; hCG begins to rise in the blood | Continue medications; decide about home tests as agreed | Nothing scheduled |
| 9 to 11 | hCG is usually high enough to measure reliably | Blood draw near home | Reads the beta and calls you |
| About 11 to 13 | hCG roughly doubles if the pregnancy is progressing | Second blood draw | Compares the two numbers |
Through the whole wait, you keep taking estrogen and progesterone exactly as prescribed. Do not stop or skip a dose, whatever a home test shows.
What do the numbers mean?
The clinic looks at two things: the first number, and how fast it rises.
Clinics generally want a first beta above about 50 to 100 mIU/mL at 9 to 11 days after a day-5 transfer. A lower number is not automatically bad news, and a higher one is not a guarantee. That is why there is a second test.
The clinic repeats the beta about 48 hours later. A value that roughly doubles is the sign of a progressing pregnancy. A number that rises slowly, stays flat or falls means the clinic will watch closely and may test again.
The hCG range stated here is under review by Mark Silverberg, MD; thresholds vary by clinic. Your clinic's nurses will tell you what your numbers mean for you.
Home pregnancy tests: should you?
Home urine tests can show a faint line from about day 5 to 7 after transfer. Some surrogates test at home. Some never do. Neither choice is wrong.
What matters is agreeing in advance. PLS asks you and the intended parents to decide before transfer whether you will home test, and when. Many intended parents prefer to hear the clinic's result together. Others want to know the moment you do. If you agreed not to test, and you change your mind, tell your case manager first.
A home test can be falsely negative early, before hCG is high enough. The clinic's blood number is the one that counts.
Who gets the result first?
You and the intended parents agree on this at the match meeting. Common choices are:
- The clinic calls you, and you call the intended parents.
- The clinic calls the intended parents and you at the same time.
- You and the intended parents hear the result together on a call with the clinic.
Your case manager knows the plan and helps keep it. Natalie Gaudio-Fricano and Jenni Symons, who carry the active PLS matches, have both waited on a beta call themselves.
Symptoms during the two-week wait and what they do or do not mean
Most of what you feel in the two-week wait comes from the medications, not from a pregnancy. Progesterone causes breast tenderness, bloating, tiredness and mild cramping. Estrogen can cause nausea and mood changes. You can feel all of these whether or not the embryo implants.
Light spotting can happen too, and so can no symptoms at all. Neither tells you the result.
Call the clinic if you have heavy bleeding, severe pain, a fever, or a red, swollen injection site.
The wait is hard. Your case manager checks in during it, and mental health support from an independent licensed professional is available, paid by the intended parents.
What happens if the test is negative
If the beta is negative, the clinic tells you to stop your medications. Your period usually starts within days.
A negative test after a good transfer is common and is not a sign that anything is wrong with you. The intended parents and their clinic decide whether to plan another transfer. Your agreement provides for another transfer if both sides agree.
What you were paid is yours. You keep the monthly allowance paid so far, the $500 medication start fee and the $1,000 transfer fee. See what happens after a failed transfer. Your case manager checks in, and counseling is offered before you have to ask.
What happens if it is positive
If the beta is positive and rising, you keep taking estrogen and progesterone. The clinic schedules more beta tests to confirm the doubling, then a first ultrasound at about 6 to 7 weeks of pregnancy to see the gestational sac and the heartbeat.
Base compensation installments start when the heartbeat is confirmed. The clinic manages the pregnancy until it releases you to your own OB at about 10 to 12 weeks. That stretch is described on pregnancy to OB release. The days before the wait are on transfer day.
Have a question about your own wait? Ask SurrogacyHotline.com, the free expert Q&A site from PLS, and get an answer within 24 to 48 hours.
Sources
- American Society for Reproductive Medicine (ASRM), patient resources on embryo transfer and early pregnancy testing. https://www.asrm.org
- American College of Obstetricians and Gynecologists (ACOG), patient information on early pregnancy.
- Private Label Surrogacy compensation schedule, pending confirmation by Nancy Block, RN.