What is a biochemical (chemical) pregnancy, how is it recognised, why is hCG followed and what happens next? General information and urgent warnings.
A biochemical pregnancy is a very early pregnancy loss, recognised by the hCG hormone falling and turning negative before the pregnancy has reached a stage that can be imaged by ultrasound, even though the pregnancy test came out positive. It is also commonly called a chemical pregnancy. Coming after the positive result expected following IVF, this situation can be upsetting and often leaves many questions. The information below offers a general framework and does not replace a diagnosis or treatment recommendation specific to the individual.
What is a biochemical pregnancy?
According to the current consensus document on this subject, if a pregnancy has been detected only by hCG in the blood or urine, no ultrasound assessment has been made, and consecutive values have fallen to negative, this picture is called a biochemical pregnancy loss. In other words, the pregnancy has ended before reaching a stage that could be imaged.
Is it the same as a "chemical pregnancy"?
Yes, in everyday language the same situation is called a "chemical pregnancy". Current consensus documents, on the other hand, recommend the word "biochemical" in place of "chemical".
Is it a real pregnancy loss?
The current view on this subject accepts this situation as a pregnancy loss. It is a very early loss detected by a pregnancy test, and the sadness you feel is understandable. If you are experiencing this picture, your feelings should not be belittled on the grounds of how early the loss was.
How is a biochemical pregnancy recognised?
A biochemical pregnancy is mostly noticed through a period-like bleed. In some people there may be no marked complaint, and the situation is understood only from the values having fallen at a follow-up test. But when there is pain or bleeding while a pregnancy test is positive, this symptom is not regarded on its own as an expected course. This is not a situation in which you simply wait and see.
Why is hCG measured again?
A single value of the pregnancy hormone does not tell the whole situation. Whether the value is rising or falling over time is important; for this reason the test may be repeated at intervals set by your doctor.
Why does it happen?
The cause of a biochemical pregnancy often cannot be determined. You can talk with your doctor about whether an assessment specific to you is needed on this subject.
Why is monitoring needed for ectopic pregnancy while the hCG is falling?
Even if the hormone falls, if the location of the pregnancy has never been seen on ultrasound, the possibility that the pregnancy was outside the uterus may not have been completely ruled out; this is the reason for following the hCG until it reaches zero. A single hCG value neither confirms nor rules out an ectopic pregnancy. In a pregnancy whose location cannot be seen, your doctor proceeds by following the hormone values and your symptoms. Because ectopic pregnancy can also be seen in pregnancies formed after IVF, pain or bleeding symptoms are taken seriously.
What does following the hCG until it reaches zero show?
Your doctor may repeat the blood test to follow the fall of your hCG value. How many times and at what interval it is repeated varies with your doctor's plan. This monitoring helps to see that the pregnancy has really ended and that no problem remains with regard to an ectopic pregnancy.
When are you ready for a new attempt?
The timing of a new IVF attempt or an attempt at pregnancy is determined by your doctor. This decision is shaped by the findings, the treatment plan and by whether you feel ready.
When is investigation considered if it recurs?
If you have had more than one pregnancy loss, share this with your doctor; the doctor decides whether an additional assessment is needed.
Can you get emotional support after the loss?
A loss that follows a positive test can lead to feelings such as sadness, anger, anxiety or guilt. In experiences of loss it is important that the emotional impact is taken into account; support can be obtained from experienced health professionals who know how to listen. Talking with those close to you or with your doctor can help. If intense sadness and hopelessness continue, you can get support in the area of mental health.
Frequently Asked Questions
Are biochemical pregnancy and pregnancy of unknown location the same thing?
No. According to current terms, a pregnancy detected only by hCG, with no ultrasound done, is a biochemical pregnancy. If the pregnancy cannot be seen on ultrasound after a positive test, this picture is called a "pregnancy of unknown location" and is monitored. Whether an ultrasound has been done determines which definition applies to you.
What should I do if spotting or pain begins while the test is positive?
When spotting or pain begins while the pregnancy test is positive, it cannot be known at that moment whether the outcome is a biochemical pregnancy; the same symptoms can be seen in an ectopic pregnancy too.
Is my partner affected in the same way?
The emotional impact of a pregnancy loss and support preferences can differ in women and men. Talking about how you each feel and what you need, and getting support together if necessary, can be helpful.
Can a biochemical pregnancy be recognised without any marked complaint?
Yes. In some people there may be no marked complaint, and the situation is understood from the values falling at a follow-up test.
Is a single hCG value enough?
No. How the value changes over time is important; your doctor may repeat the test at intervals they set.
If the hCG is falling, is the possibility of an ectopic pregnancy completely over?
No. If the location of the pregnancy was never seen, the possibility of an ectopic pregnancy may not have been completely ruled out. For this reason monitoring is continued.
Can the cause of a biochemical pregnancy always be found?
No. The cause often cannot be determined. You can talk with your doctor about whether an assessment specific to you is needed.
Does everyone wait the same period for a new attempt?
The timing of a new attempt is determined by your doctor according to your findings, your treatment plan and whether you feel ready.
If I have had more than one loss, should I share this?
Yes. Tell your doctor about your recurrent losses. The doctor decides whether an additional assessment is needed.
Does its being very early make the loss I have experienced less important?
No. This situation is a pregnancy loss. Your sadness should not be belittled because the loss was early.
Can I get support if intense sadness and hopelessness continue?
Yes. You can talk with those close to you or with your doctor, and if intense sadness and hopelessness continue, you can get support in the area of mental health.
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