IUI #3: Chemical Pregnancy

Even though my second intrauterine insemination (IUI) attempt did not make me a mother, it did prove that I was able to get pregnant and stay pregnant during the most critical months. To the reproductive endocrinologist who treated my infertility, this was encouraging; the aneuploidy was merely bad luck. Surely, my age had a lot to do with the unfortunate diagnosis, but since the chances of having another fetus with trisomy 13 were close to nil, I was eager to try to get pregnant again, hoping that the odds would now be in my favor.

We followed the exact same stimulation protocol (150 iu of Menopur injections daily) and monitored my ovaries every few days. After three days on the medication, the ultrasound showed two follicles (5 mm and 8 mm) in the right ovary and two follicles (10 mm and 11 mm) in the left one. The follicles continued to grow, but very slowly. After six more days, I still had only two follicles (10 mm and 10 mm) in one ovary but now three (13 mm, 13 mm, 19 mm) in the other. I continued with the Menopur for another day, and then we triggered the ovulation.

On the day of the procedure, the biggest egg had already ovulated, and three others (15 mm, 15 mm, 19 mm) were still lingering. My doctor could have postponed the trigger by a day or two and waited for the smaller follicles to grow so that we end up with a higher number of mature eggs, but I am sure he had good reasons to decide not to wait. He did warn me, however, that this time we needed a lot more luck.

I don’t believe in luck, so I wasn’t too hopeful when I went to have my hCG measured twelve days after the IUI. Surprisingly, the results came out high enough to suspect pregnancy: I had an hCG of 20. I had just had enough time to raise my hopes when the second blood test, two days later, revealed that the hCG level had dropped to 8. I was told I had chemical pregnancy.

Chemical pregnancy, as I found out, is a very early miscarriage—so early in fact that a woman doesn’t even get to feel pregnant. The name is derived from the fact that the pregnancy could be confirmed only trough blood or urine tests (no detection on imaging). Once a gestational sac is seen on ultrasound, a pregnancy is called clinical. If you care to use exact terminology, a failed clinical pregnancy is called a miscarriage, and a failed pregnancy prior to ultrasound visualization of the fetus is referred to as chemical pregnancy.

The most likely cause of my chemical pregnancy was a chromosomal abnormality. Again. I tried to console myself with the thought that since I’ve already had two pregnancy losses due to aneuploidy, my statistical chances for a successful pregnancy from a fourth IUI attempt must be quite high. We started another ovarian stimulation the very next month.