Staying Sane After a Positive Pregnancy Test

You were just received the news that your pregnancy test was positive. What now? And what does the number mean?

This can feel confusing since most of us assume that one is either pregnant or not. And if the test was positive, yes, you are pregnant. But there is also a number, the actual beta HCG level, and this number is important. You may have been told that your number is “really good” or that the test was positive but the number wasn’t exactly where your doctor wanted it, so they are cautiously optimistic. Or you might have been told that the test was positive, but the number was low and there is some concern. 

This first number can be somewhat predictive, but not entirely.  There have been thousands of babies born where that first number was low but then began to rise appropriately. So the rise in number over the next few days can be just as important as that first number.

Research shows that most normal pregnancies have a HCG level of around or above 100 iu/ml two weeks after fertilization. But a level greater than 100 iu/ml does not mean that it is multiple pregnancy.  If you did IVF and had an embryo transfer, the date of fertilization and transfer is clearly known, and thus more importance can be placed on the exact level. Less so if you got pregnant through “relations” or an IUI.  

Most clinics request that you come back two to three days after your first test to repeat the blood test; the number is expected to generally double in 2-3 days and continue to do so for a period of time. So for example, if your first number was 105, your doctor would like to see it around 210 in 2-3 days. If the first number was lower than 100 but rises normally after that, your levels may continue to be monitored. If the first level was in the 100 range and it did double 2-3 days later, you may not be asked to come in for any more blood tests. If your first number was well below 100, and didn’t double as hoped, you might be at risk of an early miscarriage., sometimes referred to as a “chemical pregnancy”.  Your doctor will likely continue to monitor your levels for some time. 

Remember that some pregnancies with initially low or poorly rising levels of HCG do not result in a miscarriage. Also, initial low or high levels of HCG do not mean that, if the pregnancy eventually continues normally, the baby will have health issues.

What can I do and not do in terms of my health habits?

Now that you are pregnant, you need to follow the recommendations for pregnancy, which includes abstaining from all alcohol, and trying your best to not have more than one cup of coffee per day. Avoid smoking cigarettes and being exposed to secondhand smoke. Do your best to eat well, which means fruits and veggies, whole grains, lean meats, nuts, etc. and basically follow a well-balanced diet. One other thing to avoid is foods that can contain listeria, which can increase one’s risk of miscarriage. Foods to avoid include unpasteurized cheeses, deli meats, unheated cheese from a deli, cold cuts, premade deli salads, pate or meat spreads, smoked fish, raw sprouts, unrefrigerated raw melon, or  fermented or dry sausages. 

Should I be having pregnancy symptoms now? And if I don’t, what does that mean?

You are probably wondering if you “should” be having pregnancy symptoms and if you aren’t, might be worried what that means about the health of your pregnancy. Most patients who went through infertility treatment are taking some form of progesterone, whether shots or a vaginal route.  Unfortunately, progesterone can be the great imitator, in that it can cause many of the early symptoms of pregnancy, such as fatigue, breast tenderness, and even nausea. Other symptoms that can be from the progesterone or the pregnancy itself can be bloating and mild cramping, but there is no way to tell if those are from the medication or the pregnancy or both.  It is also entirely normal to have no symptoms whatsoever!  As frustrating as it might be, the actual blood levels and the subsequent ultrasound scan are far better predictors of the health of the pregnancy than one’s symptoms.  It is also normal for symptoms to come and go. 

What if I experience spotting or bleeding?

Many pregnancies which occur as a result of infertility treatment can include spotting and even bleeding.  So it is not a reason to panic.  It can feel counter-intuitive that you can be pregnant and spotting and things might still be ok.  But, if you do have any of these issues, you need to let your doctor/nurse know. Make sure you tell them if it is spotting vs bright red bleeding, and if you are or are not having cramping as well. They will likely reassure you,  and may well ask that you come in for another blood test or an ultrasound.  

I feel pretty anxious these days- will this increase my risk of a miscarriage?

At this point in time, what you think or do or feel will have nothing to do with your pregnancy progressing normally. Many pregnant women worry that if they get mad or frustrated or feel sad, that it will have a negative impact on the pregnancy, but this simply isn’t true.  Most pregnant women, especially those who conceived after infertility treatment, worry a lot during their pregnancies and the babies are totally fine!  Ask your doctor/nurse/health care team, but for most women, during early pregnancy they can continue to have sex, exercise as they were before becoming pregnant, and pursue whatever stress-relieving activities worked for them before conceiving. 

My stress level is interfering with my life- what can I do?

It is incredibly normal to feel anxious after conceiving following infertility. You have worked really hard to get here and likely already have protective feelings about the baby. The first thing to do is to think about what helped you with your anxiety during infertility. Something that worked for you in the past has a good chance of helping you now.  What about talking to a close friend/family member? Taking a walk? Baking/cooking/arts and crafts? This is a great time to begin a regular relaxation practice since although pregnancy might feel pretty anxiety-provoking right now, having a newborn can present new challenges for one’s anxiety levels. It is easiest to learn/incorporate a relaxation practice by making it part of your daily routine. Many find that listening to someone guide you through relaxation helps keep you more focused than trying meditation or some other method on your own. There are some great apps out there, such as Calm or Insight Timer. They offer thousands of guided relaxations with all kinds of different guides. Finally, don’t underestimate the benefits of distraction- listening to music, binging on your fav tv shows, rereading all eight Harry Potter books, etc. 

Most women who conceive after infertility are shocked that their feelings of anxiety and irritability don’t disappear as soon as they find out that they are pregnant. It can actually feel kind of unfair!  But remember that if you had good HcG levels which rose appropriately, and especially if you had a normal prenatal ultrasound, your chance of a loss is low.  Despite this factual knowledge, it is entirely normal to feel fear.  It also can feel strange to have so little contact with your health care team. During a treatment cycle, you may have had contact with a nurse or MA almost every day, and yet you might have almost three weeks between your blood tests and an ultrasound.   

If you are feeling no negative emotions and just feel calm and happy, just enjoy this time! 

What is the next step after the pregnancy blood test(s)? An ultrasound?

It is likely that you will be scheduled for a prenatal ultrasound approximately three weeks after your positive pregnancy test, but this timing can depend on your physician, your medical history, and your blood test results. So it can vary- the timing is not cause for concern. 

The prenatal ultrasound is performed for several reasons: to show where the fetus is, how big it is, and hopefully that there is only one present! Another reason is to determine the presence and rate of the fetus’ heartbeat. There should be a measurable heartbeat by seven weeks of pregnancy (three weeks after a positive pregnancy test). Remember that you are considered to be four weeks pregnant the day of your positive pregnancy test, so the ultrasound if performed three weeks later is considered to be a seven week scan! The ideal heart rate for a seven week fetus is 120 beats per minute or higher. 

It is very important to remember that a seven-week scan is not definitive. There are normal pregnancies where the initial heart rate is a bit slow, or the fetus looks a bit small- in those cases, you might be asked to come back in a few days or a week. 

If your seven-week scan is normal and all looks good, your chance of a miscarriage is likely to be less than 10%. 

 Is there anything at all I can do to decrease the chance of a miscarriage?

Unfortunately, it is now up to Mother Nature. Your actions and thoughts can’t cause a miscarriage. Follow all the recommendations from above though so you never have the opportunity to question anything you did or didn’t do.

When can I “tell”??

Once you have had a normal prenatal scan, your odds of having a healthy baby are really good. However, to be on the conservative side, waiting until you are at least 10 weeks isn’t a bad idea. Most women who experience infertility have had plenty of time to fantasize how they wanted to share their happy news. But as is the case with any pregnancy, you might want to wait for your first OB appointment so you feel more confident.

Please remember that even though you are now pregnant, we are still are there for you, especially before we discharge you to your obstetrician/nurse midwife. If you have any questions or concerns about this new journey, don’t hesitate to reach out to us!