Negative pregnancy test 13 days after embryo transfer

The wait time to find out if you're pregnant after fertility treatment (also coined the "two week wait" or #tww) is fraught with all sorts of anxieties and emotions. The anticipation during that window of time stirs a pot of emotions that can be hard to manage, especially with the added pressure of the old adage that stress affects your fertility.

For many, the culmination of their anxiety and emotional rollercoaster ends with the penultimate moment: "THE" blood test (beta HCG level also called "beta"). These tests are usually done at their doctor's office at the start of their day which is followed by a never ending wait for the phone call with the result.

Many people opt to "cheat" and do a home pregnancy test during their two week wait, prior to finding out the results of their blood test. Why would someone do that? Well, it makes sense for a lot of reasons.

For starters, finding out that you are pregnant is an intimate and personal moment that many people have long imagined—one that likely didn't involve a phone call from a doctor or nurse.

Second, that phone call could come at a time when you're not prepared for the news. Planning for the possibility of stepping out of a conference call or meeting, or finding an empty conference room when your phone rings is an added layer of complexity—especially when you aren't prepared for the emotions that might ensue when you hear the results. So it makes sense that you might want to experience the moment when you find out if you're pregnant or not in the privacy of your own space, or on your own time.

However, before taking that test, there are a few things you should be aware of when interpreting the result—namely the possibility of false results.

1. False negative: The pregnancy test shows a negative result, but you really are positive—this may happen if you are testing too early.
   • For a blastocyst embryo transfer, you may want to think twice before taking a urine pregnancy test before Day 7 post transfer for this reason.
   • Another reason could be that your pregnancy levels are positive, just low: Pregnancy tests are designed to show positive at a certain threshold or level of serum beta-HCG (BHCG) levels. IF your level is positive, but on the lower end, it may result in a negative test. Although in some cases a low serum BHCG level may be indicative of a miscarriage or tubal pregnancy, every doctor can attest to the fact that we've seen live birth and healthy babies born from low initial BHCG levels! This is why I tell patients that even if their home pregnancy test is negative, do NOT stop any of your meds until instructed to do so after the official blood test.
2. False positive: This doesn't happen often, but is still a possibility. This more commonly happens in case where an HcG trigger has been used (in cases of ovulation induction cycle, IVF, or in some cases where a stimulated embryo transfer cycle is done).
   • The trigger shot used to induce ovulation contains the same substance that is detected in a pregnancy test. When testing too early, the test will pick up the remaining HcG which is still present from the trigger shots.
   • It's been shown that HcG from the trigger shot may give off a positive pregnancy test as long as 10-11 days after the trigger, which is why I recommend patients wait at least this long after their trigger to take a home pregnancy test, if possible, the full two-weeks post-trigger.

We respect every patient's decision to test at home, or wait for the results of the blood test, but in the event that you do test at home—regardless of what it shows—it is important to continue all prescribed medications until told otherwise by your provider.

—Dr. Nidhee Sachdev

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