Management of Declining β-hCG After Blastocyst Transfer

Prognosis and Monitoring

• The American Society for Reproductive Medicine recommends serial β-hCG monitoring combined with ultrasound surveillance to rule out ectopic pregnancy until either an intrauterine pregnancy is confirmed or β-hCG declines to <5 mIU/mL 1

Counseling for Future Cycles

• The European Society of Human Reproduction and Embryology (ESHRE) guidelines recommend single embryo transfer as the standard approach for future cycles, as there is no evidence that transferring two blastocysts improves cumulative live birth rates, and it significantly increases risks of multiple pregnancy complications 2
• The ESHRE guidelines found no clear indication to favor double embryo transfer over single embryo transfer based on previous failed treatments, and this failed cycle does not change the recommendation for single blastocyst transfer in subsequent attempts 1