You’re pregnant! Now what?

The positive pregnancy test

The journey to parenthood, for many, starts with profound hope and anticipation. However, for individuals who have endured the rigours of infertility treatments or the profound grief of multiple miscarriages, a positive pregnancy test is a joyful time, although tinged with cautious optimism and a distinct sense of apprehension. This significant positive result, typically determined through a blood test measuring the hormone hCG (human chorionic gonadotropin), signals the beginning of a new chapter filled with careful monitoring and hopeful expectations.

Understanding the critical role of hCG levels, their ideal range, and their doubling rate becomes the next essential step in this journey, offering early insights into the pregnancy’s viability and progression. hCG level can vary widely among individuals, making the range of “normal” quite broad. Generally, an hCG level of about 5 mIU/mL or higher is considered positive for pregnancy, but it’s the rate of increase that often provides more significant insight.

Understanding hCG levels and their importance

hCG levels typically double approximately every 48 to 72 hours in the early weeks of pregnancy, indicating a potentially healthy and developing pregnancy. This doubling rate is a crucial marker that healthcare providers monitor closely. Around the 8th to 11th weeks of pregnancy, hCG levels will peak before gradually declining and stabilising for the remainder of the pregnancy.

• Good hCG Numbers: There isn’t a single “good” number for early pregnancy since hCG levels can vary so widely. However, a positive trend of doubling every two to three days is generally seen as a good sign.
• Doubling Rate: The doubling rate of hCG is often more telling than the initial level. A slower increase may raise concerns about the viability of the pregnancy, leading to further monitoring and possibly additional testing.
• Variability in Levels: It’s important to remember that a wide range of hCG levels can be normal, and one single hCG level does not determine pregnancy outcome. Continuous monitoring provides a more accurate picture.

The role of the ultrasound scan

The next crucial step is the ultrasound scan. This scan is typically scheduled about a week after your positive test result, around the 6th to 7th weeks of pregnancy, to confirm a clinical pregnancy.

A clinical pregnancy is confirmed when an ultrasound scan reveals the presence of a gestational sac within the uterus. At this early stage, the gestational sac may be the only visible sign of pregnancy. It’s a fluid-filled structure that encases the developing embryo and is a clear indicator that the embryo has implanted in the uterine lining. As the weeks progress, the yolk sac and fetal pole (the early form of the fetus) will become visible, and by about the 6th weeks, you might even detect the baby’s heartbeat, a thrilling and reassuring sign of a viable pregnancy.

This first ultrasound is a pivotal moment for you, offering not only confirmation of the pregnancy but also important information about its viability and the potential for a successful outcome. The scan checks for:

• Location of the pregnancy: Ensuring the embryo has implanted in the uterus and not elsewhere, which could indicate an ectopic pregnancy, a serious condition requiring immediate attention.
• Number of embryos: Particularly relevant for IVF pregnancies, where there’s a higher chance of multiples, knowing the number of embryos that have implanted helps prepare for a multiple pregnancy.
• Viability: Detecting a heartbeat and the correct size of the gestational sac and embryo for the gestational age are vital indicators of a healthy, progressing pregnancy.

What to Expect During the Scan

During the scan, a transvaginal ultrasound probe is often used to provide the clearest image in early pregnancy. This method involves placing a small, long ultrasound probe into the vagina. While this might sound uncomfortable, it is generally not painful and offers the best early pregnancy visualization. You’ll be lying down during the procedure, and privacy and sensitivity to your comfort are prioritised.

This early confirmation scan is a profound experience, often mixed with anticipation and hope. It’s the first time you’ll see visual evidence of your baby, marking a significant milestone in your pregnancy journey, especially after a period of infertility.

The ultrasound, combined with the trajectory of hCG levels, offers a comprehensive view of the early stages of pregnancy. It helps in assessing the health and development of the pregnancy, providing crucial information for the next steps in prenatal care. For those who have experienced the challenges of infertility or the pain of miscarriages, these early indicators are not just medical data; they represent hope and a step closer to the dream of parenthood.

Navigating early pregnancy symptoms

Early symptoms of pregnancy can emerge swiftly and may encompass a wide range of experiences. You might notice a missed period, experience nausea, feel breast tenderness, have an increased need to urinate, encounter fatigue, notice heightened sensitivity to tastes and smells, and even go through mood swings. These symptoms herald the start of your pregnancy, each one a sign of the changes your body is undergoing to support the new life growing within.

What happens next?

After the initial ultrasound confirms that your baby is developing normally, it’s time for you to consult with your doctor or an obstetrician who will take care of you throughout your pregnancy and up to childbirth. Facilities like Ferticentro will remain in touch with you throughout this period, eager for news about your well-being or for information about your baby.

Should you agree, many parents-to-be find joy in sharing their journey, including letting the clinic know about the baby and including a picture in their baby album. If you prefer privacy, clinics often request basic data such as the date of birth, birth weight, and gestational age to complete the treatment process documentation.

The emotional and physical journey of IVF pregnancies

Many couples report that pregnancies achieved after IVF treatment are emotionally more intense than those conceived naturally. However, physically, there is no difference between an IVF pregnancy and a pregnancy conceived naturally. That said, the risks and concerns associated with pregnancy remain the same, whether it’s an IVF or naturally conceived pregnancy.

Nonetheless, there are certain situations that deserve special attention:

• If you have experienced miscarriages or stillbirths in the past;
• If you are an older woman, as there is a greater risk of pregnancy complications such as gestational diabetes or preeclampsia (hypertension during pregnancy);
• If you are expecting multiples (twins, triplets, or more), which inherently carries more risk and requires special care.

In instances where there are higher risks associated with pregnancy, the approach to care is typically more cautious and tailored to address these specific risks. Here’s an overview of what usually happens in these situations regarding care:

History of Miscarriages or Stillbirths

• Enhanced Monitoring: You might receive more frequent ultrasound scans and appointments to monitor the health of the pregnancy closely. This can help in early detection of any issues that could be addressed promptly.
• Progesterone Supplements: In some cases, especially if previous losses were early in the pregnancy, progesterone supplements might be prescribed as they can help support the uterine lining and potentially prevent miscarriage.
• Genetic Counseling: If miscarriages were recurrent, genetic counseling might be recommended to explore if there are any chromosomal issues that could be affecting the pregnancies.

Advanced Maternal Age

• Comprehensive Screening: Older pregnant individuals are often offered additional screening tests for chromosomal abnormalities, such as the NIPT (Non-Invasive Prenatal Testing), alongside the routine screenings.
• Regular Monitoring for Complications: There’s a higher vigilance for pregnancy-related complications like gestational diabetes and preeclampsia. This involves regular blood pressure checks and glucose monitoring.
• Specialist Consultations: You may have more frequent consultations with specialists, such as maternal-fetal medicine doctors, who are experts in managing high-risk pregnancies.

Expecting Multiples

• Increased Surveillance: Pregnancies with multiples typically involve more frequent ultrasounds to monitor the development of each baby and to check for signs of complications like TTTS (Twin-to-Twin Transfusion Syndrome) in identical twins.
• Nutritional and Lifestyle Advice: Given the increased demands on the body when carrying multiples, tailored advice on nutrition and activity levels can be provided to support a healthy pregnancy.
• Preterm Birth Preparedness: As multiples are more likely to be born prematurely, discussions about the signs of preterm labor and preparations for a potential early delivery are common.

General Care Considerations

• Personalised Birth Plan: Considering your specific situation, you might work closely with your healthcare provider to develop a personalised birth plan that addresses any potential risks and your preferences for labor and delivery.
• Mental Health Support: Recognizing the increased anxiety and stress that can accompany high-risk pregnancies, access to mental health support, such as counseling or therapy, may be recommended to help manage any emotional challenges.
• Community Support: Joining support groups, either in-person or online, can provide additional emotional support and practical advice from others who have been in similar situations.

Overall, the aim is to provide a supportive, informed, and attentive care environment that addresses both the physical and emotional aspects of a high-risk pregnancy, ensuring the best outcomes for both the parent and the baby.

A profound moment

The journey from infertility treatment to pregnancy is profound and filled with a mix of emotions and physical changes. Understanding what to expect after a positive pregnancy test can help you navigate this journey with more confidence and ease. Remember, it’s important to lean on the support of your healthcare providers, who can guide you through the unique aspects of your pregnancy, ensuring both your well-being and that of your developing baby. This new chapter, though challenging, is also filled with potential for joy and fulfilment as you move closer to meeting your child.