{"version":"1.0.0","segments":[{"startTime":0.815,"endTime":3.543,"body":"Today we talk about how a single HCG"},{"startTime":3.599,"endTime":6.095,"body":"test can predict the outcome of an IVA"},{"startTime":6.135,"endTime":8.935,"body":"pregnancy. Giving hope or setting"},{"startTime":9.015,"endTime":11.355,"body":"expectations right from the start."},{"startTime":12.375,"endTime":15.2,"body":"I'DOCTOR Mark Amols, and this"},{"startTime":15.54,"endTime":18.44,"body":"is Taco about Fertility Tuesday."},{"startTime":30.19,"endTime":33.094,"body":"When undergoing fertility treatments, the two week"},{"startTime":33.142,"endTime":35.702,"body":"wait to find out if you're pregnant can feel like an"},{"startTime":35.726,"endTime":38.47,"body":"eternity. But what if a single blood"},{"startTime":38.51,"endTime":41.43,"body":"test could give you a strong indication of whether"},{"startTime":41.47,"endTime":44.33,"body":"your pregnancy will continue or not?"},{"startTime":44.79,"endTime":47.702,"body":"Well, research has shown that ACG levels"},{"startTime":47.806,"endTime":50.438,"body":"at just 16 days after ovulation"},{"startTime":50.614,"endTime":53.118,"body":"can be a powerful predictor of success."},{"startTime":53.294,"endTime":56.254,"body":"And today we're going to dive into the science behind these"},{"startTime":56.302,"endTime":59.128,"body":"numbers. What do they really mean and how"},{"startTime":59.184,"endTime":61.86,"body":"can they guide your expectations?"},{"startTime":62.44,"endTime":65.104,"body":"Whether you're in the midst of an IVF cycle or just"},{"startTime":65.152,"endTime":67.88,"body":"curious about the science of early pregnancy, this"},{"startTime":67.92,"endTime":70.744,"body":"episode is for you. Now,"},{"startTime":70.792,"endTime":73.456,"body":"before we get into the nitty gritty of what"},{"startTime":73.528,"endTime":76.528,"body":"HCG levels mean, what let's talk about what"},{"startTime":76.544,"endTime":79.072,"body":"is the purpose of hcg?"},{"startTime":79.256,"endTime":82.136,"body":"I don't think you're going to be surprised that God didnt make"},{"startTime":82.168,"endTime":85.116,"body":"HCG just to use it as a pregnancy test."},{"startTime":85.268,"endTime":88.172,"body":"It's actually a very critical function in"},{"startTime":88.236,"endTime":90.836,"body":"early pregnancy. It'produced from the"},{"startTime":90.868,"endTime":92.636,"body":"placental cells, specifically the"},{"startTime":92.668,"endTime":95.588,"body":"syncyidiotrophopblastic cells, usually starting"},{"startTime":95.644,"endTime":97.924,"body":"around six to eight days post"},{"startTime":98.012,"endTime":100.396,"body":"fertilization. And the purpose of this"},{"startTime":100.428,"endTime":103.22,"body":"hormone is to mimic deuteenizing"},{"startTime":103.26,"endTime":105.996,"body":"hormone. And the purpose of"},{"startTime":106.028,"endTime":108.652,"body":"that is to keep the corpus luteum from"},{"startTime":108.676,"endTime":111.354,"body":"degrading. See, every month when you"},{"startTime":111.402,"endTime":114.018,"body":"ovulate, the sac that releases the"},{"startTime":114.034,"endTime":116.082,"body":"egg ends up producing"},{"startTime":116.146,"endTime":118.954,"body":"progesterone. And that sac"},{"startTime":119.042,"endTime":121.79,"body":"will stick around for approximately two weeks"},{"startTime":122.41,"endTime":125.298,"body":"and then it will degrade. And when it"},{"startTime":125.314,"endTime":128.242,"body":"degrades, thegestion levels will drop and that will"},{"startTime":128.266,"endTime":131.042,"body":"lead to IM menses. However, when you"},{"startTime":131.066,"endTime":133.698,"body":"get pregnant, you do not want it to drop,"},{"startTime":133.874,"endTime":136.82,"body":"otherwise you would lose the pregnancy. So to stop"},{"startTime":136.86,"endTime":139.452,"body":"the corpus luteum from degrading, the"},{"startTime":139.516,"endTime":142.356,"body":"placenta cells make 8 CG, which"},{"startTime":142.428,"endTime":145.252,"body":"looks like the hormone LH, which the body was"},{"startTime":145.276,"endTime":147.844,"body":"producing before to make the progesterone, but"},{"startTime":147.892,"endTime":150.684,"body":"now it's being produced by the baby. And"},{"startTime":150.732,"endTime":153.34,"body":"that keeps the corpus luteum from the gradating, which keeps"},{"startTime":153.38,"endTime":156.068,"body":"progestero levels up and keeps the pregnancy moving"},{"startTime":156.124,"endTime":158.492,"body":"forward. Essentially,"},{"startTime":158.676,"endTime":161.536,"body":"ACG rescues the corpus lutum,"},{"startTime":161.708,"endTime":164.432,"body":"allowing it to continue producing progesterone"},{"startTime":164.576,"endTime":167.552,"body":"until the placenta can take over around 8 to 10 weeks of"},{"startTime":167.576,"endTime":170.544,"body":"pregnancy. Prior to that point, it is"},{"startTime":170.592,"endTime":173.496,"body":"the corpus luteum that'producing all the progesterone needed"},{"startTime":173.528,"endTime":176.392,"body":"for the pregnancy, which is being run"},{"startTime":176.496,"endTime":178.792,"body":"by the HCG from the"},{"startTime":178.816,"endTime":181.464,"body":"synidiorophoblast of the placenta."},{"startTime":181.592,"endTime":184.272,"body":"This is very important when you start talking about bleeding and"},{"startTime":184.296,"endTime":186.99,"body":"pregnancy. When you get pregnant naturally,"},{"startTime":187.16,"endTime":189.882,"body":"if something goes wrong with the baby, then that means"},{"startTime":189.946,"endTime":192.938,"body":"HCG will not be produced by the placenta,"},{"startTime":193.074,"endTime":195.93,"body":"which will lead to a progesterone drop, which will then lead"},{"startTime":195.97,"endTime":198.39,"body":"to the pregnancy being lost and bleeding."},{"startTime":198.81,"endTime":201.21,"body":"But when you do fertility"},{"startTime":201.25,"endTime":203.906,"body":"treatment, sometimes you take progesterone"},{"startTime":204.098,"endTime":206.674,"body":"and that progesterone will be there"},{"startTime":206.722,"endTime":209.722,"body":"regardless if the pregnancy is doing well or not."},{"startTime":209.906,"endTime":212.77,"body":"Meaning the corpus luteum doesn't"},{"startTime":212.81,"endTime":215.574,"body":"need to have HCG to keep going. So if"},{"startTime":215.622,"endTime":218.262,"body":"something's wrong with a baby and the Hg levels"},{"startTime":218.366,"endTime":221.366,"body":"drop, there won't be a drop in the progesterone"},{"startTime":221.478,"endTime":224.23,"body":"triggering bleeding. Instead, you could"},{"startTime":224.31,"endTime":227.302,"body":"technically have a miscarriage and never know it without a drop of"},{"startTime":227.326,"endTime":229.726,"body":"blood because the progesterone you are"},{"startTime":229.758,"endTime":232.566,"body":"giving, it's what's protecting the pregnancy and"},{"startTime":232.598,"endTime":235.038,"body":"protecting you from bleeding. This is why some"},{"startTime":235.094,"endTime":237.782,"body":"miscarriages that occur infertility treatment"},{"startTime":237.966,"endTime":240.374,"body":"will occur without any bleeding at all."},{"startTime":240.542,"endTime":243.364,"body":"Overall, the point is, ACG is not"},{"startTime":243.412,"endTime":246.276,"body":"just a pregnancy marker. It's actually a signal"},{"startTime":246.428,"endTime":249.028,"body":"that rescues the corpus luteum to keep it alive"},{"startTime":249.164,"endTime":251.804,"body":"and sustain the pregnancy in the earliest weeks"},{"startTime":251.972,"endTime":254.74,"body":"until later when the placenta can be self"},{"startTime":254.78,"endTime":257.428,"body":"sufficient and produce all the progesterone needs by"},{"startTime":257.444,"endTime":260.396,"body":"itself. This is also the reason why when"},{"startTime":260.428,"endTime":263.284,"body":"you ovulate, whether you're doing a modified"},{"startTime":263.332,"endTime":266.292,"body":"natural FET or iui, you only need"},{"startTime":266.316,"endTime":269.164,"body":"to supplement the progesterone, which can be"},{"startTime":269.212,"endTime":272.044,"body":"vaginal versus when you'doing"},{"startTime":272.092,"endTime":274.996,"body":"a frozen embryo transfer and you're not ovulating,"},{"startTime":275.148,"endTime":277.988,"body":"you need to support the progesterone completely because"},{"startTime":278.004,"endTime":280.956,"body":"youe not supplementing, youre providing all of it."},{"startTime":281.148,"endTime":283.772,"body":"The idea for this podcast came from a"},{"startTime":283.796,"endTime":286.196,"body":"published article in the Journal of Fertility and"},{"startTime":286.228,"endTime":289.012,"body":"Sterility. It was volume 73,"},{"startTime":289.116,"endTime":292.028,"body":"issued two in February of 2000 and"},{"startTime":292.044,"endTime":294.22,"body":"it was titled Human Chorionic"},{"startTime":294.26,"endTime":296.818,"body":"Gnaturropin as a Predictor of Outcome"},{"startTime":296.964,"endTime":299.142,"body":"in Assisted Reproductive Technology."},{"startTime":299.206,"endTime":301.75,"body":"Pregnancies essentially can"},{"startTime":301.79,"endTime":304.63,"body":"HCG level tell us whether the pregnancy"},{"startTime":304.67,"endTime":307.502,"body":"has a better chance at to continue or to"},{"startTime":307.526,"endTime":310.014,"body":"not. So lets break down what the study did"},{"startTime":310.062,"endTime":312.934,"body":"show. It was a retrospective analysis"},{"startTime":312.982,"endTime":315.542,"body":"of 662 ART"},{"startTime":315.606,"endTime":318.07,"body":"pregnancies, meaning fertility treatment"},{"startTime":318.11,"endTime":320.886,"body":"pregnancies. Retrospective means"},{"startTime":320.998,"endTime":323.775,"body":"it wasnt done, prospectively where they had pregnancies and saw what"},{"startTime":323.799,"endTime":326.639,"body":"happened. Instead they looked back at data, of"},{"startTime":326.671,"endTime":329.399,"body":"prior prenies in the past and that's how they"},{"startTime":329.431,"endTime":332.375,"body":"analyzed the data. They measured ACG at"},{"startTime":332.399,"endTime":335.271,"body":"just one point, day 16 post"},{"startTime":335.327,"endTime":337.519,"body":"ovulation. This would"},{"startTime":337.551,"endTime":340.455,"body":"correspond to 10 days after an"},{"startTime":340.479,"endTime":343.231,"body":"embryo Transfer and the goal of the study was to"},{"startTime":343.247,"endTime":346.215,"body":"determine if a single HCG test could predict"},{"startTime":346.279,"endTime":349.073,"body":"pregnancy outcome. Now, this is important to understand."},{"startTime":349.241,"endTime":352.145,"body":"This does not mean that these things say"},{"startTime":352.177,"endTime":355.147,"body":"that your pregnancy will go good or go bad. It's just saying"},{"startTime":355.203,"endTime":357.971,"body":"if you only have one number, what would it"},{"startTime":357.995,"endTime":360.675,"body":"predict? So let's talk about the key findings."},{"startTime":360.827,"endTime":363.755,"body":"Essentially, when they looked at the EG level they broke up into"},{"startTime":363.787,"endTime":366.723,"body":"categories 25 to 50, 50"},{"startTime":366.771,"endTime":369.086,"body":"to 100, 100 to 200,"},{"startTime":369.215,"endTime":371.651,"body":"200 to 500, 500 to"},{"startTime":371.675,"endTime":374.587,"body":"1000 and greater than 1000. When"},{"startTime":374.603,"endTime":377.331,"body":"you were looking at the 25 to 50 international"},{"startTime":377.395,"endTime":380.143,"body":"units per liter, they found that the ongoing"},{"startTime":380.191,"endTime":382.559,"body":"pregnancy rate probability was less than"},{"startTime":382.599,"endTime":385.407,"body":"35% and that the miscarriage rate"},{"startTime":385.503,"endTime":387.659,"body":"was greater than 65%."},{"startTime":388.199,"endTime":390.767,"body":"When they looked at the 50 to 100"},{"startTime":390.903,"endTime":393.751,"body":"international units per liter, they found that"},{"startTime":393.775,"endTime":396.079,"body":"the ongoing princical rate was 35 to"},{"startTime":396.119,"endTime":398.975,"body":"64% and that the miscarriage"},{"startTime":399.007,"endTime":401.499,"body":"rate was 36 to 65%."},{"startTime":402.439,"endTime":405.391,"body":"When they looked at the 100 to 200 international units of"},{"startTime":405.415,"endTime":408.379,"body":"ACG per liter, they found that 64"},{"startTime":408.419,"endTime":410.971,"body":"to 80% of the pregnancies"},{"startTime":411.155,"endTime":413.747,"body":"had ongoing probability and that the"},{"startTime":413.763,"endTime":415.955,"body":"miscarri risk was down to 20 to"},{"startTime":415.987,"endTime":418.571,"body":"36%. When they looked at"},{"startTime":418.635,"endTime":421.32,"body":"200 to 500 international units per liter,"},{"startTime":421.78,"endTime":424.356,"body":"the ongoing pregnancy probability was 80 to"},{"startTime":424.388,"endTime":427.18,"body":"95%. And now the miscarriion rate was"},{"startTime":427.22,"endTime":430.068,"body":"only 5 to 20%. Now when they looked"},{"startTime":430.084,"endTime":432.884,"body":"at 500 international units to"},{"startTime":432.892,"endTime":435.22,"body":"1000 in that quarter"},{"startTime":435.34,"endTime":438.036,"body":"category, 95 to 100%"},{"startTime":438.228,"endTime":441.14,"body":"had ongoing pregnancies and the miscards"},{"startTime":441.18,"endTime":444.052,"body":"risk was only 0% to 5%. And when they"},{"startTime":444.076,"endTime":446.892,"body":"looked at people with over 1000 for that first"},{"startTime":447.036,"endTime":449.9,"body":"ACG level, 100% had ongoing"},{"startTime":449.94,"endTime":452.348,"body":"pregnancy rates and the miscary rate was"},{"startTime":452.404,"endTime":455.204,"body":"zero. So let's talk about what this means."},{"startTime":455.372,"endTime":458.356,"body":"Does this mean if your ECG is under 50"},{"startTime":458.548,"endTime":461.502,"body":"that you're not going to have a successful pregnancy? Not"},{"startTime":461.526,"endTime":464.51,"body":"at all. It's just saying statistically if you take a"},{"startTime":464.55,"endTime":466.83,"body":"group of people and you look at their Hg"},{"startTime":466.87,"endTime":469.782,"body":"levels and it's below"},{"startTime":469.846,"endTime":472.638,"body":"50, then the ongoing pregnancy rate"},{"startTime":472.734,"endTime":475.55,"body":"ends up dropping less than 50%. Specifically"},{"startTime":475.63,"endTime":478.598,"body":"under 35%. Now it's important to understand that"},{"startTime":478.654,"endTime":481.31,"body":"it has to be 16 days post"},{"startTime":481.35,"endTime":484.342,"body":"opvulation. If you do your ACG early, it's"},{"startTime":484.366,"endTime":487.246,"body":"going to be lower. If you put back two embryos, it"},{"startTime":487.278,"endTime":490.27,"body":"may be higher than expected. There are even some studies that"},{"startTime":490.31,"endTime":493.102,"body":"show that when you do PGT that"},{"startTime":493.166,"endTime":495.974,"body":"by biopsy the embryo you actually can lower the ACG"},{"startTime":496.022,"endTime":498.686,"body":"levels a little bit. It's also important to understand this is A"},{"startTime":498.718,"endTime":501.61,"body":"range they're not saying under 50."},{"startTime":501.99,"endTime":504.542,"body":"So what that means is that it could be"},{"startTime":504.686,"endTime":507.606,"body":"30, 40, 45 up to 50,"},{"startTime":507.605,"endTime":510.0,"body":"and there could be slight differences between those. But as A"},{"startTime":510.04,"endTime":512.416,"body":"group under 50 is under"},{"startTime":512.448,"endTime":515.262,"body":"35, although I don't have the data, I would"},{"startTime":515.456,"endTime":518.25,"body":"suspect if you were 48, it probably was"},{"startTime":518.29,"endTime":521.13,"body":"very similar to the group that was around 50. So"},{"startTime":521.17,"endTime":523.906,"body":"the largest takeaway from this is that if the ECG"},{"startTime":523.938,"endTime":526.842,"body":"is below 50 international units per"},{"startTime":526.866,"endTime":529.546,"body":"liter, the pry is highly"},{"startTime":529.578,"endTime":532.274,"body":"unlikely to continue. But that doesn't mean in your"},{"startTime":532.322,"endTime":535.258,"body":"specific situation it's just in general. But if"},{"startTime":535.274,"endTime":537.97,"body":"the ECG is above 500, the"},{"startTime":538.01,"endTime":540.414,"body":"chances of our ongoing preentancy is very"},{"startTime":540.462,"endTime":543.444,"body":"high. Now its'important to understand they didnt"},{"startTime":543.492,"endTime":546.252,"body":"look at things like doubling of the hcg,"},{"startTime":546.356,"endTime":549.22,"body":"they didn't look at progesterone levels. Fact they didn't even"},{"startTime":549.26,"endTime":552.228,"body":"factor in age as much. All of these things"},{"startTime":552.284,"endTime":554.86,"body":"can definitely factor. It doesnt matter if your first"},{"startTime":554.9,"endTime":557.284,"body":"ACG is 500. If it is"},{"startTime":557.332,"endTime":560.332,"body":"500 but its not doubling, something could"},{"startTime":560.356,"endTime":563.292,"body":"be wrong. The same thing. It was noted that women"},{"startTime":563.316,"endTime":566.052,"body":"who were over 40 years of age needed higher"},{"startTime":566.116,"endTime":569.108,"body":"Hg levels compared to their peers who"},{"startTime":569.124,"endTime":572.084,"body":"are younger than them to have the same probability of ongoing"},{"startTime":572.132,"endTime":575.059,"body":"pregnancy. Now as you can see, 50 to"},{"startTime":575.099,"endTime":578.091,"body":"500 is a very wide range. Most people"},{"startTime":578.155,"endTime":580.675,"body":"don't fall into that. Most people might be"},{"startTime":580.787,"endTime":583.275,"body":"100, maybe they're 300."},{"startTime":583.467,"endTime":586.427,"body":"The reason they chose such wide points"},{"startTime":586.483,"endTime":589.235,"body":"is because then they could show that at the"},{"startTime":589.267,"endTime":592.019,"body":"extreme sides there is some major"},{"startTime":592.059,"endTime":594.955,"body":"difference. The other point to consider is whether"},{"startTime":594.987,"endTime":597.851,"body":"you did pgta not just is the"},{"startTime":597.875,"endTime":600.355,"body":"ECG level going to be lower, but we also know the"},{"startTime":600.387,"endTime":603.235,"body":"miscarriage risk is going to be lower. Like"},{"startTime":603.267,"endTime":605.955,"body":"all studies, you have to evaluate whether it"},{"startTime":605.987,"endTime":608.499,"body":"had strength and where the weaknesses"},{"startTime":608.539,"endTime":611.279,"body":"were. In this study there were some good things."},{"startTime":611.659,"endTime":614.411,"body":"For example, the sample size was good"},{"startTime":614.555,"endTime":617.555,"body":"at 662 pregnancies. Additionally, I"},{"startTime":617.587,"endTime":620.379,"body":"like the fact that they standardized the timing of the bloodshot"},{"startTime":620.499,"endTime":622.943,"body":"at 16 days post ovulation."},{"startTime":623.131,"endTime":626.111,"body":"This ensures consistency. So when we're comparing apples to"},{"startTime":626.135,"endTime":628.823,"body":"apples, I also like the idea that it was"},{"startTime":628.871,"endTime":631.623,"body":"broad and the fact that it wasn't just IVF but also"},{"startTime":631.671,"endTime":634.023,"body":"IUIs. And they also used logistic"},{"startTime":634.071,"endTime":637.023,"body":"regression. That was a strong statistical method"},{"startTime":637.071,"endTime":639.999,"body":"for binary outcomes, which helped support their claims."},{"startTime":640.119,"endTime":642.375,"body":"Now the limitations of the study is the fact that it was"},{"startTime":642.407,"endTime":645.151,"body":"retrospective, meaning it wasn't randomized."},{"startTime":645.255,"endTime":648.119,"body":"So there's the potential for selection bias. They"},{"startTime":648.159,"endTime":650.815,"body":"also did analyze ECG doubling rates"},{"startTime":650.887,"endTime":653.821,"body":"which is another important factor and I feel could"},{"startTime":653.845,"endTime":656.661,"body":"definitely affect the results. They also didn't"},{"startTime":656.725,"endTime":659.157,"body":"Control for confounders like the embryo quality"},{"startTime":659.253,"endTime":662.165,"body":"or PGT or underlying"},{"startTime":662.197,"endTime":665.149,"body":"fertility conditions that may affect it as well. The other thing"},{"startTime":665.189,"endTime":667.957,"body":"was during the study they did change the ACG"},{"startTime":668.013,"endTime":670.349,"body":"testing method, which may cause some"},{"startTime":670.429,"endTime":673.194,"body":"inconsistency. Overall, I, give the study a"},{"startTime":673.226,"endTime":676.1,"body":"B. Clinically useful, but not the gold"},{"startTime":676.156,"endTime":678.612,"body":"standard when it comes to studies. I would love to see a"},{"startTime":678.652,"endTime":681.484,"body":"prospective randomized study and maybe confirm some of the"},{"startTime":681.508,"endTime":684.47,"body":"confounders that could be affecting it. But understand why"},{"startTime":684.486,"endTime":687.422,"body":"they didn't do that because it wasn't large than enough sample size"},{"startTime":687.462,"endTime":690.43,"body":"to be able to add all those other things. So the"},{"startTime":690.446,"endTime":693.414,"body":"most important question for you is how can you use"},{"startTime":693.438,"endTime":696.414,"body":"this data? I think overall it can just help"},{"startTime":696.518,"endTime":699.438,"body":"with your expectations. In the end, always talk"},{"startTime":699.47,"endTime":702.11,"body":"to your doctor because they're going to look at things"},{"startTime":702.166,"endTime":705.086,"body":"like if the ACG is doubling and also look at your"},{"startTime":705.134,"endTime":708.07,"body":"situation. Someone who has s never had a miscarriage or someone who"},{"startTime":708.086,"endTime":710.936,"body":"has had multiple miscarriages, we're going to have different"},{"startTime":711.024,"endTime":713.696,"body":"expectations. And I'm not going to rely on just a"},{"startTime":713.744,"endTime":716.656,"body":"number. At our clinic, we tell people as long as it's"},{"startTime":716.704,"endTime":719.68,"body":"50, we feel pretty good. Now that doesn't mean if"},{"startTime":719.696,"endTime":722.464,"body":"I see 200, I don't feel good too."},{"startTime":722.568,"endTime":725.212,"body":"But I also don't feel amazing because it's higher."},{"startTime":725.552,"endTime":728.448,"body":"They use a very high cutoff rate for showing things"},{"startTime":728.48,"endTime":731.32,"body":"are great. But in reality that's not a number most people"},{"startTime":731.376,"endTime":734.072,"body":"get. It's like saying, well, if you play"},{"startTime":734.112,"endTime":736.856,"body":"basketball and youre 6 foot, youre going to do"},{"startTime":736.904,"endTime":739.862,"body":"very well, but if you're 10ft"},{"startTime":739.902,"endTime":742.814,"body":"tall, well then you're going to definitely do well. Well, that's"},{"startTime":742.838,"endTime":745.782,"body":"a very extreme height and so sure it's going to"},{"startTime":745.862,"endTime":748.414,"body":"give you a high probabilityability of"},{"startTime":748.478,"endTime":751.446,"body":"success, but it's not very reasonable. And that's what"},{"startTime":751.454,"endTime":754.246,"body":"I felt with a study. 500 is not a very common"},{"startTime":754.294,"endTime":757.27,"body":"number. People say on their first ACG level. If"},{"startTime":757.286,"endTime":759.798,"body":"you really want to know how things are going, you look at the doubling"},{"startTime":759.83,"endTime":762.79,"body":"rate, you look at the initial hcg and you look"},{"startTime":762.806,"endTime":765.248,"body":"at other factors like the quality of the embryo."},{"startTime":765.43,"endTime":768.42,"body":"And also if they did pgta, no matter what,"},{"startTime":768.476,"endTime":770.82,"body":"you always want to repeat the"},{"startTime":770.836,"endTime":773.66,"body":"acg. At our clinic, we even now check"},{"startTime":773.676,"endTime":775.932,"body":"it a third time. So we don't even just look for"},{"startTime":775.972,"endTime":778.844,"body":"doubling, but we check a third time. And that's because when we"},{"startTime":778.868,"endTime":781.684,"body":"first started we would just do the first two"},{"startTime":781.708,"endTime":784.612,"body":"ACGs as long as they doubled. We would set everyone up"},{"startTime":784.652,"endTime":787.612,"body":"for an OB scan and about 1%"},{"startTime":787.652,"endTime":790.484,"body":"of the time or less, we would start seeing people come in and there'd be"},{"startTime":790.508,"endTime":793.362,"body":"no baby in the uterus. So after that"},{"startTime":793.442,"endTime":796.066,"body":"we then add it to a third test. And after doing"},{"startTime":796.114,"endTime":798.914,"body":"that, we rarely ever see someone come"},{"startTime":798.938,"endTime":801.69,"body":"in and not see a pregnancy in the uterus. And"},{"startTime":801.706,"endTime":804.682,"body":"that's because we now know with three"},{"startTime":804.722,"endTime":807.65,"body":"data points it's very unlikely that it's just"},{"startTime":807.666,"endTime":810.65,"body":"going to be a chemical miscarriage. So Does"},{"startTime":810.666,"endTime":813.222,"body":"a low H.G. always be miscarriage?"},{"startTime":813.562,"endTime":816.45,"body":"Not always. But if there is an increased"},{"startTime":816.506,"endTime":819.406,"body":"risk, can a high HCG level predict"},{"startTime":819.454,"endTime":822.438,"body":"twins? Yeah, sometimes it can, but"},{"startTime":822.51,"endTime":825.43,"body":"it's not definitive. And can this test"},{"startTime":825.486,"endTime":828.398,"body":"guarantee in a healthy pregnancy? Well, the answer to that"},{"startTime":828.43,"endTime":830.79,"body":"is no. It only predicts the"},{"startTime":830.846,"endTime":833.814,"body":"likelihood, not the viability. Think"},{"startTime":833.838,"endTime":835.838,"body":"of it as an OD predictor."},{"startTime":836.03,"endTime":838.802,"body":"Overall, use this study"},{"startTime":839.302,"endTime":842.15,"body":"to help you predict the success of the"},{"startTime":842.166,"endTime":844.858,"body":"pregnancy. Understand that"},{"startTime":845.01,"endTime":847.738,"body":"ACCG is more than just a test, it a"},{"startTime":847.77,"endTime":850.61,"body":"lifeline of the early pregnancy. And although the"},{"startTime":850.666,"endTime":853.098,"body":"single number that you get 16 days post"},{"startTime":853.13,"endTime":855.834,"body":"opvulation may be a strong predictor,"},{"startTime":855.938,"endTime":858.594,"body":"but the best way to predict is by looking at"},{"startTime":858.658,"endTime":861.538,"body":"doubling levels, talking to your doctor so they can take"},{"startTime":861.57,"endTime":864.394,"body":"the whole picture and put that together to really give"},{"startTime":864.418,"endTime":867.242,"body":"you the right expectations. If you found"},{"startTime":867.282,"endTime":869.754,"body":"this episode helpful, share with someone going through"},{"startTime":869.778,"endTime":872.706,"body":"ivf, maybe some fertility treatment. If"},{"startTime":872.714,"endTime":875.698,"body":"you have questions about the hcg, reach out"},{"startTime":875.81,"endTime":878.114,"body":"to your doctor and ask them."},{"startTime":878.298,"endTime":880.542,"body":"Fertility is a very stressful"},{"startTime":880.842,"endTime":883.698,"body":"journey and hopefully this episode"},{"startTime":883.81,"endTime":886.594,"body":"will help you feel a little bit more comfortable. When you see the"},{"startTime":886.618,"endTime":889.21,"body":"HCG level, don't be worried if"},{"startTime":889.226,"endTime":892.122,"body":"it'not 500 above. Again, that's not"},{"startTime":892.162,"endTime":895.074,"body":"very common. They picked that number because it was"},{"startTime":895.098,"endTime":897.626,"body":"able to then say oh look, these all do very"},{"startTime":897.674,"endTime":900.528,"body":"well but in reality most people will not be at"},{"startTime":900.56,"endTime":903.28,"body":"500, but most are usually above"},{"startTime":903.336,"endTime":906.224,"body":"100. And what the study showed was that if"},{"startTime":906.248,"endTime":908.952,"body":"youre above 100 youre looking at"},{"startTime":908.992,"endTime":911.76,"body":"an 80% chance of potentially"},{"startTime":911.816,"endTime":914.732,"body":"having a successful pregnancy."},{"startTime":915.312,"endTime":918.28,"body":"As always, if you like this podcast please tell"},{"startTime":918.296,"endTime":921.184,"body":"us about it. We really like to hear that. Tell your friends"},{"startTime":921.248,"endTime":924.048,"body":"about it and as always, give a five star review on your favorite"},{"startTime":924.08,"endTime":926.816,"body":"medium. The most important thing is to keep coming"},{"startTime":926.864,"endTime":929.834,"body":"back. I look forward to talking you again next week on"},{"startTime":930.008,"endTime":931.582,"body":"Taco Belt Fertility Tuesday."}]}