What is the next course of action after a positive beta hCG (human chorionic gonadotropin) test following a frozen embryo transfer (FET) while on progesterone (Inj. Susten), estrogen (Tab. Progynova), and other medications?

Post-FET Management with Positive Beta-hCG

Continue all current medications (progesterone, estrogen, aspirin, wysolone, and HCG) until ultrasound confirmation of viable intrauterine pregnancy at approximately 6-7 weeks gestational age, then continue luteal support for an additional 1-3 weeks before gradual discontinuation. 1

Immediate Next Steps

Schedule Ultrasound Confirmation

• Perform transvaginal ultrasound approximately 4 weeks after embryo transfer to confirm viable intrauterine pregnancy with fetal cardiac activity 1
• This timing is critical to rule out ectopic pregnancy and confirm appropriate pregnancy location before making medication adjustments 1

Continue Current Medication Regimen

• Maintain all progesterone supplementation (Inj. Susten 100mg IM daily, Susten 400mg PV, Tab. Duphaston 10mg daily) without modification until ultrasound confirmation 1
• Continue Tab. Progynova 2mg BD (estrogen support) at current dose 1
• Continue Tab. Ecospirin 75mg (low-dose aspirin) as prescribed
• Continue Tab. Wysolone 5mg BD (corticosteroid) as prescribed
• Continue Inj. HCG 5000 IU every third day until ultrasound confirmation 1

Duration of Luteal Support After Pregnancy Confirmation

Evidence-Based Timing for Medication Discontinuation

Once viable intrauterine pregnancy is confirmed by ultrasound:

• Continue luteal support for 1-3 additional weeks after ultrasound confirmation in frozen embryo transfer cycles 1
• For artificial cycles (which appears to be your case given the estrogen supplementation), continue both estrogen and progesterone at original doses for 3-4 weeks after ultrasound confirmation 1
• Then gradually reduce dosage over 2 weeks to complete discontinuation 1

Rationale for Continued Support

The current evidence demonstrates that early cessation of progesterone after positive beta-hCG does not compromise pregnancy outcomes in standard IVF cycles 2, 3, 4. However, your patient is on an artificial cycle protocol with exogenous estrogen, which requires longer support duration 1.

Medication-Specific Guidance

Progesterone Supplementation

• Your patient is receiving triple progesterone therapy (intramuscular, vaginal, and oral dydrogesterone), which provides robust luteal support
• This combination ensures adequate endometrial support and pregnancy maintenance 1
• Do not discontinue progesterone prematurely - wait for ultrasound confirmation plus the additional 3-4 weeks as specified above 1

Estrogen (Progynova) Management

• Continue estrogen supplementation in parallel with progesterone throughout the support period 1
• In artificial FET cycles, the corpus luteum is not producing endogenous hormones, making exogenous support essential 1
• Taper estrogen simultaneously with progesterone during the discontinuation phase 1

HCG Injections

• HCG 5000 IU every third day can be discontinued after ultrasound confirmation of viable pregnancy 1
• The corpus luteum will be adequately stimulated by endogenous HCG from the developing pregnancy at that point

Aspirin and Corticosteroids

• Continue aspirin and wysolone as prescribed - these are typically continued based on specific maternal indications (likely for immunologic or thrombophilic factors)
• Duration should be determined by the indication for which they were prescribed

Monitoring Protocol

Serial Beta-hCG Monitoring

• Obtain repeat beta-hCG 48 hours after initial positive test to confirm appropriate doubling 3
• Appropriately rising beta-hCG levels (doubling every 48-72 hours) indicate viable early pregnancy 3, 5
• Beta-hCG levels should exceed 1,000-1,500 mIU/mL before ultrasound to ensure intrauterine gestational sac visibility 1

Ultrasound Timing

• First ultrasound at 6-7 weeks gestational age (approximately 4 weeks post-transfer for blastocyst transfer) 1
• Confirm intrauterine location, gestational sac, yolk sac, and fetal cardiac activity 1
• Rule out ectopic pregnancy, which occurs in approximately 1-2% of IVF pregnancies 1

Common Pitfalls to Avoid

Do Not Stop Medications Prematurely

• The most critical error is discontinuing luteal support immediately after positive beta-hCG 1
• While some evidence suggests early cessation is safe in natural or stimulated cycles 2, 3, 4, artificial FET cycles require extended support 1
• Your patient's artificial cycle protocol mandates continuation until 9-10 weeks gestational age 1

Do Not Reduce Doses Before Ultrasound Confirmation

• Maintain full therapeutic doses until viable intrauterine pregnancy is confirmed 1
• Premature dose reduction risks pregnancy loss, particularly in artificial cycles 1

Monitor for Ectopic Pregnancy

• Any patient with positive beta-hCG and abdominal pain requires urgent evaluation 1
• Beta-hCG levels below expected for gestational age or plateauing values raise concern for ectopic pregnancy 1
• Progesterone levels <15 ng/mL suggest abnormal pregnancy (ectopic or nonviable intrauterine) 5

Summary Algorithm

1. Continue all current medications unchanged until ultrasound at 6-7 weeks 1
2. Obtain repeat beta-hCG at 48 hours to confirm doubling 3
3. Schedule ultrasound at 6-7 weeks gestational age to confirm viable intrauterine pregnancy 1
4. After ultrasound confirmation, continue medications for 3-4 additional weeks at full doses 1
5. Then taper estrogen and progesterone over 2 weeks to complete discontinuation 1
6. Total duration: approximately 9-10 weeks gestational age for medication discontinuation in artificial FET cycles 1