You took the test. The line is real, or you suspect it is, and your next move is to pick up the phone and tell the clinic that helped you get here. Telling your RE you're pregnant is short on script and long on what comes next. You want a schedule, and a calendar of what they will do. That is what this post is for.
Telling your RE you're pregnant: when to call the clinic
Call the morning after your first positive home test. Most reproductive endocrinologists (REs) want to know early so they can schedule the beta hCG draw, protect your medication continuity, and book the first scan. There is no benefit to waiting until the missed period passes, and no benefit to waiting until the line darkens further. The line is information they can act on today.
The script is short. "I had a positive home test [X] days post-transfer," or "post-trigger," or "post-IUI." "When would you like me to come in for a beta?" That is enough. The clinic will tell you the date and time for the first draw, whether to fast, and what to do about your medications between now and then.
If you have already been discharged from the RE and conceived spontaneously in a treatment-free month, still tell them. Many fertility clinics will provide first-trimester monitoring on a courtesy basis for previous patients, especially if you have a history of loss or recurrent miscarriage. If the clinic declines and refers you back to your GP, that referral is appropriate. Your GP will then order the same beta, just on a slightly different timeline.
Weekends and holidays are not a reason to wait. REs keep a nurse on call for exactly this kind of contact. The threshold for an out-of-hours call is straightforward: pain, bleeding, dizziness, or shoulder-tip pain alongside a positive test gets a same-day call, not a Monday-morning one4,5.
The standard RE monitoring sequence
Most fertility clinics follow a recognisable sequence in early pregnancy. The timing is built around two priorities: catching low or non-doubling hCG early, and catching ectopic pregnancy before it becomes an emergency.
Beta number one: drawn 9 to 14 days after the event that started the count. Roughly 9 days after a day-5 blastocyst transfer. Around 9 days after a day-3 cleavage-stage transfer. About 14 days after an hCG trigger in a timed-intercourse or IUI cycle1. The exact day depends on your clinic, but most are within this window.
Beta number two: drawn 48 hours after the first. The clinician is reading the trend, not the number. The Barnhart curves redefined the minimum rise for a viable intrauterine pregnancy as 53 percent in 48 hours, which is well below the often-quoted "must double" rule2. A rise of 53 to 100 percent over 48 hours is consistent with an ongoing intrauterine pregnancy. Slower rises warrant closer monitoring; faster rises are common with multiples but not diagnostic.
Beta number three (sometimes): some clinics draw a third beta 48 to 72 hours after the second, particularly if the first two were borderline or if there is a history of loss. Some skip directly to ultrasound. Both protocols are valid.
First ultrasound: booked between 6 weeks 0 days and 7 weeks 0 days gestational age. The scan confirms intrauterine location, the gestational sac, yolk sac, fetal pole, and cardiac activity3.
Follow-up ultrasound: usually one to two weeks after the first, around 8 to 9 weeks, before discharge to the OB.
If you have a clear timeline in front of you, the wait between draws and between scans becomes a known quantity rather than an open-ended dread. Write the dates on a calendar the moment your clinic gives them to you.
When should you get your first ultrasound in pregnancy after fertility treatment
Standard general-obstetrics practice books a dating ultrasound between 8 and 12 weeks for someone who conceived spontaneously3. Fertility clinics scan earlier, between 6 and 7 weeks. The difference is not arbitrary. There are three reasons the earlier scan is the standard in pregnancy after infertility (PAI).
First, the dating is more accurate. After fertility treatment, the clinic knows the exact day of trigger, retrieval, or transfer. Gestational age is calculated forward from that known point rather than estimated backwards from a last menstrual period. By 6 to 7 weeks, the ultrasound landmarks are visible enough to confirm the dating that the clinic has already calculated.
Second, the earlier scan rules out ectopic pregnancy. The rate of ectopic pregnancy after IVF is higher than after spontaneous conception, and visualising an intrauterine sac at 6 to 7 weeks confirms that the pregnancy is in the right place4,5. This is one of the most important reasons your RE will not let you wait until 8 to 12 weeks for the first scan.
Third, the emotional cost of unmonitored waiting after fertility treatment is high. The Boyd 2014 paper on PAI psychological burden documents the surveillance pattern that develops across the first trimester and the value of early reassurance scans in managing it. The 6-to-7 week scan is doing clinical work and emotional work at the same time.
The scan is looking for specific structures. Gestational sac, visible by about 5 weeks. Yolk sac, visible by about 5.5 weeks. Fetal pole, visible by 6 weeks. Cardiac activity, usually present by 6 to 6.5 weeks. The Doubilet criteria define when the absence of these structures is diagnostic of a nonviable pregnancy versus a "too early to see" scan3. Those criteria are why your RE may book a repeat scan one week later rather than make a final call on day one if anything is borderline.
The scan will almost certainly be transvaginal at this stage. At 6 weeks the uterus is still small and an abdominal probe cannot see clearly. The transvaginal probe sits closer to the uterus and produces a much sharper image. It is uncomfortable but not painful.
Medications: what to keep taking, and why
This is the section I would put on a fridge magnet for every patient who has just had a positive test.
Progesterone: intramuscular injections (PIO), vaginal suppositories like Crinone or Endometrin, or oral progesterone, you continue on your existing schedule until your RE tells you to stop. For most FET cycles, progesterone continues to around 10 to 12 weeks of gestation, when the placenta takes over hormonal support1. Do not skip a dose because "now that I am pregnant my body can take over." That is not how the timing works in an FET cycle. The placenta is not producing enough progesterone to support the pregnancy until the very end of the first trimester.
Estrogen: patches or oral estradiol for programmed FET cycles continue per protocol, typically until the same window when progesterone tapers.
Aspirin 81 mg, metformin, thyroid medication: continue unless your RE specifically tells you otherwise. None of these should be stopped on your own.
Why stopping suddenly is dangerous: progesterone withdrawal can cause bleeding. In early pregnancy that bleeding can look exactly like a loss, send you for an urgent scan, and put you through hours of fear for a pregnancy that was fine until you stopped your medication. The reflex that says "I am pregnant now, so I should let the body take over" is one of the most common and most avoidable causes of unnecessary panic in the first 48 hours.
What the RE will, and will not, tell you
Your RE will tell you the beta number, the doubling pattern, what the ultrasound shows, when to come back, and what to call them about. They will tell you whether your numbers are within the expected range for your days post-trigger or post-transfer. They will give you statistical reassurance.
Your RE will not tell you that everything will be fine. They cannot. A first-trimester pregnancy after infertility is statistically more likely to end in a live birth than to end in loss, but no clinician can give you certainty in the first weeks. What they can give you is monitoring, which is the only useful thing anyone has at this stage.
It is okay to ask for the actual number, not just "it is rising." Write the number down each time. It is okay to ask whether your number is "expected" for your days post-ovulation or post-transfer. Your RE knows the reference range for their lab and will tell you where you sit in it.
It is also okay to push back, gently, on a clinic that withholds information. Your records are yours.
What to do, and not do, this week
Do confirm your medication schedule with the nurse on the call. Do drink water before the beta draw, which makes the venous draw easier. Do write down every beta number, the date and time of each draw, and the date of the next scan.
Do tell the clinic about any spotting, any cramping that feels different from what you expect, and any one-sided pain. Spotting alone, especially after a transfer, is usually not concerning. Spotting plus pain is a phone call.
Do not stop your progesterone or estrogen on your own.
Do not compare your beta to a stranger's number online. Lab assays vary between labs. Reference ranges vary between clinics. A number that is "low" in one clinic's chart may be perfectly within range in another. Your clinic's reference range is the one that matters.
Do not schedule social events around the first scan window. Most people in pregnancy after infertility want privacy that day, and you cannot predict in advance whether you will want to talk to anyone after the appointment. Block the day. You can always uncancel. Telling your RE you're pregnant starts a calendar; the rest of the first trimester runs on the dates they hand you.
What's next
- If beta one and beta two show appropriate rise, the next reads are interpreting beta hCG doubling time and what to expect at your first pregnancy ultrasound.
- If the beta is borderline, falling, or you are seeing spotting that feels concerning, see low beta hCG: when to worry and the companion on chemical pregnancy.
- If the first scan is reassuring and you are looking ahead to the OB handoff, see graduating from your RE to an OB.
Related in this cluster
Sources
- ASRM Practice Committee of the American Society for Reproductive Medicine. Performing the embryo transfer: a guideline. Fertility and Sterility 2017;107(4):882-896. Link
- Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstetrics & Gynecology 2004;104(1):50-55. Link
- American College of Obstetricians and Gynecologists. Committee Opinion No. 700: Methods for estimating the due date. Obstetrics & Gynecology 2017;129(5):e150-e154. Link
- National Institute for Health and Care Excellence. NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management. 2019; updated 2023. Link
- Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 21: Diagnosis and management of ectopic pregnancy. 2016. Link
Common questions
When should I call my RE after a positive home pregnancy test?
Call the morning after your first positive home test. Most reproductive endocrinologists want to know early so they can schedule the beta hCG draw, protect your medication continuity, and book the first scan. There is no benefit to waiting until the missed period passes or until the line darkens. Weekends and holidays are not a reason to wait, since REs keep a nurse on call.
When is the first beta hCG drawn, and how much should it rise?
The first beta is drawn 9 to 14 days after the event that started the count, and the second is drawn 48 hours later. The clinician reads the trend, not the single number. The Barnhart curves set the minimum rise for a viable intrauterine pregnancy at 53 percent in 48 hours, well below the often-quoted must-double rule. A rise of 53 to 100 percent over 48 hours is consistent with an ongoing pregnancy.
When should I get my first ultrasound in pregnancy after fertility treatment?
Fertility clinics book the first scan between 6 weeks 0 days and 7 weeks 0 days, earlier than the 8 to 12 week dating scan used for spontaneous conception. The earlier scan confirms accurate dating from the known trigger or transfer date, rules out ectopic pregnancy, and provides early reassurance. The scan is almost certainly transvaginal at this stage, which is uncomfortable but not painful.
Should I stop my progesterone once I get a positive test?
No. Continue progesterone, estrogen, and other medications on your existing schedule until your RE tells you to stop. For most FET cycles, progesterone continues to around 10 to 12 weeks, when the placenta takes over hormonal support. Stopping suddenly can cause progesterone withdrawal bleeding that looks exactly like a loss and sends you for an urgent scan.
Why should I not compare my beta hCG number to numbers I see online?
Lab assays vary between labs and reference ranges vary between clinics, so a number that looks low in one clinic's chart may be perfectly within range in another. Your clinic's reference range is the only one that applies to you. Ask your RE whether your number is expected for your days post-trigger or post-transfer, and write each number down.