6.10 Understanding Chemical Pregnancy After Frozen Embryo Transfer in Surrogacy

1. What Is a Chemical Pregnancy?

A chemical pregnancy is an early pregnancy loss that occurs shortly after implantation. In the context of gestational surrogacy, this means that the embryo successfully implants in the surrogate mother’s uterus, but the pregnancy does not progress beyond the initial stages.

Unlike a clinical pregnancy, where an ultrasound confirms a gestational sac, a chemical pregnancy is detected only through blood tests measuring hCG levels (the hormone produced during pregnancy). The pregnancy ends before a fetal heartbeat can be seen on an ultrasound (American Society for Reproductive Medicine [ASRM], 2023).

2. How Common Is a Chemical Pregnancy?

Chemical pregnancies are more common than most people think, though rates vary depending on several factors like embryo quality, maternal age, and whether preimplantation genetic testing (PGT-A) was used.

In natural conception, chemical pregnancies make up about 50–60% of all early losses, often before a woman knows she’s pregnant (National Institutes of Health [NIH], 2022).
In IVF and frozen embryo transfers (FET), the rate is about 10–25% per transfer (American College of Obstetricians and Gynecologists [ACOG], 2023).
In gestational surrogacy, where surrogates are carefully screened and high-quality embryos are often used, the rate is slightly lower—around 10–20% per transfer (Fertility and Sterility Journal, 2022).

3. How Is a Chemical Pregnancy Diagnosed?

After a frozen embryo transfer (FET), pregnancy is closely monitored through blood tests and ultrasounds. A chemical pregnancy is typically identified in three stages. First, a beta hCG blood test—usually done 9 to 11 days after transfer—shows a positive result, confirming that implantation began (ASRM, 2023). In a healthy pregnancy, hCG levels should double every 48 hours. In a chemical pregnancy, those levels may rise too slowly, plateau, or begin to decline instead of increasing as expected (Mayo Clinic, 2023). Finally, by around 5 to 6 weeks, a normal pregnancy would show a gestational sac on ultrasound. If hCG levels drop before that point and no sac is seen, it confirms the pregnancy has ended early (Fertility and Sterility Journal, 2022).

4. Does a Chemical Pregnancy Indicate an Issue with the Surrogate Mother?

One of the most common concerns following a chemical pregnancy is whether it indicates a problem with the surrogate mother’s health or fertility. However, it is essential to understand:

A chemical pregnancy does NOT mean something is wrong with the surrogate.

Surrogates undergo extensive medical screening before embryo transfer, including uterine evaluations, hormone level testing, and overall reproductive health assessments. If a surrogate has been medically cleared, her uterus is considered healthy and capable of carrying a pregnancy (ASRM, 2023).

In most cases, a chemical pregnancy is linked to embryo quality, rather than the surrogate’s ability to carry a pregnancy.

5. What Causes a Chemical Pregnancy?

The most common reason for a chemical pregnancy is a chromosomal issue in the embryo that prevents it from developing properly. Even with advanced testing like PGT-A, not every embryo will lead to a healthy pregnancy.

Other possible causes include:

Embryo quality or abnormalities
Implantation that begins but doesn’t fully complete
Rarely, underlying medical issues like clotting disorders or hormonal imbalances—though these are usually ruled out during surrogate screening

In most cases, no exact cause can be pinpointed. It’s simply a part of the IVF process that can occasionally happen, even when everything is done right.

6. Emotional Impact on Surrogates

Even though chemical pregnancies are common, that doesn’t make them easy. Many surrogates feel a mix of sadness, guilt, or frustration—especially after investing so much emotionally and physically in the process.

If you’re feeling this way, you’re not alone—and it’s important to remember: you did everything right. This outcome is not your fault. You followed your medical protocols, showed up with care and commitment, and gave the embryo a real chance.

It’s okay to grieve or take time to process the experience. And if you’re ready, most surrogates are able to try again in a future cycle after their body resets.

Your effort and heart in this journey truly matter—and they are deeply appreciated.

7. What Happens Next?

If a chemical pregnancy is confirmed, the fertility team will:

Monitor your hCG levels until they return to baseline
Check in to make sure you’re feeling physically well and ready for another cycle
Meet with the intended parents to discuss the embryo history and next steps

In most cases, the surrogate can move forward with another transfer once her body is ready—usually after a normal menstrual cycle returns.

8. Moving Forward After a Chemical Pregnancy

Chemical pregnancies can be disappointing for both surrogates and intended parents, but they don’t mean the journey has to end here. Most surrogates are able to try again, and many go on to have successful pregnancies.

What’s important to remember:

A chemical pregnancy does not mean something is wrong with the surrogate’s body
It’s usually related to embryo quality or genetic issues, not anything within your control
You can try again—and often with success

At GSHC Surrogacy & Egg Donation, we’re here to support you not only medically, but emotionally. We know how much love, time, and effort goes into each journey—and we’ll walk with you through every step, every outcome, and every new beginning.

If you’re ever unsure about next steps, or just need someone to talk to, we’re here. You're not doing this alone.

References

American Society for Reproductive Medicine (ASRM). (2023). Understanding Early Pregnancy Loss in IVF.
National Institutes of Health (NIH). (2022). Chemical Pregnancy and Implantation Failure.
American College of Obstetricians and Gynecologists (ACOG). (2023). Recurrent Pregnancy Loss: Causes and Treatment.
Fertility and Sterility Journal. (2022). Impact of Embryo Quality on IVF Success Rates.
Mayo Clinic. (2023). Pregnancy Loss: Causes and Next Steps.

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