6.11 Understanding Chemical Pregnancy After Frozen Embryo Transfer in Surrogacy

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).

How Common Is a Chemical Pregnancy?

The likelihood of a chemical pregnancy varies based on factors such as embryo quality, maternal age, and whether preimplantation genetic testing (PGT-A) was performed.

In natural conception, chemical pregnancies account for 50–60% of all pregnancies, often occurring before a woman even realizes she is pregnant (National Institutes of Health [NIH], 2022).
In IVF and frozen embryo transfers (FET), the rate is 10–25% per transfer (American College of Obstetricians and Gynecologists [ACOG], 2023).
In gestational surrogacy, where surrogates are medically screened and implanted with high-quality embryos, the chemical pregnancy rate is typically lower, ranging from 10–20% per embryo transfer (Fertility and Sterility Journal, 2022).

How Is a Chemical Pregnancy Diagnosed?

After a frozen embryo transfer (FET), pregnancy is monitored closely to confirm implantation and viability. A chemical pregnancy is diagnosed based on:

✔ Initial Positive hCG Test – A surrogate’s beta hCG blood test, usually conducted 9–11 days post-transfer, confirms early pregnancy. A chemical pregnancy will still result in an initial positive pregnancy test (ASRM, 2023).

✔ Low or Declining hCG Levels – In a healthy pregnancy, hCG levels should double every 48 hours. In a chemical pregnancy, the levels either rise too slowly, plateau, or begin to drop instead of increasing as expected (Mayo Clinic, 2023).

✔ No Gestational Sac on Ultrasound – By 5–6 weeks of pregnancy, a viable pregnancy should show a gestational sac on ultrasound. If hCG levels drop before this stage, it confirms a chemical pregnancy (Fertility and Sterility Journal, 2022).

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.

What Causes a Chemical Pregnancy?

A chemical pregnancy is typically caused by embryo-related factors, such as:

Chromosomal Abnormalities – The most common cause, where the embryo has genetic defects preventing normal development (NIH, 2022).
Embryo Quality – Even with preimplantation genetic testing (PGT-A), not all embryos successfully implant and grow (Fertility and Sterility Journal, 2023).
Implantation Failure – The embryo may begin implanting but fail to fully attach to the uterine lining (Mayo Clinic, 2023).
Other Factors – Less commonly, hormonal imbalances, blood clotting disorders, or immune system responsescould contribute, though these are usually ruled out during surrogate screening (ACOG, 2023).

Understanding the Emotional Impact on Surrogates

At GSHC Surrogacy & Egg Donation, we understand that experiencing a chemical pregnancy can be frustrating and disheartening for surrogates. Many surrogates may feel a sense of disappointment or guilt, wondering if they did something wrong—but please know that this is not your fault.

A chemical pregnancy is almost always due to embryo quality or chromosomal factors, not the surrogate’s health or actions. You have followed all medical protocols and given this journey your best effort. It’s important to give yourself grace and allow space for emotional healing.

In most cases, a surrogate can proceed with another embryo transfer once her cycle resets, offering a renewed opportunity for success. Your dedication to helping intended parents build their family is truly invaluable.

What Happens Next?

If a gestational surrogate experiences a chemical pregnancy, the medical team will:

✔ Monitor hCG levels until they return to baseline.

✔ Assess the surrogate’s health to confirm she is physically ready for a future transfer.

✔ Review the embryo quality and history to determine the next steps for the intended parents.

In most cases, the surrogate can proceed with another embryo transfer once her cycle resets.

Final Thoughts: Moving Forward After a Chemical Pregnancy

A chemical pregnancy can be disappointing for both intended parents and surrogates, but it’s important to remember:

It does not indicate an issue with the surrogate mother’s health or ability to carry a pregnancy.
It is typically linked to embryo quality or chromosomal abnormalities.
Most surrogates can attempt another embryo transfer in a future cycle.

At GSHC Surrogacy & Egg Donation, we recognize that surrogacy requires patience, resilience, and expert support. Our experienced team collaborates with fertility specialists, surrogates, and intended parents to provide the highest level of medical guidance and emotional care.

By staying informed and working with a trusted surrogacy agency like GSHC, intended parents and surrogates can navigate challenges with confidence and hope.

📞 Are you considering surrogacy? Contact GSHC Surrogacy & Egg Donation today to learn more about our process and how we support surrogates at every stage.

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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