| Summary: | Objective: To report a very rare case of live birth with unexpectedly low serum hCG level on day 11 after blastocyst embryo transfer. Design: Case report. Setting: Private infertility center. Patient(s): A 30-year-old nulliparous woman presented with PCOS and 1 year of infertility. Interventions(s): Conventional IVF was scheduled and a long-acting agonist protocol was selected. Main Outcome Measure(s): Maternal serum hCG levels and transvaginal ultrasound exams for the embryo’s well-being. Result(s): The hCG level was 11.6 IU/L on day 11 after the transfer of two blastocyst embryos, which was considered as either failing or extrauterine pregnancy. After blood titration, there were delayed hCG increases. A series of transvaginal ultrasounds also indicated a delayed but normal-appearing intrauterine pregnancy. A healthy baby boy was delivered at term by means of cesarean section. Conclusion(s): A low initial serum hCG level may be associated with certain maternal or fetal characteristics and IVF treatment variables. Close conservative observation is warranted before undertaking any therapeutic intervention.
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