PUPO is a infertility phenomenon.  It operates on two levels, allowing infertile couples (and women especially) to hope and celebrate while simultaneously acknowledging the fragility of our pregnancy experiences.

PUPO is Pregnant Until Proven Otherwise.

Today, according to my nurse, I am “very pregnant.”  Any Human Chorionic Gonadotropin (HCG) level over 30 is considered pregnant, and my clinic considers anything over 50 to be good.

My number is 542, and we’re at the first level of PUPO–celebration!


I’m also 4 weeks pregnant today.  Traditional calculations rely on menstrual cycles, adding two weeks to the date of the last period (since ovulation typically occurs about two weeks after one’s period).  My embryo(s) is 15 days old (we transferred 5 day embryos on November 20).  Then we add the two week cushion as with natural conception.  (It is important to use the same calculations and be on the standard timeline to measure growth; this is also why pregnancy is calculated at 10 months rather than 9 1/2.)

With an HCG result greater than five, the lab was also to run a progesterone and estradiol test to make sure those levels are appropriate to sustain a pregnancy.  I just called the local lab because my clinic hadn’t received those results, only to discover that the lab misread the orders as “less than.”  They’re running those tests now.

In the meantime, we’re making only one minor change to my meds.  I’ll stay on my daily thyroid medication, baby aspirin, and vitamins.  I’ll also keep changing my four estrogen patches every other day and doing those very fun progesterone injections every other day.  (My nurse, the best nurse ever, is mailing me more short needles–she rocks!)  The only change is increasing the vaginal progesterone from twice daily to three times.

Saturday, I have another HCG test.  The number needs to increase by 53% (essentially doubling every two days), so we’re looking for 829.26 or higher.  We’ll also test my TSH level to make sure my thyroid is behaving.  Should everything go well, my first ultrasound will be around Dec. 17, with the second two weeks later.

However, the second layer of PUPO is still here; those who struggle with infertility always live in the shadow of what-might-go-wrong:

  • The numbers might not double because the embryo(s) could still arrest.
  • Or one of two could arrest.  (We transferred two, but there’s really no way to know what’s going on in there until the ultrasounds.)
  • We could have a blighted ovum (when the embryo attaches and the yolk sac that provides nourishment to the embryo until the placenta develops grows but the embryo does not,
  • or a chemical pregnancy (when early cells that will become the placenta attach to the uterus and start producing HCG, but the placenta and embryo fail to develop,
  • or an ectopic pregnancy (when an embryo implants somewhere outside of the uterus –usually in a Fallopian tube but sometimes other places like the cervix),
  • or a heterotopic pregnancy (when one embryo attaches in the uterus and another, outside).

But, for the moment, I’m PUPO.  And we’re celebrating, y’all!

5 thoughts on “PUPO

  1. Congratulations!!!!! What a great day. With those numbers, you should start preparing yourself for the possibility of twins. After the first few days of absolute joy, I found the wait for the first ultrasound even harder than the wait for the blood test. I also had bleeding in that time and it terrified me and I had a panic attack. Turns out bleeding is super common, evidenced by the fact that I’m writing this comment with my right hand while I have a sleeping baby boy in my left arm while dad is burping twin brother on the other couch. Third try for us. Enjoy these days!!!!! They will go fast, even though it feels like it drags on


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