Miscarriages occur in 20% or more of pregnancies demonstrating fetal heart activity by ultrasonography [1, 2], It has been well documented that dropping, slow rising, or low levels of serum beta human chorionic gonadotropin (hCG) are associated with miscarriage [3, 4]. The aforementioned studies refer to multiple serum samples showing inappropriate rise of serum hCG.

One study evaluated 22 pregnancies with subtle slow-rising serum beta hCG levels including even one level that did not rise sufficiently and found that 16 showed fetal heart activity at eight weeks though none had viability past the first trimester [5]. A search was initiated to see if there are even any exceptions to the general rule that if even one hCG level fails to rise appropriately, a woman will not successfully complete the first trimester and thus not deliver a live baby. One case was found who successfully completed the first trimester despite an inappropriate rise in the hCG levels [6]. It took nine years from 2003 and over 8, 000 pregnancies evaluated to find this one case [6].

The objective of the case study reported here is to report a second case of fetal viability past the first trimester after evaluating 2, 000 more pregnancies and to report the delivery outcome not only of the present case, but also to report for the first time the delivery outcome for the aforementioned previous case report [6].

A 32-year-old woman with secondary infertility conceived while observing follicular maturation. Thus the precise date of ovulation was known. Her only treatment was vaginal progesterone during the luteal phase. Her first serum hCG level taken 17 days from ovulation was appropriate at 484 mIU/mL. She was not able to return for 11 days for a repeat serum beta hCG level. At 28 days from ovulation a level of 10, 000 mIU/mL was expected but her level was only 4, 844 mIU/mL. Three days later when one should have expected a level of serum beta hCG 2.5 times higher than the previous 4, 844 mIU/mL level, the level was only 9, 585 mIU/mL (about double). Despite the rise of serum beta hCG slower than expected, the woman delivered a healthy baby full-term. The first case report only reported viability past the first trimester. Thus reported for the first time is that pregnancy also resulted in the delivery of a healthy baby.

When a physician counsels a couple, it is important to be familiar with the usual outcomes of a given situation. Indeed the couple described here were advised of the likelihood of miscarriage. However, they were given the faint hope of a success by making them aware of that at least one exception to the rule [6]. This first exception to the rule could be considered either a miracle or possible laboratory error. Finding a second case could change the tone of the consult to “it is unlikely” for the pregnancy to proceed to a live delivery but there have been at least two case reports where despite an inappropriately rising serum beta hCG level, two live babies have been born.