Dr. Caitriona Henchion:

The rate of failure depends on the exact gestational period, but it varies from approximately 1% under seven weeks to about 2.5% by the time 12 weeks are reached. Therefore, it goes up slightly during that gestational period. In some cases, it is obvious it has occurred because no bleeding has happened and somebody is going to report that quickly. If it were to happen in the community, then we would quickly refer the people concerned to one of the clinics in the maternity units providing care. Those units would be extremely responsive in seeing those people quickly. It is upsetting for people because they thought it was going to be sorted out. This aspect is part of the consent process, though, so people know about it and we are clear with them about it. It is stressful, however, because people might then have to wait for a few days for a hospital appointment.

The real problem comes in cases where people may have this experience slightly earlier than they thought. I refer to situations where people might have had less bleeding than they thought, so then they may be anxious the procedure has failed, when in fact it has been okay. Even more anxiety may be felt in the opposite situation, where people thought they had enough bleeding, but they did not actually lose a pregnancy and it was still there. Therefore, there is this whole aspect of first trying to ascertain whether someone is still pregnant. In a situation where there has been a positive test, the question is whether that is just because of some remaining residual hormone and there is nothing to worry about. Rather than just adopting an approach of telling people it often takes a bit longer for the pregnancy hormones level to fall and that it sounds like everything is fine and we will just do the test again in a week, we are always in the position of saying we cannot really just afford to wait for a week in case we run out of time.

Therefore, we must over-investigate people, whether that involves sending them to the hospital for scans or doing blood tests to check whether their hormone levels are dropping. It means that women are being overstressed and over-investigated. We are constantly going around with these numbers in our heads. For example, if a person had a blood test on Monday, I must ensure I get the result, communicate again and ensure that person comes back in on Thursday. There is nothing wrong with these people. They are perfectly well and healthy, and we should not be having this major concern about what their blood test results are.