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Early Pregnancy - Including HCG levels and ultrasound findings

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Background

When pregnancy begins depends on how "pregnancy' is defined. Does it begin when the sperm first penetrates the egg? Does it begin when the male and female pronuclei (see picture below) containing the chromosomal material move close together and decondense in the newly fertilized egg?

One cell human embryo from IVF
Human zygote embryo several hours after fertilization
2 circular structures (pronuclei) in the center contain maternal and paternal DNA
Sperm and egg were put together 16 hours ago

More embryo images
  • Does pregnancy begin when the male and female chromosomes pair up with each other and the fertilized egg subsequently divides into a 2-cell embryo?
  • Does it begin when the embryo implantation begins about 6 to 8 days after ovulation?
  • Or, does it begin when the woman recognizes that she is pregnant after her missed menstrual period and positive pregnancy test?

HCG levels in pregnancy

HCG, or human chorionic gonadotropin, is a hormone made by the pregnancy that can be detected in the mother's blood or urine even before the woman's missed period. This hormone is what we look for with a "pregnancy test".

HCG is first detectable in the blood as early as 7-8 days after ovulation by very sensitive HCG assays (research assays). In real life, blood pregnancy tests will be positive (> 2 mIU/ml) by 10-11 days after HCG injection or LH surge.

In general, the HCG level will double every 2-3 days in early pregnancy.

85% of normal pregnancies will have the HCG level double every 72 hours.

HCG levels peak at about 8-10 weeks of pregnancy and then decline, remaining at lower levels for the rest of the pregnancy.

There is a large variation in a "normal" HCG level for any given time in pregnancy.

Pregnancies destined to miscarry and ectopic (tubal) pregnancies tend to show lower levels (eventually), but often have normal levels initially.

Learn about pregnancy after ectopic pregnancy

Some normal pregnancies will have quite low levels of HCG - and deliver perfect babies. Caution must be used in making too much of HCG "numbers". Ultrasound findings after 5-6 weeks of pregnancy are much more predictive of pregnancy outcome than are HCG levels.

For women that have had an HCG injection as part of their fertility treatment, the hormone takes about 5-14 days to clear from her system, depending on the dose and the individual woman. This can causes problems with interpretation of pregnancy tests done earlier than 14 days after an HCG injection.

HCG levels from normal singleton pregnancies (and twins below)

Levels are listed for various days after the ovulatory HCG injection or LH surge
First (same as Third) International Reference Preparation was used
"High" is highest seen in this group of pregnancies
"Low" is lowest seen in this group of pregnancies
"#" is the number of tests done for that day in this group of pregnancies

The values below are from a group of 53 normal singleton pregnancies. Because this is a very small group of patients and because lab assays vary, it is important not to rely on these values to determine whether your pregnancy is viable, a single, a twin, etc.

  • Check with your physician about your own levels

NORMAL SINGLE PREGNANCIES

Day after HCG or LH Average
mIU/ml
High
mIU/ml
Low
mIU/ml
#
14 48 119 17 12
15 59 147 17 18
16 95 223 33 23
17 132 429 17 21
18 292 758 70 19
19 303 514 111 23
20 522 1690 135 13
21 1061 4130 324 12
22 1287 3279 185 22
23 2034 4660 506 13
24 2637 10000 540 16
The information in the table above is part of a study carried out by Dr. Sherbahn that compared HCG levels from single, twin and heterotopic (combined intrauterine and ectopic) pregnancies.


HCG levels from normal twin pregnancies

Twin pregnancies tend to show higher HCG levels on a given day of pregnancy. However, there is a large variation in HCG levels between pregnancies, and great overlap exists between single and twin pregnancies.

The values below are from a group of 29 normal twin pregnancies. Because this is a very small group of patients and because lab assays vary, it is important not to rely on these values to determine whether your pregnancy is viable, a single, a twin, etc.

  • Check with your physician about your own levels

NORMAL TWIN PREGNANCIES

Day after LH or HCG Average
mIU/ml
High
mIU/ml
Low
mIU/ml
#
14 68 313 56 7
15 88 159 26 9
16 146 803 112 12
17 154 542 52 8
18 360 1760 200 9
19 499 2509 215 13
21 963 5859 631 10
The information in the tables above is part of a study carried out by Dr. Sherbahn that compared HCG levels from single, twin and heterotopic (combined intrauterine and ectopic) pregnancies.


Ultrasound pictures in early pregnancy:

Transvaginal ultrasounds of normal pregnancies at 5.5 weeks of gestation
Gestational sac (black area) is seen with yolk sac inside. An identical (monozygotic) twin pregnancy at the same stage is shown as well as an early twin pregnancy showing non-identical (fraternal) twins.

Transvaginal ultrasound of a normal pregnancy at 6 weeks of gestation

Transvaginal ultrasound pictures of normal pregnancies at 8 to 10 weeks of gestation

Transvaginal ultrasound of a normal pregnancy at 12 weeks of gestation

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