HCG is growing slowly but what to do. Slow increase or decrease in hCG levels in the early stages

Human chorionic gonadotropin (hCG) usually doubles every 48-72 hours in the early stages of pregnancy until levels exceed 6000 mIU/ml. An increase of more than 60% after 48 hours is considered normal, but less than 53% is considered abnormal. Although slower growth in itself does not indicate pregnancy loss, it is difficult to say about a decrease in hCG levels.

The concentration of this hormone in the blood is usually measured at intervals of 48-72 hours (2-3 days) to determine the development of pregnancy in the earliest stages. Typically, these tests are performed at a time when ultrasound cannot yet determine the viability of the fetus.

A slow rate of increase or decrease in hCG levels during the first 8-10 weeks of pregnancy indicates the death of the trophoblast (cells of the outer layer of the embryo) and may indicate an ectopic or non-viable intrauterine pregnancy.

How accurate is the hCG level in determining a normal pregnancy?

The level of this hormone in the blood is a sufficient indicator to determine the viability of the fetus only until it exceeds 6000 mIU and / or until 6-7 weeks of pregnancy. Later, it is necessary to undergo an additional ultrasound examination to determine the presence. After which there is no need to check the progress of pregnancy using an hCG test, as the famous American professor, Doctor of Medical Sciences, obstetrician-gynecologist Amos Grunebaum says.

One 2007 Canadian study also found that once hCG levels exceed 5000 mIU (or 5-6 weeks into pregnancy), hCG levels should not be relied upon as a reliable determinant of pregnancy viability in the first trimester.

Simply put, after 5-7 weeks of pregnancy, ultrasound becomes the best tool for getting information about how the pregnancy is progressing, and it is much more accurate than hCG numbers.

Slow hCG rise

Unlike a drop in hCG levels (when the new test result is less than the previous one), a slow increase does not indicate a problem so clearly.

The doctor compares changes in hCG values ​​with established expected curves, which can help him determine how the pregnancy is progressing and whether additional action is needed. But there are many limitations to assessing the growth rate of this hormone, and this indicator itself should never be used to draw conclusions - symptoms or signs of pregnancy should also be taken into account.

Reasons for slow increase

A slow increase in hCG levels may be due to:

• normal pregnancy;
• ectopic pregnancy;
• or him.

Only a doctor can determine which of these is more likely in each particular case.

What is the lowest acceptable rate of increase in hCG?

A study in 2006 showed, and in 2012 confirmed, that an increase of at least 35% in 48 hours may be the minimum increase in a normal early intrauterine pregnancy. Therefore, assumptions about the non-viability of the embryo, even if during the first month after conception, hCG increases at a rate of less than 53% within 48 hours, cannot always be correct.

How often does hCG rise slowly in a normal pregnancy?

While a slow increase in hCG doubling time can be a possible sign of miscarriage or a symptom of an ectopic pregnancy, this is not always the case. According to the American Pregnancy Association, about 15% of viable pregnancies may have a slower hCG doubling time.

Decrease in hCG levels

If there is not growth, but a tendency to decrease in the level of human chorionic gonadotropin in early pregnancy, it becomes clear that the embryo is not able to develop normally. In this case, intervention or surveillance options may be considered. If the hCG level drops by less than 35-50% in 48 hours (see table below), then this may indicate the presence of trophoblast (the outer layer of the embryo - editor's note) or development. In this case, examination and intervention are necessary for a final diagnosis.

Expected minimum percentage decrease in hCG in case of non-viable pregnancy:

More information about this table (click)

• The table above shows how the hCG level should decrease in a non-viable pregnancy. This is data from a study conducted in 2014. The previous similar analysis by scientists was carried out in 2004, and there the minimum level of decrease in hCG was lower, although for a period of 7 days it almost leveled off. The reason for this difference is the use of updated statistical methods and a more diverse population in the newer study.
• The confidence interval here is 95%. That is, this means that only 5% of women after pregnancy loss will have hCG levels that fall more slowly than shown in the table.
• A slower decline in hCG than the threshold values ​​in the table may indicate the presence of retained trophoblast or an ectopic pregnancy.

For what reason does hCG rise slowly? This is a frequently asked question among women who are preparing to become mothers for the first time. Human chorionic gonadotropin, or hCG, is a hormone produced by a woman’s embryonic organ during pregnancy; it is one of the leading indicators of its presence and successful course. Until 7-11 weeks, its growth occurs rapidly, then it slows down. In the first 3 months, human chorionic gonadotropin causes the production of progesterone and estrogen - hormones necessary for the successful development of pregnancy.

Establishing gonadotropin levels during pregnancy

Analysis of the level of human chorionic gonadotropin content makes it possible to determine the presence of pregnancy at a period when an ultrasound examination cannot yet give results. Stimulation of the production of progesterone and estrogen by human chorionic gonadotropin continues until the woman’s embryonic organ (placenta) begins to produce and form hormonal levels on its own. HCG is made up of an alpha unit and a beta unit. Of these, the beta unit is unique in its composition, which makes it possible to use it in tests to determine pregnancy. Analysis of the amount of beta-gonadotropin in the blood makes it possible to determine the presence of pregnancy after 14 days.

A drop in the amount of human chorionic gonadotropin in the blood during pregnancy or a decrease in its growth rate indicates spontaneous miscarriage or development of the fetus outside the uterus.

The presence of elevated gonadotropin levels in men, as well as non-pregnant women, serves as an alarming signal. At best, this is an incorrect analysis; at worst, it is the beginning of the development of cancer tumors in the body.

HCG hormone tests

To determine the presence of the hormone human chorionic gonadotropin in the blood, a woman needs to have her urine and blood tested. The analysis is done in the morning and on an empty stomach. When scheduling an analysis at another time, you must remember that at least 5 hours must pass between meals and the procedure.

In terms of reliability, a blood test comes first; the most inaccurate method is a pregnancy test, although it is popular among women. Why is a hormone test prescribed? Gynecologists do this in order to:

• diagnose early pregnancy;
• monitor the development of pregnancy;
• exclude the development of the fetus outside the uterus;
• identify pathologies in child development;
• detect fetal freezing in time;
• establish the risk of miscarriage;
• diagnose malignant tumors.

To diagnose testicular tumors, such an analysis is also prescribed for men.

Often, the gynecologist asks for repeated blood tests with an interval of one week in the same laboratory. This is done to accurately establish pregnancy or eliminate errors in the analysis. When the level of gonadotropin increases by 1.5-2 times, we can say that the woman is pregnant. If its level does not increase or decreases, then there is no pregnancy. You need to know that the norms and accuracy of determining the level of human chorionic gonadotropin are different in all laboratories.

For men, as well as pregnant women, the gonadotropin content ranges from 0 to 5 mU/ml (international units per 1 ml).

During the normal course of pregnancy, the gonadotropin content is directly dependent on its duration; from conception to the last weeks of pregnancy it increases from 25 mU/ml to 78,000 mU/ml. During the first trimester, the level of hCG increases several thousand times, then the sharp increase in the number of hormones stops and occurs slowly. Changes in gonadotropin levels are purely individual for each woman; there are no strict limits. During the period of bearing a baby, there is an increase or decrease in the level of hCG.

The content of gonadotropin in the blood increases too quickly in the case of:

• incorrect determination of the period (the period is longer than expected);
• multiple pregnancy;
• hydatidiform mole.

HCG rises too slowly if:

• there was an error in determining the deadline (the deadline is shorter than expected);
• delay in fetal development;
• the fetus develops outside the uterus;
• fetal freezing occurred;
• there is a risk of miscarriage.

Is it possible for incorrect results?

The possibility of obtaining incorrect results when testing blood for human chorionic gonadotropin is not excluded. Such conclusions are called false positive or false negative.

The first case, in which there is no pregnancy, but the result is positive, is very rare.

An incorrect negative result (the test does not confirm the presence of pregnancy) is possible if the rules are violated when donating blood, if the gestational age is incorrectly determined, with late ovulation and in exceptional circumstances - ectopic pregnancy.

If you suspect an erroneous result in both cases, the gynecologist recommends taking the tests again.

In addition, the content of gonadotropin in the blood is affected by drugs used to treat infertility and containing this hormone (Choragon, Pregnil). Before taking tests, it is necessary to warn laboratory workers about taking such drugs. Other drugs do not affect the level of hCG in the blood.

Changes in hCG levels during pathological pregnancy

The increase in the amount of gonadotropin in the blood during an ectopic pregnancy does not occur as steadily as during a normal pregnancy. In the first week, while the egg develops outside the uterus (ovary or fallopian tube), its level rises. But already from the second month there is a decrease in the amount of the hormone. By comparing test results with the norm, it is possible to diagnose the pathological nature of pregnancy. As a rule, deviations from normal indicators are noticeable already from the middle of the third month.

There are cases when the fetus stops developing in the uterus and dies. This is a frozen pregnancy. At a very early stage, the heartbeat is not yet audible and cannot be detected on ultrasound. It is possible to detect pathology only by the level of gonadotropin in the blood. In most cases, freezing occurs in the first 3 months. During a frozen pregnancy, the uterus continues to grow, but the level of gonadotropin does not increase, but gradually decreases.

Pathologies also include pregnancy with two or more fetuses. The reason for this phenomenon may be:

• heredity (there was a similar case in the family of one of the parents);
• maturation of several follicles or one, but containing several eggs;
• taking hormonal medications;
• conception at a late age;
• in vitro fertilization.

The level of gonadotropin when carrying two or more embryos is necessarily higher than during a normally developing pregnancy with one fetus.

Typically, hCG levels for a multiple pregnancy are at least 2 times higher than the level of human chorionic gonadotropin for a single pregnancy.

Age-related changes in a woman’s body, caused by the cessation of the menstrual cycle, also lead to a slow increase in human chorionic gonadotropin in the blood. For women during menopause, a level of 14 mU/ml is considered normal.

After an abortion or loss of a child due to miscarriage, gonadotropin levels remain slightly higher than normal for several days. After 1.5 months it approaches normal.

The first weeks of pregnancy are especially exciting for women who planned to conceive and carefully prepared for it. Doubts that the long-awaited event has occurred prevail even after a delay in menstruation and a positive result of a rapid test. What other signs can be used to confirm the fact of conception? A blood test for human chorionic gonadotropin will help with this. It is he who acts as the main marker of the birth of a new life.

What is hCG, what is the role of this hormone in the female body?

Human chorionic gonadotropin (hCG) is produced by chorion tissue immediately after implantation of the embryo into the uterine cavity (approximately 12 days after conception). When there is no pregnancy, the level of this hormone is close to zero. After conception occurs, it increases to tens of thousands of units, reaching a limit by the 10th week, and then decreases slightly.

The role of hCG in the early stages of pregnancy is very high. It supports the work of the corpus luteum - a temporary endocrine gland that produces progesterone, increases the number of chorionic villi, and provides them with nutrition. With its increase, gradual adaptation to pregnancy occurs, hormonal levels and important body functions undergo restructuring.

Adaptation to pregnancy under the influence of hCG consists of an increase in the production of hormones from the adrenal cortex. They suppress the immune reaction towards the fetus on the part of the mother’s body, because for it the fetus is to some extent foreign. The production of hCG depends on how successfully the implantation process is going. If the fertilized egg is healthy, it produces the required amount of gonadotropin and gestation proceeds normally.

Diagnostic tests to determine hCG levels

2-3 days after implantation, an increase in hCG is observed in the blood; after 3-5 days, the hormone begins to be released along with the urine. If there are indirect signs of pregnancy (delayed cycles, breast swelling, changes in taste habits), it is recommended to perform a rapid test. The probability of his error is 5%.

A blood test for hCG will provide more accurate information. Biomaterial can be donated upon a doctor’s referral or independently at a paid clinic. To do this, blood is taken from a vein on an empty stomach in the morning. The answer will be ready on the same day or the next day. Based on the results of the analysis, the fact of conception is judged.

How does the concentration of hCG change during pregnancy?

The interpretation of the test results should be entrusted to the doctor. However, it is important to know that if the reading is less than 5 mU/ml, intrauterine pregnancy is excluded, and the reason for the delay in the cycle is different.

When hCG increases to values ​​above 5 mU/ml, you can prepare for motherhood. In any case, it is important to undergo an examination by a doctor who will confirm the fact of conception, register and monitor human chorionic gonadotropin levels in the first weeks.

What hCG result is considered normal? The permissible hormone levels by week are shown in the table:

The table indicators are not an absolute dogma; after IVF they are always slightly higher. Each expectant mother has her own optimal limits, so to assess the dynamics of the increase in the hormone, the doctor evaluates the previous and new tests. When reporting from the last day of menstruation to the 4th week of obstetric pregnancy, the level of gonadotropin doubles every two days.

The rate of doubling of a parameter can be calculated using the formula “2.2+-0.8 days”. Hormone levels can increase faster, doubling every 1.5 days, or more slowly, doubling every 3 days. Having reached its limit by 9-11 weeks, it stops growing and then slows down. Subsequently, it decreases slightly to levels of 6-7 weeks and remains this way until childbirth. After the baby is born, the hCG level gradually drops, and by the 4th week of the child’s life it does not normally exceed 5 mU/ml.

Reasons for the slow growth of hCG, its slowdown or decrease in the early stages

Deviations from standard indicators can be considered signs of pathology. It is important for the doctor to understand why this happened and urgently eliminate the anomaly. If hCG slowly grows in the blood of a pregnant woman in the early stages, the physical development of the embryo is likely to be delayed. This happens because the formation of the placenta slows down and the blood flow between the expectant mother and the child is disrupted. The embryo does not receive enough oxygen and nutrients, which leads to intrauterine hypoxia.

A low hCG level, a sudden drop in its level in the first weeks of gestation, is a serious symptom that may indicate:

• placental insufficiency;
• ectopic implantation;
• fading pregnancy;
• slowing down the physical development of the embryo;
• the threat of failure;
• chromosomal abnormalities;
• rejection of the fertilized egg before the cycle is delayed;
• detachment and non-implantation of an embryo transferred using IVF.

A low increase in gonadotropin may indicate placental insufficiency, fetal hypoxia, and intrauterine death. The rate increases slowly in the later stages, if the pregnancy is post-term, this situation is monitored by doctors.

Only a doctor can draw conclusions about what is considered normal and pathological. Often the analysis has to be retaken to exclude a laboratory error. If there are no suspicious signs, it is recommended to repeat the analysis in a week, and then perform an ultrasound.

Ectopic pregnancy after natural fertilization or IVF poses a particular danger to women's health. At first, the woman notices the same signs as during normal conception. However, after a while they are accompanied by pathological symptoms - pain in the lower abdomen, bloody spotting. A blood test in this case does not show an increase in hCG, although a delay in menstruation is observed. It is important to diagnose this condition in time and remove the embryo using laparoscopy. Otherwise, rupture of the fallopian tube (the place where the fertilized egg usually begins to grow), peritonitis, and sepsis are possible.

Treatment tactics

In 15% of cases, a slow increase in gonadotropin levels in the early stages is a natural phenomenon observed in the absence of pathology. In any case, having discovered deviations in the increase in the pregnancy hormone, the doctor takes the patient under special control and prescribes additional examinations.

Bearing with an insufficient increase in hCG is complicated, since pregnancy is most often associated with certain pathologies and proceeds poorly. However, it is often possible to preserve and carry a healthy child. Much depends on the reason for the decrease in hCG levels:

• if a drop in hCG is associated with an ectopic pregnancy, emergency surgery is indicated to save the patient’s life (more details in the article:);
• in case of a frozen pregnancy, a diagnostic curettage is performed, the cause of the pathology is subsequently determined, hormonal correction is carried out and careful preparation for a new pregnancy is carried out;
• when there is a threat of spontaneous abortion, retention in a hospital is indicated, where important therapeutic measures are carried out.

Treatment in a hospital involves monitoring hCG levels over time, as well as taking other tests that provide the doctor with additional information about the patient’s health status. Special medications containing gonadotropin taken from the urine of pregnant women (Pregnil, Horagon, Ecostimulin) often help to increase the concentration of the pregnancy hormone. Usually injections of drugs are given in dosages of 1500, 2000, 5000 IU. The dose is selected individually, while the patient’s condition is monitored. If treatment measures are taken in a timely manner, the chances of carrying a baby increase.

Hello Elena Viktorovna! I have a difficult situation. The polypropylene of the endometrium was successfully removed and she took duphaston for more than 6 months, the long-awaited delay came. The last menstruation was 08/29/2016, I took an hCG test on 10/17/2016, the doctor said the result was negative and the tests did not show all this time and did not show them after. I was referred to a family planning center. On 10/28/2016 I had an appointment at this center, during the examination they immediately did a transvaginal ultrasound and the doctor said don’t worry, my period will arrive now. On this day, a rash had already started on the forehead and mainly in the temporal part of the forehead - transparent watery pimples in a large amount, and after every meal I felt very sick, but without vomiting, I already lost two kilos in ten days, then the nausea went away, and with it, the appearance of acne disappeared. But a week after the visit to the family planning center, there are no periods and no, I decide to take duphaston, since before that the attending physician said that when you get pregnant, you will take it continuously for several months. The second week has passed since the last examination and on November 11th and 12th it begins to smear, the discharge is brown, the pain is minor on the lower right side. On Sunday the 13th, there is bleeding as during menstruation, but only in less than twice the amount (in general, I have a lot of it and the cycle has leveled off with diphaston to 28 days, and the duration of the days themselves is 4) the next day the bleeding decreases and seems to stop , to which I sigh with relief and pray to God that everything will work out and the pregnancy will continue. 14 in the morning I see that there was brown discharge at night, I try not to heat it up, I go to work. And already at work in the morning the following happens: I feel a splash and a splash of liquid from me - blood, I put on a pad, I am in shock, I try not to get hysterical and within 2-3 hours there is bleeding and pieces measuring up to 4 cm by 1.5-2 cm , there were about 5-6 of them during this time and the bleeding subsided by the evening, today one can say that it is no longer dripping, and yesterday and today I felt in the lower abdomen as if the muscles were toned after training, although there was no physical activity at all. I have an appointment with my doctor scheduled for tomorrow, since the family planning center has prescribed a lot of tests for hormones and smears. Why didn’t I immediately run to the doctor - and would they have accepted me, because the pregnancy was not diagnosed? Yes, and I only began to come to my senses today, before that I didn’t understand anything. Question: were you pregnant? What happened was a miscarriage? And for what reasons were they unable to determine whether there was a pregnancy or not? Thank you for your attention and I look forward to your answer, I want to clarify the situation for myself and see what my doctor can tell me.