The document provides information about beta human chorionic gonadotropin (β-HCG) levels during pregnancy. It discusses how β-HCG is the first detectable pregnancy hormone, its role in maintaining the corpus luteum and promoting progesterone secretion. Normal β-HCG level ranges are provided for different weeks of pregnancy. Blood and urine tests are used to measure β-HCG levels to diagnose and monitor pregnancy and detect potential issues.

1. Slide 1 --- Title
Slide 2
Beta HCG Facts
• The hormone HCG is a hormone secreted during pregnancy. (that’s why it’s also
called the pregnancy hormone)
• The hormone HCG is secreted at the time of implantation by the trophoblast cells
(which later becomes the placenta), when the embryo attaches to the uterine
wall.
• Main role : to maintain the corpus luteum (whose role is to secrete
progesterone) which is necessary for implantation of the embryo.
BHCG promotes the maintenance of the corpus luteum during the beginning of
pregnancy, causing it to secrete the hormone progesterone. Progesterone enriches
the uterus with a thick lining of blood vessels and capillaries so that it can sustain
the growing fetus.
Source WIKIPEDIA
Slide 3
Beta HCG Facts
 This is first hormone that detects pregnancy as it is present in the blood about
ten days after fertilization, and in the urine a few days later.
 The most sensitive, accurate and reliable pregnancy test is a blood test for the
presence of beta HCG (human chorionic gonadotropin), often just called "beta".
 Beta HCG levels vary according to the gestational age.
Source: IVFConnections.com
Slide 4
Beta HCG Facts
 Beta HCG levels during pregnancy (more than 10 mIU/ml) in the blood can be
detected as early as 2 days before the period is missed.
 Beta-HCG are typically about 100 mIU/ml 14 days after ovulation in a healthy
singleton pregnancy. They should double every 48- 72 hours in a healthy
pregnancy.
Source: IVFConnections.com
Slide 5
Why Beta- HCG ….not just HCG????
• The test for HCG to diagnose pregnancy, as well as other problems of pregnancy
is done by determining the levels of β-subunit (beta- subunit) of hCG (β-hCG).

2.  The HCG hormone has 2 sub units- namely the ALPHA AND BETA sub-
units.
• The alpha sub-unit has components identical to that of
luteinizing hormone (LH), follicle-stimulating hormone (FSH),
thyroid-stimulating hormone (TSH)
• The beta subunit is unique to only to hCG.
• This procedure is employed to ensure that tests do not make false positives by
confusing hCG with the levels of LH (Luetenizing Hormone) and FSH (Follicle
stimulating Hormone).
Source WIKIPEDIA
Slide 6
USES:
 Confirmation of pregnancy
 Fertility
― In the presence of one or more mature ovarian follicles, ovulation can be
triggered by the administration of hCG. As ovulation will happen between
38 and 40 hours after a single HCG injection, procedures can be
scheduled to take advantage of this time sequence, such as intrauterine
insemination or sexual intercourse.
 Human chorionic gonadotropin is extensively used parenterally
as an ovulation inducer instead of luteinizing hormone (since the
Alpha unit of the HCG is similar to the LH)
 As the most abundant biological source is women who are
presently pregnant, some organizations collect urine from
pregnant women to extract hCG for use in fertility treatment.
 Tumor marker
― Human chorionic gonadotropin can be used as a tumor marker, as its β
subunit is secreted by some cancers.
― For this reason a positive result in males can be a test for testicular
cancer. The normal range for men is between 0-5 mIU/mL. Combined with
alpha-fetoprotein, β-HCG is an excellent tumor marker for the monitoring
of germ cell tumors.
Source WIKIPEDIA

3. Slide 7
There are 2 pregnancy tests for HCG:
Blood Test Urine Test
Blood Test:
Other names:
 Serial beta HCG
 Repeat quantitative beta HCG
 Human chorionic gonadotropin blood test
 Beta-HCG blood test
 Pregnancy test – blood
 Source: ADAM INC.
Slide 8
HCG Blood Test
QUALITATIVE QUANTITATIVE
(MAJOR ADVANTAGE)
Source: dr Bremner’s Infertility web.
Slide 9 – 10
How is the test performed?
1. Blood is typically drawn from a vein, usually from the inside of the elbow or the
back of the hand. The site is cleaned with antiseptic. The health care provider
wraps an elastic band around the upper arm to apply pressure to the area and
make the vein swell with blood.
2. Next, the health care provider gently inserts a needle into the vein. The 2-4ml of
blood collected into an airtight vial or tube attached to the needle. The elastic
band is removed from your arm.
3. Once the blood has been collected, the needle is removed, and the puncture site
is covered to stop any bleeding.
4. The blood collects into a small glass tube called a pipette, or onto a slide or test
strip. A bandage may be placed over the area if there is any bleeding.
 Source: Source: ADAM INC.

4. Slide 11
RISKS:
There is very little risk involved with having blood sample taken. Veins and arteries
vary in size from one patient to another and from one side of the body to the other.
Taking blood from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
 Excessive bleeding
 Fainting or feeling light-headed
 Hematoma (blood accumulating under the skin)
 Infection (a slight risk any time the skin is broken)
 Source: ADAM INC.
Slide 12
Why is the test performed?
• Quantitative HCG measurements can help to determine the exact age of the
fetus and can diagnose abnormal preqnancies, such as ectopic pregnancies,
molar pregnancies, and potential miscarriages.
• It is also used as part of a screening test for Down Syndrome.
• This test is also done to diagnose abnormal conditions unrelated to pregnancy
that can raise HCG levels.
• The lack of a visible fetus on vaginal ultrasound after the βhCG levels have
reached 150,000 mIU/ml is strongly indicative of an ectopic pregnancy.
Source: ADAM INC., WIKIPEDIA
Slide 13
HCG Urine Test
• The urine test may any of several other test formats, home-, physician's office-,
or laboratory-based.
– Home based urine test is the most common.
• Detection thresholds range from 20 to 100 mIU/ml, depending on the brand of
test.
Early in pregnancy, more accurate results may be obtained by using the first
urine of the morning (when hCG levels are highest).
 Commonly a Qualitative type of pregnancy test.
― Only tells whether the pt is pregnant or not, without telling the exact levels
of B-HCG present.

5. Slide 14
HCG Urine Test
• Advantages:
– urine pregnancy test kits are less expensive; and testing can be done at
home by the patient herself.
– The kits available are very accurate and widely available and the test can
be completed in about 3-5 minutes.
Slide 15
How do you do a B-HCG urine test?
― The majority of the brands for the urine test tell the user to hold a stick in the urine
stream. Others involve collecting urine in a cup and then dipping the stick into it.
Another brand tells the woman to collect urine in a cup and then put a few drops into
a special container with a dropper.
• Then the woman needs to wait a few minutes. Different brands instruct the
woman to wait different amounts of time. Once the time has passed, the user
should inspect the "result window."
• The user is pregnant if a line or plus symbol.
• It does not matter how faint the line is. A line, whether bold or faint, means the
result is positive.
Source: dr Bremner’s Infertility web.
Slide 16
How is a urine test accurate?
Home pregnancy tests (HPTs) can be quite accurate. But the accuracy depends on
many things. These include:
• How is it being used- Be sure to follow the directions and check the
expiration date.
• Who uses them - The amount of hCG in the urine will be different for every
pregnant woman. So, some women will have accurate results on the day of
the missed period while others will need to wait longer.
• When is it being used- The amount of hCG or pregnancy hormone in the
urine increases with time. So, the earlier after a missed period the test is

6. taken, the harder it is to spot the hCG. If you wait one week after a missed
period to test, you are more apt to have an accurate result. Also, testing the
urine first thing in the morning may boost the accuracy.
• The time of fetal implantation- Pregnancy tests look for the hormone human
chorionic gonadotropin (hCG) that is only produced once the fertilized egg
has implanted in the uterine wall. In most cases, this happens about 6 days
after conception. But studies show that in up to 10 percent of women, the
embryo doesn't implant until much later, after the first day of the missed
period. So, home pregnancy tests will be accurate as soon as one day after a
missed period for some women but not for others.
• The brand of the test- Some home pregnancy tests are more sensitive than
others. So, some tests are better than others at spotting hCG early on.
Source: dr Bremner’s Infertility web.
Slide 17
How is a urine test not accurate?
• Every woman ovulates at different times in her menstrual cycle. Plus, embryos
implant in the uterus at different times. So, the accuracy of HPT results varies
from woman to woman.
• Sometimes women get false negative results (when the test says you are not
pregnant and you are) when they test too early in the pregnancy.
• When the urine is dilute (specific gravity less than 1.015), the hCG concentration
may not be representative of the blood concentration, and the test may be falsely
negative.
Source: dr Bremner’s Infertility web.
Slide 18
Beta - HCG Normal Values ---- (Title)

7. Slide 19
weeks since LMP mIU/mL
3 5 – 50
4 5 – 426
5 18 – 7,340
6 1,080 – 56,500
7–8 7,650 – 229,000
9 – 12 25,700 – 288,000
13 – 16 13,300 – 254,000
17 – 24 4,060 – 165,400
25 – 40 3,640 – 117,000
Non-pregnant females <5.0
Postmenopausal females <9.5
Source WIKIPEDIA
Slide 20
What do HIGH values of B-HCG means?
• Normal Pregnancy. Numbers vary from person to person.
• Multiple Pregnancy
– Spontaneous twins. Sometimes, the embryo splits and become identical
twins.
– Fraternal twins.
• Gestational trophoblastic disease like Hydatidiform moles ("molar pregnancy")
• Choriocarcinoma may produce high levels of βhCG (due to the presence of
syncytialtrophoblasts- part of the villi that make up the placenta) despite the
absence of an embryo.
• Ovarian Cancer (women); Testicular Cancer (men)
Source: IVFConnections.com, ADAM INC.

8. Slide 21
What do LOW values of B-HCG means?
• A reason for a low beta is that some embryos are "late" implanters. Typically, an
embryo begins to implant and your body begins to produce hCG between 8-10
days past conception.
• Some research shows that frozen embryos are slower/later to implant than fresh
embryos.
• The number may be low because of a chemical pregnancy. Sadly, this is a very
early miscarriage. It is estimated that up to 25% of pregnancies end in early
miscarriages - but researchers aren't sure. Women can experience a chemical
pregnancy without ever knowing it.
• The number may just be low, since B-HCG levels, since B-HCG levels vary from
person to person.
• The pregnancy may be ectopic -- outside of the uterus. An embryo can travel out
of the uterus and up a fallopian tube, or even out into the abdominal cavity.
Ectopics are rare, but they happen.
• Fetal death
• Incomplete miscarriage
• Threatened spontaneous abortion
Source: IVFConnections.com, ADAM INC.
Slide 22
When does B-HCG hormone start to lower down and disappear?
Once a gestational sac is seen in normal pregnancies, B-HCG levels gradually
decreases.
The initial decrease in beta hCG (βhCG) after full-term delivery is quite
rapid, so that an hCG level following the delivery will have dropped to less
than 50 mIU within 2 weeks, and hCG will be undetectable after 3 to 4
weeks
In the case of first-trimester abortion, if hCG is clearing normally from the
bloodstream as expected, the hCG level should decline steadily, halving at least
every 48 hours. BhCG is likely to be detectable by sensitive tests, including
commonly-used office urine test kits, for as long as 60 days after first-trimester
abortion.