Hcg level and twins
What Does My hCG Level Mean?
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Katie Koss Dec 15 353 Comments
So you're in the IVF process, and now you’ve waited the long 10-16 days for your first pregnancy test. Your hCG level comes back positive. Congratulations!
Then the panic sets in. Is my number too low? Is it too high? Does this mean I'm having twins? Triplets? At InVia Fertility, we often have patients ask us to interpret their hCG level from that first positive test—and the truth is, most of the time that's not possible.
What does an hCG level measure?
hCG (Human Chorionic Gonadotropin) is the “pregnancy hormone." It is detected soon after implantation and typically doubles every 72 hours. It reaches its peak by 8-11 weeks of pregnancy and levels off. An hCG level under 5 is considered negative. Between 5 and 25 is considered a low positive and can alert the provider to an abnormal pregnancy (i. e., chemical or ectopic). Over 25 is considered positive for pregnancy.
This being said, a single hCG level does not provide much information. It's necessary to take repeat serum (blood) levels to see if the level is decreasing or rising appropriately. Once the hCG level has reached approximately 1,000, a transvaginal ultrasound should be able to detect a gestational sac in the uterus. After that point, serial ultrasounds will provide the most important information for your fertility specialist.
Range of hCG levels and what they can mean
The chart below provides median hCG levels, but also a range. As you can see, the range varies significantly:
The range for singletons is 5 – 397 and for twins it is 48 – 683. As you can see, there is a big overlap between the first hCG level in singleton and twins. What this means is that even if you have a first hCG level of 397, it could be a singleton pregnancy. Also, if the first hCG level is 48; it could still be a twin pregnancy.
Thus, a single hCG level cannot distinguish between a singleton and a twin pregnancy. Of course, if the first hCG level is say, 1200 mIU/mL; it is most like a multiple pregnancy — but you cannot be sure till the ultrasound a couple of weeks later.
A similar observation can be made when it comes to miscarriage. Here, the first hCG level range is from 5 – 268. Thus, even patients with (an excellent) first hCG level of 268 mIU/mL can miscarry.
Finally, your hCG level can be affected by whether you had a day 5 or day 3 embryo transfer.
The bottom line
So, to summarize: when the first hCG test is positive, it's great news—you've overcome a huge hurdle, and it's okay to enjoy the moment! You are indeed pregnant! However, it may be prudent to remember that the follow up hCG levels have to show appropriate increase, and subsequent ultrasounds have to show appropriate growth, before it's possible to confirm that it is an ongoing pregnancy.
The hCG levels above are only guidelines.
There are always exceptions to the rule. This is why, even if the hCG levels are low, it is important to continue the medications and keep follow up monitoring appointments.
To work with a qualified, board-certified fertility specialist, make an appointment at one of InVia’s four Chicago area fertility clinics.
The hCG Levels That Could Mean You're Having Twins
If you’re concerned about having twins, or if you have been told that your hCG levels indicate there are two little ones on the way, here’s everything you need to know about hCG (human chorionic gonadotropin) and if you might be having twins.
When you get a positive pregnancy test at home, one of the first things you need to do is make an appointment with your obstetrician for your first prenatal visit. At that appointment, your doctor will want to test your hormone levels, specifically your hCG level, to confirm your pregnancy. hCG (human chorionic gonadotropin) is a hormone produced by the body during pregnancy to support fetal growth and development.
Today, we are going to dive into the world of hCG and how and why this is something you should pay attention to during early pregnancy.
What is an hCG Level?
hCG or “the pregnancy hormone” is the most commonly measured hormone during pregnancy. It’s normally produced in the placenta after the egg (or eggs) has been fertilized and traveled to the uterus. hCG is the hormone that alerts your body that you’re pregnant. hCG levels are used as an indicator for the health of your pregnancy. hCG is a useful marker to estimate the gestational age of your pregnancy and to help you determine how far along you are in weeks. hCG levels also assist with determining whether or not you will experience a miscarriage, but hCG testing is not always 100% accurate.
Can a Store-Bought Pregnancy Test Show How High Your HCG level Is?
If you take a home pregnancy test, the results will be based on two main hormones – estrogen and hCG. Levels of these hormones are approximately 1000 times higher during pregnancy than in non-pregnant women.
At this time, a store-bought pregnancy test can not give you a specific hCG level; only a woman’s first visit to the doctor can determine the amount of hCG in her system through a simple blood draw.
If you just heard that second heartbeat for the first time, or you know it’s been two for a while, you need to read our twin pregnancy week by week timeline to help you learn what happens week by week with twins. Click here to learn more… and while you’re at it, check out our expecting twins classes and twin parent coaching services.
What Weeks of Pregnancy Does hCG Show Up?
hCG can be detected in the bloodstream about 11 days after conception, with a level of 6 – 40 mIU/ml hCG. The level of hCG doubles every 48-72 hours during early pregnancy. In most normal pregnancies, hCG values increase from the day a fertilized egg implants into the uterine wall, eventually peak around 8-10 weeks after implantation, and plateau as the pregnancy progresses.
The hCG Levels That Mean You’re Having Twins
According to several studies, women pregnant with twins may have a higher level of hCG baseline levels compared to the normal level of hCG in a singleton pregnancy. hCG is the hormone that alerts your body that you’re pregnant. hCG levels are highest during early pregnancy and gradually decline as the pregnancy progresses to term. hCG will be at its highest level when an embryo implants into the uterus.
hCG typically reaches 90,000-100,000 mIU/mL for a singleton pregnancy. Your doctor will be paying closer attention to trends instead of numbers due to the fact that there’s a wide range of normal hCG levels. As long as hCG rises as expected, your doctor will consider your pregnancy as healthy.
Here is a chart of standard hCG levels for a singleton pregnancy. If your levels are on the higher end of the standard hCG range, this could be a clue that you’re having twins.
| Week of Pregnancy | Typical hCG Range |
|---|---|
| 3 weeks | 5–50 mIU/mL |
| 4 weeks | 5–426 mIU/mL |
| 5 weeks | 18–7,340 mIU/mL |
| 6 weeks | 1,080–56,500 mIU/mL |
| 7-8 weeks | 7,650–229,000 mIU/mL |
| 9-12 weeks | 25,700–288,000 mIU/mL |
| 13-16 weeks | 13,300–254,000 mIU/mL |
| 17-24 weeks | 4,060–165,400 mIU/mL |
| 25–40 weeks | 3,640–117,000 mIU/mL |
What Do High hCG Levels Indicate?
In most pregnancies, the level of hCG normally doubles every 48-72 hours and increases by at least 60% every two days.
The higher your levels of hCG are initially, the higher they will be throughout your entire pregnancy. If your HCG levels are higher than average, you could be having twins. An hCG level that is 30%-50% higher than a standard singleton pregnancy could mean a twin pregnancy.
Can hCG Levels Be Found In Urine?
The hormone hCG can be detected in a urine test, but the exact level of hCG can only be measured through a blood test.
Does a High Level of HCG Mean You’re Having Twins?
High levels of hCG do not necessarily mean that you will have twins. You can have high levels of hCG with a singleton pregnancy. The chances of having twins increase with higher levels of hCG, but they cannot be predicted accurately based on this alone. The only way to confirm that you’re having twins is to have an ultrasound, as early as 6 weeks of pregnancy. hCG levels that are higher than normal during pregnancy can sometimes be the result of a problem with the pregnancy, including an hCG-producing tumor (also known as choriocarcinoma), ectopic pregnancies, or a molar pregnancy.
How Common are Twin Pregnancies?
Twin pregnancies occur in three to four out of every 100 pregnancies. Twins account for nearly 80 percent of all multiple births. Triplet and quadruplet births are less frequent but still occur once per 1000 deliveries.
Signs You Are Having Twins
According to research studies, it has been proven that if hCG levels are higher than expected for someone’s week of gestation, then they may be carrying multiple fetuses. Another study revealed that twin pregnancies tend to start out with higher hCG levels than single pregnancies do.
Some studies show that women pregnant with multiples had higher hCG base level counts. Increased hCG levels may indicate a pregnancy that includes twins.
What low hCG levels might mean
Low hCG levels mean that hCG is not being produced in high quantity by the body, which could be the result of testing very early in the pregnancy when the levels are too low. Typically, within a few days, the hCG level will rise much higher.
However, in some cases, hCG levels that are too low or not increasing can indicate a miscarriage, also known as a chemical pregnancy. If your hCG levels are not following expected patterns, your doctor may request additional blood draws every few days in order to get a better idea of how the levels are changing.
What high hCG levels might mean
A high hCG level means that hCG is being produced in high quantity by the body, typically due to a strong single pregnancy or a multiple-birth pregnancy. But if your levels aren’t high, that doesn’t automatically mean that there’s something wrong with your pregnancy. It truly depends on what point in time you are in your pregnancy, which can be difficult to determine if you’re not sure of the date of your last period.
High hCG levels alone typically do not indicate that you are having twins, but it may increase your chance of pregnancy with multiples over the normal baseline hCG value for a singleton pregnancy.
Is hCG monitored prior to ultrasound?
Yes, typically, your doctor’s office will check that your blood is showing hCG levels high enough to be considered a healthy pregnancy before scheduling your first ultrasound.
What are the signs of twin pregnancy?
Signs of a twin pregnancy are cramping, bleeding, spotting, nausea or vomiting, and fatigue — the same symptoms as for singleton pregnancies, but when you’re having twins, these symptoms are typically a LOT stronger. Read this article about signs of twin pregnancy to learn more about the signs that you might be having twins.
It is understandable that pregnant women will be curious about the possibility of having multiples. If your doctor has requested additional blood draws in order to get a better idea of how hCG levels are changing, it could mean they suspect you may have twins on board. Keep an eye out for any other symptoms and contact your physician if anything seems off or unusual. And hang in there until you can get that ultrasound done and know for sure if you’re having twins!
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Pregnant with twins and not sure where to start? Visit the Ultimate Twin Pregnancy Guide to find all the top articles and resources to get you ready for twins.
While you’re at it, check out our expecting twin classes and Twiniversity shop!
The hCG table with twins by day and week is a way to make sure that the expectant mother is expecting two babies. Doctors also use such data when managing multiple pregnancies.
Human chorionic gonadotropin (hCG) is one of the most reliable ways to diagnose pregnancy.
Significance of the hormone and its features
Chorionic gonadotropin ensures the functioning of the corpus luteum, the production of progesterone, which protects the pregnancy, and provides nutrition to the fetus. Pregnancy is determined by the concentration of this hormone in the blood: the hormone is abundantly produced by the shell of the embryo after it has attached to the uterine wall and prepared for further development. nine0003
Rapid pregnancy tests are based on the determination of a high concentration of hCG in the urine.
The hormone is unique in its own way. It is produced in a small amount by the pituitary gland, so it is found in the blood of women of climatic age, with certain diseases (for example, oncology of the appendages or ovaries), and even in men.
How hCG levels change
For each pregnancy, the growth of human chorionic gonadotropin is unique, and a slight deviation of the indicators from the standard norms is allowed. But tabular data helps to understand the dynamics, to track how the pregnancy is progressing in the early stages. nine0003
Indicative hCG table for twins by week compared to singleton pregnancy.
| Pregnancy (weeks) | Concentration of hCG during multiple pregnancy (in mU/ml) | HCG concentration in singleton pregnancy (in mU/ml) |
|---|---|---|
| 1-2 | 50-340 | 25-156 |
| 2-3 | 208-9740 | 101-4870 |
| 3-4 | 2220-63 000 | 1110-31 500 |
| 4-5 | 5120-164 600 | 2560-82 300 |
| 5-6 | 46 200-302 000 | 23 100-151 000 |
| 6-7 | 54 600-466 000 | 27 300-233 000 |
| 7-11 | nine0036 41 800-582 000209 00-291 000 | |
| 11-16 | 12 280-206 000 | 6140-103 000 |
| 16-21 | 9440-160 200 | 4720-80 100 |
| 21-39 | 5400-156 200 | 2700-78 100 |
Until the 11th week, the hormone rapidly increases, after the 11th week its concentration decreases.
The table clearly shows that the level of hCG with twins is twice as high as with a singleton pregnancy. nine0003
Methods for determining the level of hCG
The level of hCG is determined in three ways. The hormone concentration is checked:
- rapid pregnancy test;
- laboratory blood test;
- laboratory analysis of urine.
Pregnancy tests intended for home use. do not show the amount of human chorionic gonadotropin in numbers. They only determine the sufficiency of the hormone, provide initial information about whether a woman has become pregnant or not. nine0003
After a home test, a woman goes to the doctors to confirm her pregnancy. Professional studies of urine and blood in laboratories show the exact amount of the hormone.
How to pass tests correctly
No special preparation is required for taking a blood test for hCG. The analysis is taken in the morning, on an empty stomach.
Blood is taken from a vein, the analysis will be recognized after a couple of hours or the next day (depending on the workload of the laboratory).
To pass urine for analysis, it is collected at home in a sealed container for analysis. Urine is collected in the morning and handed over to the laboratory in the morning. nine0003
Features of twin pregnancy during IVF
During in vitro fertilization (IVF), several embryos are implanted into the uterine cavity at once. This is done to increase the chance of getting pregnant. The replanting of several embryos often leads to the fact that a woman develops a multiple pregnancy. According to statistics, twins are born more often with in vitro fertilization than with natural conception.
After the embryo transfer, the woman's hCG level is already positive. With IVF, a pregnant woman takes tests every five days, starting from the day of embryo replanting. Such careful monitoring is important because early pregnancy with artificial insemination is especially difficult.
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A pregnant woman is closely monitored at the time when hCG is actively increasing: these are 10, 11, 12, 13, 14, 15, 16 weeks. At this time, it is important to keep track of the numbers, comparing them with previous readings. If hCG decreases rather than increases, this indicates serious fetal pathologies.
HCG table for twins after IVF
Compared to a singleton pregnancy, the hCG rate for twins after IVF is twice as high. A sharp increase in hCG is characteristic of a number of pathologies: cystic drift, preeclampsia, diabetes mellitus. Doctors carefully monitor the well-being of a pregnant woman in order to exclude a pathological increase in hCG. nine0003
The maximum concentration of hCG is observed at the 10th week of gestation. By this time, it reaches from 42,000 to 206,000 mU / ml. The level of hCG is measured on the 14th day after implantation of the fetus. By this time, the embryos are attached to the wall of the uterus (with a favorable development of pregnancy).
Average norms - hCG table with twins (IVF) by day.
| Pregnancy (days) | HCG concentration at twins (in mU / ml) |
|---|---|
| 14 | 60-340 |
| 15 | 80-540 |
| 16 | 140-800 |
| 17 | 240-1160 |
| 18 | 440-1680 |
| 19 | 740-2600 |
| 20 | 1100-4000 |
| 30 | nine0036 21 000-40 000|
| 40 | 50,000-110,000 |
| 50 | 10,000-300,000 |
| 60 | 40,000-400,000 |
| 70 | 40,000-200,000 |
| 80 | 35,000-180,000 |
| 90 | 30,000-120,000 |
Deviations
If the values in the analysis deviate, do not delay going to the doctor: immediately go to the appointment with the received data.
Especially dangerous is a sharp decrease in the concentration of hCG during the first weeks. If the hCG level is outside the normal range, the attending physician will prescribe additional studies to rule out possible pathologies.
HCG norms by weeks of pregnancy
HCG norms by weeks of pregnancy - Private maternity hospital Ekaterininskaya Clinics nine0002Content
- Table of average hCG norms
- Table of average hCG norms for carrying twins
- Table of average hCG values after IVF with engrafted twins
- Limits for free hCG β-subunit
- Norm РАРР-А
- What if I am at high risk?
- How to confirm or deny the results of screening?
- The doctor says I need an abortion. What to do?
One of the main tests during pregnancy is the study of the level of pregnancy hormone - hCG or human chorionic gonadotropin. If expectant mothers want to know if the hormone level is normal, we made a summary table of values
Table of average hCG norms:
| Gestation period | HCG in honey/ml | HCG in mIU/ml | HCG in ng/ml |
| 1-2 weeks | 25-156 | 5-25 (doubtful result) | - |
| 2-3 weeks | 101-4870 | 5-25 (doubtful result) | - |
| 3-4 weeks | 1100 – 31500 | 25-156 | - |
| 4-5 weeks | 2560 – 82300 | 101-4870 | - |
| 5-6 weeks | 23100 - 151000 | 1110 -31500 | - |
| 6-7 weeks | 27300 – 233000 | 2560 -82300 | - |
| 7-11 weeks | 20900 – 291000 | 23100 -233000 | 23. 7 - 130.4 |
| 11-16 weeks | 6140 – 103000 | 20900 -103000 | 17.4 - 50.0 |
| 16-21 weeks | 4720 – 80100 | 6140 – 80100 | 4.67 - 33.3 |
| 21-39 weeks | 2700 – 78100 | 2700 -78100 | - |
Table of average hCG norms when carrying twins:
| Gestation period, weeks | Mean range of hCG concentration (mU/ml) |
| 1-2 weeks | 50 – 112 |
| 2-3 weeks | 209 – 9740 |
| 3-4 weeks | 2220 – 63000 |
| 4-5 weeks | 5122 – 164600 |
| 5-6 weeks | 46200 – 302000 |
| 6-7 weeks | 54610 – 466000 |
| 7-11 weeks | 41810 – 582000 |
| 11-16 weeks | 12280 – 206000 |
| 16-21 weeks | 9440 – 160210 |
| 21-39 weeks | 5400 – 156200 |
Table of average hCG values after IVF with engrafted twins:
| Gestational age, weeks | HCG range, mU/ml |
| 1-2 weeks | 50 – 600 |
| 2-3 weeks | 3000 - 10000 |
| 3-4 weeks | 20000 – 60000 |
| 4-5 weeks | 40000 – 200000 |
| 5-6 weeks | 100000 – 400000 |
| 6-7 weeks | 100000 – 400000 |
| 7-11 weeks | 40000 – 200000 |
| 11-16 weeks | 40000 – 120000 |
| 16-21 weeks | 20000 – 70000 |
| 21-39 weeks | 20000 – 120000 |
Free hCG β-subunit limits
Measuring free hCG β-subunit levels can more accurately determine the risk of Down syndrome in an unborn child than measuring total hCG.
Norms for free β-hCG subunit in the first trimester:
| Gestational period, weeks | HCG in ng/ml |
|---|---|
| 9 weeks | nine0036 23.6 - 193.1 ng / ml, or 0.5 - 2 MoM|
| 10 weeks | 25.8 - 181.6 ng/mL or 0.5 - 2 MoM |
| 11 weeks | 17.4 - 130.4 ng/mL or 0.5 - 2 MoM |
| 12 weeks | 13.4 - 128.5 ng/mL or 0.5 - 2 MoM |
| 13 weeks | 14.2 - 114.7 ng/mL or 0.5 - 2 MoM |
Norms in ng / ml may vary in different laboratories, therefore the data indicated is not final, and in any case you should consult your doctor. If the result is indicated in MoM, then the norms are the same for all laboratories and for all analyzes: from 0.5 to 2 MoM. nine0618If hCG is abnormal, then:
- If the free hCG β-subunit is higher than normal for your gestational age, or more than 2 MoM, then the child has an increased risk of Down syndrome.
- If the free hCG β-subunit is below normal for your gestational age, or is less than 0.5 MoM, then the baby is at increased risk of Edwards syndrome.
PAPP-A norm
PAPP-A, or "pregnancy-associated plasma protein A" as it is called, is the second indicator used in first trimester biochemical screening. The level of this protein constantly increases during pregnancy, and deviations in the indicator may indicate various diseases in the unborn child. nine0003
Norm for PAPP-A depending on the duration of pregnancy:
Gestational period, weeks HCG in ng/ml 8-9 weeks 0.17 - 1.54 mU/ml, or 0.5 to 2 MoM 9-10 weeks 0.32 - 2.42 mU/ml or 0.5 to 2 MoM 10-11 weeks 0.46 - 3.73 mU/ml, or 0.5 to 2 MoM 11-12 weeks 0.79– 4.76 mU/ml, or 0.5 to 2 MoM 12-13 weeks 1. 03 - 6.01 mU/ml, or 0.5 to 2 MoM
13-14 weeks 1.47 - 8.54 mU/ml, or 0.5 to 2 MoM
Norms in ng / ml may vary in different laboratories, therefore the data indicated is not final, and in any case you should consult your doctor. If the result is indicated in MoM, then the norms are the same for all laboratories and for all analyzes: from 0.5 to 2 MoM. nine0618If PAPP-A is abnormal:
- If PAPP-A is lower for your gestational age, or less than 0.5 MoM, your baby is at increased risk of Down syndrome and Edwards syndrome.
- If PAPP-A is higher than normal for your gestational age, or more than 2 MoM, but other screening values are normal, then there is no cause for concern.
Studies have shown that a group of women with elevated PAPP-A during pregnancy is no more at risk of fetal disease or pregnancy complications than other women with normal PAPP-A. nine0003
What if I am at high risk?
If your screening reveals an increased risk of having a baby with Down syndrome, then this is not a reason to terminate the pregnancy.
You will be referred for a consultation with a geneticist who, if necessary, will recommend examinations: chorionic villus biopsy or amniocentesis
How to confirm or refute the screening results?
If you think the screening was not done correctly, then you should be re-examined at another clinic, but for this you need to retake all the tests and get an ultrasound. This method is possible only if the gestational age at the time of the examination does not exceed 13 weeks and 6 days. nine0003
The doctor says I need an abortion. What to do?
Unfortunately, there are times when a doctor strongly recommends or even forces an abortion based on screening results. Remember: no doctor has the right to such actions. Screening is not a definitive method for diagnosing Down syndrome and, based on poor results alone, a pregnancy should not be terminated.
Say that you want to consult a geneticist and undergo diagnostic procedures for Down syndrome (or other disease): chorionic villus biopsy (if you are 10-13 weeks pregnant) or amniocentesis (if you are 16-17 weeks pregnant).
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The author of the article:
Ananyina Anna Aleksandrovna
Obstetrician-gynecologist
Work experience since 2010
Sign upEat more foods rich in iron: beef tongue, liver, buckwheat and oatmeal, prunes, dried apricots, green apples, etc. But diet alone will not work to raise hemoglobin. nine0127 Medical therapy with iron supplements is required. If the problem is associated with insufficient intake of iron into the body, one set of drugs is needed, if with absorption, another. The doctor must select drugs.
Injection therapy may be required for more severe anemia.If there are no contraindications, natural childbirth is possible. Only an obstetrician-gynecologist should decide on the possibility of EP.
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With an increase in the duration of pregnancy and the growth of the baby, the uterus increases - this can lead to increased tone. Sometimes tension arises in response to the movements of the child. Strong physical exertion, stress, overwork of a pregnant woman can also lead to increased tone. nine0127 In early pregnancy, uterine tone may be associated primarily with reduced progesterone production. In this case, the doctor prescribes the patient treatment with progesterone preparations.
Symptoms of increased tone
All pregnant women experience tone differently. Someone - like heaviness and tension in the lower abdomen. Others - as a pulling pain in the lumbar region. In the 2nd and 3rd trimesters of pregnancy, a woman can feel the tone by putting her hand on her stomach: the uterus becomes "stone", then relaxes. nine0003Obstetrician-gynecologist
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