You peed on a stick and it changed colors. Yay!  You’re pregnant. That pee test shows that your levels of a pregnancy hormone, hCG, has risen.

This rise in hCG is the first in many changes to hormone levels over the course of a pregnancy. Testing your hormone levels can also show you how well your pregnancy is progressing — and whether you’re at a high risk for early miscarriage.

Here is a quick overview graph showing how hormones change to get us started on this topic:

(Graph from wikimedia.org – Creative Commons License)

hCG levels from conception to birth

Human chorionic gonadotropin, or hCG, is what you are checking for on a pregnancy test. hCG will show up on a urine test about 12-14 days after conception.  Blood tests are even more sensitive and can detect the rise in hCG levels about 10 days after conception.

For most women, hCG levels will double every 72 hours. The rising levels will peak around the third month of pregnancy and then decline to a steady level for the rest of the pregnancy.

What does it mean if the hCG level isn’t rising?

One early sign of miscarriage is a fall in the hCG levels during the first two months of pregnancy. A low or falling hCG level could also show an ectopic pregnancy.

The amount of hCG produced during the first weeks of pregnancy varies a lot between women.  The change in increase is more important than the numerical value.

For example, during week six of pregnancy, the normal range for hCG is between 1,080 – 56,500 mIU/mL.  That is a huge range! It is more important to know the increase in hCG over a 72 hour period. So you will need to test hCG levels twice, at least a couple of days apart. (source)

For most women undergoing IVF, the hCG levels on day 12 and 14 can actually predict whether the pregnancy will be successful. Your fertility doctor may check your levels at that point to get an idea of how the pregnancy will proceed. (study)

What is hCG actually doing in your body?

Inside the ovary, your body forms a temporary endocrine structure called the corpus luteum. The corpus luteum surrounds the oocyte (immature egg cell) and produces hormones needed for pregnancy.

Progesterone is one hormone that the corpus luteum makes. It causes a thickening the uterine wall in preparation for receiving a fertilized egg.

If the oocyte isn’t fertilized, the corpus luteum naturally stops producing progesterone and degenerates. This happens each month during a normal menstrual cycle.

If the oocyte is fertilized, it will produce human chorionic gonadotropin (hCG). The hCG hormone signals the corpus luteum to continue secreting progesterone. The progesterone causes the thickening of the uterine lining, increasing blood vessel formation to support the developing baby.

Once the placenta fully forms, it will take over the production of progesterone for the remainder of the pregnancy. hCG levels then decline as the placenta takes over progesterone production.

Progesterone levels from conception to birth:

Progesterone levels rise quickly after fertilization and continue that trend throughout the first trimester.

Besides preparing the uterus to support the growing baby, progesterone also balances the immune system during pregnancy. (study) This helps your body to not reject the baby as ‘foreign’ DNA. This is also why many women find that their allergies go away during pregnancy.

Low progesterone levels during the first trimester, though, could increase the risk of miscarriage.

About 15-20% of women have spotting or bleeding during the first couple of months of pregnancy. While alarming, the bleeding doesn’t always indicate a miscarriage. Only about 25% of women with spotting will go on to have a miscarriage, although that risk rises for women over age 34. (study)

Studies show that progesterone levels of less than 35 nmol/L (11 ng/ml) indicate a high risk of miscarriage before week 16 of pregnancy. (study)  According to the American Pregnancy Association, “They (progesterone levels) can range from 9-47 ng/ml in the first trimester, with an average of 12-20ng/ml in the first 5-6 weeks of pregnancy.”

Some doctors may prescribe progesterone to women with low levels during the first trimester, especially for women with previous miscarriages.

Clinical trials on progesterone supplementation have given mixed results, though, so not all doctors support prescribing progesterone.

A recent meta-analysis that combined the information from nine randomized control trials found that the number of miscarriages was a lower in the groups given progesterone compared to the control groups. (study)

Testing:

If you’re working with a natural health care provider like an acupuncturist, consider testing your hCG and progesterone levels as soon as you find out you’re pregnant so that you can be supported during your pregnancy as needed.

However, unless you’re working with a fertility doctor such as a reproductive endocrinologist, it may be difficult to have your ob/gyn order your hCG and progesterone levels when you first find out you’re pregnant.

Most doctors follow the standard protocol of having a pregnant woman wait until the 7th or 8th week of pregnancy for the first exam.

Be insistent about wanting the tests done asap because of your age, history of previous miscarriage (if applicable), and/or length of time to get pregnant.

You’ll also want to have a hCG done 3 days after the initial hCG to see if it doubles.

If you have problems getting your doctor to order the tests, you can order them online using the links below:

• hCG
• Progesterone

Once you pay for the orders, you can take the requisition to a Quest lab and the results will be emailed directly to you.

Supporting hormones through diet:

Regardless of the blood tests, one thing you can control in your early pregnancy is your diet and making the appropriate changes to provide nutrients essential for your baby.

Progesterone is made in your body by converting cholesterol into pregnenolone and then into progesterone. While most people have plenty of cholesterol available, making sure that your diet includes enough fat from healthy sources is also critical for the continuation of a thriving baby. Pasture-raised eggs are a great way to get a healthy dietary source of cholesterol.

Animal studies show that high fructose intake can decrease progesterone levels, leading to problems in pregnancy. (study) Avoid foods and drinks containing high fructose corn syrup. While most people know to avoid soda, high fructose corn syrup may also be in your yogurt, salad dressing, or nutrition bars. Read those labels!

Folate has been shown in several studies to increase progesterone levels in women. (study) This is just one more reason among many to make sure that you are getting plenty of folate. You should eat folate rich foods along with taking a good prenatal vitamin that contains methylfolate.  Read more about the importance of folate for fertility and to prevent miscarriages.