The Problem of Early Detection Pregnancy Tests

During research for my book Facing Miscarriage, I stumbled across an article in the British news source, The Telegraph, talking about a “panic” that spread across the UK when early detection home pregnant tests first became available a few years ago.

I didn’t find any similar articles in US papers, but it’s easy to see why the new home pregnancy tests could cause a flurry of concern.

Old-style tests, manufactured prior to 2004, typically looked for a pregnancy hormone level of 50-100 mIU/ml and were not effective until the day a woman missed her period, on average, about 14 days post fertilization. This is when the baby is well implanted and the miscarriage rate is expected to be between 8 and 20 percent.

The new tests, however, detect the hormone at 20 mIU/ml. This is within a day or two of implantation, more like 9-10 days after fertilization.

Since the advent of early sonography, we’ve known that a huge number of fertilized eggs either never implant at all, or attempt implantation and fail. This number varies depending on who you ask, but is always frighteningly high — between 50 and 75 percent.

For many moms, working so hard to achieve pregnancy and the family of their dreams, this is a terrible and sad loss. The emotional pain in getting their period after seeing a positive pregnancy test is often strong and frightening.

These early losses, however, almost never indicate a problem that needs treatment. The fusing of the egg and sperm’s genetic material is tricky and often goes awry, either misaligning or dividing improperly in early cell growth. When the egg with chromosomal errors bumps against the uterus, the body will start the implantation process. This sets off the manufacture of pregnancy hormone, but often, the lining rejects the egg. In this case, the woman’s body will register a fleeting rise in pregnancy hormone even though the baby could not implant and grow. The new tests are so sensitive as to catch the temporary rise.

This early chromosomal rejection has no bearing on the health of the mother or her ability to carry children to term. The rush of hospital visits by distressed moms causes extra upset and frustration. They often find they are simply turned away. Others might be subjected to invasive and unnecessary tests. The problem amplifies — moms want their babies to be recognized from conception, and health care providers want to maintain a simplicity in diagnosis and treatment of clinically recognized pregnancy and miscarriage.

As I write what I hope to be the newest book about miscarriage and how to get through it, I will address the issue of the new definition of miscarriage. Do we adjust our statistics and scare women with the real figure — that over half of their pregnancies will be lost before week 5? And how do we decide when a woman actually needs intervention for recurring miscarriages? Do early losses simply “not count” anymore? I do wish sites like this one that advocate super-early testing also include a reminder of how common an early loss can be.

Perhaps we will rewrite the rules based on our early detection of pregnancies, creating a hierarchy of risk based on gestational age. But the rules will be for treatment and clinical relevance only. Our babies are our babies, whether at 16 cells or fully formed in our waiting arms.

8 thoughts on “The Problem of Early Detection Pregnancy Tests

  1. Thank you so much for developing and publishing this site. It is helping me go through what I’m undergoing now. I am miscarrying now. My husband and I have decided to go through it naturally. We are both sad and grieving now but all the articles and stories here are really helpful to both of us, especially to me.

    I am 36 y/o on my 11-12 weeks, with my first pregnancy. That coupled with a number of other conditions that I have: endometriosis, PCOS, blocked left fallopian tube, among others, makes me a high risk patient according to my ob/gyn-perinatologist. In fact, after my ultrasound yesterday when we found out that the gestational sac had already collapsed with subchrionic hemorrhaging already present, my doc told me I’m really a super high risk patient. Be that as it may, I’m really grateful for her kindness, patience and compassion.

    As I am writing this, I feel a sense of peace. Again, thank you.

  2. I just had a very early miscarriage – the highest my hcg tested was 80. Unfortunately, this is my fourth failed pregnancy in a row. I have a 2 1/2 year old daughter – she was my first pregnancy.

    My first miscarriage was at around 10 weeks – after I’d heard a heartbeat. The 3 subsequent pregnancies haven’t made it past 7 weeks. We think one was an ectopic.

    My husband and I are going to see my OB this week to discuss what to do next. We think it may be a hormone issue, but these last 2 miscarriages happened while I was taking Letrizole.

    Somewhere in my heart I almost feel like it’s just not my time yet to have another baby. My daughter is a joy and we have a good life, which, like many people is filled with outside stresses including a father with Alzheimer’s and a mother who is not taking care of herself b/c of his illness. They are in financial dire stress and rely on us for a lot. So – maybe this is my time to help support them and an baby may come when I’m ready to concentrate on me again. Who knows.

    Regarding testing…I tested on Day 29 (which I thought was Day 1) b/c I started bleeding. Test was Negative. when my period lasted over 7 days I knew something was up. That’s when I took the test and got a faint line. Got the blood test that came back at 80. So there I was more or less hoping it was failing b/c I’d already started taking the Letrizole which is a big no no if you’re pregnant. Screwed up, eh?

    Thanks for letting me vent.

  3. Make sure you love your doctor and feel s/he is doing everything possible. Four losses in a row are indeed very suspicious and sometimes stimulating egg development when you don’t need it can lead to the body ovulating poor quality eggs, causing more miscarriage. Talk to your OB about the drug, especially since you inadvertently took it at the wrong time. Letrozole is a highly dangerous drug for embryos.

  4. Deanna~
    My misscarriage was on Sept 2. The bleeding stopped after a week and a half. Now it is October 17 and I have not gotten my first period after the misscarriage. How long before I should be concerned?
    Thank you~
    Debbie

  5. I have never taken a test more sensitive than 25, but was very appreciative of this article and the “heads up” about how many pregnancies are lost very early. After having 5 healthy pregnancies in a row, I just recently experienced 2 miscarriages in a row. The most recent one was in the 4th week. I tested on day 30, and started bleeding on day 33. I am wondering if it is time for me to get testing, or were these miscarriages likely just a random thing because I 36 years old now..? Does anyone have thoughts on this..?

    Thank you for this website, it’s a blessing!
    Lisa

  6. Hi all
    I had a with held miscarriage my first time around (last year march) baby stopped growing at 8 weeks and I was suppose to be 12 weeks it was heart breaking to hear that my baby had no heart beat at all, I am pregnant now again but started bleeding at week 5 I was bleeding for 5 days and then it stopped, I am so scared I am going to miscarry again I am to afraid to even take a pregnancy test (don’t want to take the chance of getting a negative result) however my next appointment is on thursday so I don’t know I am hoping for the best…all though I am expecting the worst due to me not having any pregnancy symptoms I just feel to good to be pregnant I often forget that I am pregnant.

  7. Miscarriage, the bleeding stopped after a week and a half,If you have just discovered you are pregnant but you aren’t sure when you became pregnant your chosen healthcare professional might also recommend an ultrasound.

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