Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;34(5):495-503.
doi: 10.1111/ppe.12613. Epub 2020 Feb 13.

Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss

Lin Foo  1 , Sarah Johnson  2 , Lorrae Marriott  2 , Tom Bourne  1 , Phillip Bennett  1 , Christoph Lees  1
Affiliations

Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss

Lin Foo et al. Paediatr Perinat Epidemiol. 2020 Sep.

Abstract

Background: Lutenising hormone (LH) and human chorionic gonadotropin (hCG) hormone are useful biochemical markers to indicate ovulation and embryonic implantation, respectively. We explored "point-of-care" LH and hCG testing using a digital home-testing device in a cohort trying to conceive.

Objective: To determine conception and spontaneous pregnancy loss rates, and to assess whether trends in LH-hCG interval which are known to be associated with pregnancy viability could be identified with point-of-care testing.

Methods: We recruited healthy women aged 18-44 planning a pregnancy. Participants used a home monitor to track LH and hCG levels for 12 menstrual cycles or until pregnancy was conceived. Pregnancy outcomes (viable, clinical miscarriage, or biochemical pregnancy loss) were recorded. Monitor data were analysed by a statistician blinded to pregnancy outcome.

Results: From 387 recruits, there were 290 pregnancies with known outcomes within study timeline. Adequate monitor data for analysis were available for 150 conceptive cycles. Overall spontaneous first-trimester pregnancy loss rate was 30% with clinically recognised miscarriage rate of 17%. The difference to LH-hCG interval median had wider spread for biochemical losses (0.5-8.5 days) compared with clinical miscarriage (0-5 days) and viable pregnancies (0-6 days). Fixed effect hCG profile change distinguished between pregnancy outcomes from as early as day-2 post-hCG rise from baseline.

Conclusions: The risk of first-trimester spontaneous pregnancy loss in our prospective cohort is comparable to studies utilising daily urinary hCG collection and laboratory assays. A wider LH-hCG interval range is associated with biochemical pregnancy loss and may relate to late or early implantation. Although early hCG changes discriminate between pregnancies that will miscarry from viable pregnancies, this point-of-care testing model is not sufficiently developed to be predictive.

Keywords: biochemical pregnancy; hCG; miscarriage; ovulation.

PubMed Disclaimer

Conflict of interest statement

SJ and LM are employees of SPD Development Company Ltd., a fully owned subsidiary of SPD Swiss Precision Diagnostics GmbH; the manufacturer of the Clearblue fertility monitor used in this study.

Figures

Figure 1
Figure 1
Digital monitor HPT (home pregnancy test) test line signal data for biochemical, miscarriage, and viable pregnancies and fixed effect profile models for each group. HPT test line signal data equates to the amount of hCG present in the urine sample tested
See this image and copyright information in PMC

References

    1. Wang X, Chen C, Wang L, et al. Conception, early pregnancy loss, and time to clinical pregnancy: a population‐based prospective study. Fertil Steril. 2003;79(3):577‐584. - PubMed
    1. Wilcox AJ, Weinberg CR, O'Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319(4):189‐194. - PubMed
    1. Roos J, Johnson S, Weddell S, et al. Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation. Eur J Contraception Reprod Health Care. 2015;20(6):438‐450. - PubMed
    1. Gnoth C, Johnson S. Strips of Hope: Accuracy of Home Pregnancy Tests and New Developments. Geburtshilfe Frauenheilkd. 2014;74(7):661‐669. - PMC - PubMed
    1. Johnson SR, Miro F, Barrett S, et al. Levels of urinary human chorionic gonadotrophin (hCG) following conception and variability of menstrual cycle length in a cohort of women attempting to conceive. Curr Med Res Opin. 2009;25(3):741‐748. - PubMed

Publication types