Slide 1 --- Title Slide 2 Beta HCG Facts The hormone HCG is a hormone secreted during pregnancy.

(thats why its 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 -subunit (beta- subunit) of hCG (-hCG).

 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 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, -HCG is an excellent tumor marker for the monitoring of germ cell tumors.

Source WIKIPEDIA

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 Bremners 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.

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 hCG 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.

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 Bremners 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

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 Bremners 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 Bremners Infertility web.

Slide 18 Beta - HCG Normal Values ---- (Title)

Slide 19

weeks since LMP 3 4 5 6 78 9 12 13 16 17 24 25 40 Non-pregnant females Postmenopausal females

mIU/mL 5 50 5 426 18 7,340 1,080 56,500 7,650 229,000 25,700 288,000 13,300 254,000 4,060 165,400 3,640 117,000 <5.0 <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 hCG (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.

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 (hCG) 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.