What is human chorionic gonadotropin (hCG)?
Human chorionic gonadotropin is a special hormone protein that is produced by the membranes of the developing embryo during the entire period of pregnancy. HCG supports the normal development of pregnancy. Thanks to this hormone, the processes that cause menstruation are blocked in the body of a pregnant woman and the production of hormones necessary to maintain pregnancy increases.

An increase in the concentration of hCG in the blood and urine of a pregnant woman is one of the earliest signs of pregnancy.

The role of hCG in the first trimester of pregnancy is to stimulate the formation of hormones necessary for the development and maintenance of pregnancy, such as progesterone, estrogens (estradiol and free estriol). With the normal development of pregnancy in the future, these hormones are produced by the placenta.

Chorionic gonadotropin very important. In the male fetus, chorionic gonadotropin stimulates the so-called Leydig cells, which synthesize testosterone. Testosterone in this case is simply necessary, as it contributes to the formation of the genital organs according to the male type, and also has an effect on the adrenal cortex of the embryo. HCG consists of two units - alpha and beta hCG. The alpha component of hCG has a similar structure to the units of the hormones TSH, FSH and LH, and the beta hCG is unique. Therefore, in the diagnosis, laboratory analysis of b-hCG is of decisive importance.

Small amounts of human chorionic gonadotropin are produced by the human pituitary gland even in the absence of pregnancy. This explains the fact that in some cases very low concentrations of this hormone are determined in the blood of non-pregnant women (including women during menopause) and even in the blood of men.

Permissible levels of hCG in the blood of non-pregnant women and men

How does the human chorionic gonadotropin level change during pregnancy?

With the normal development of pregnancy, hCG is determined in the blood of pregnant women from about 8-11-14 days after conception.

The level of hCG rises rapidly and, starting from the 3rd week of pregnancy, doubles approximately every 2-3 days. The increase in the concentration in the blood of a pregnant woman continues until about 11-12 weeks of pregnancy. Between 12 and 22 weeks of pregnancy, the concentration of hCG decreases slightly. From 22 weeks until delivery, the concentration of hCG in the blood of a pregnant woman begins to increase again, but more slowly than at the beginning of pregnancy.

By the rate of increase in the concentration of hCG in the blood, doctors can determine some deviations from the normal development of pregnancy. In particular, in an ectopic pregnancy or miscarriage, the rate of increase in the concentration of hCG is lower than in a normal pregnancy.

Accelerating the rate of increase in the concentration of hCG may be a sign of hydatidiform mole (chorionadenoma), multiple pregnancy, or fetal chromosomal diseases (for example, Down's disease).

There are no strict standards for the content of hCG in the blood of pregnant women. HCG levels at the same gestational age can vary significantly from woman to woman. In this regard, single measurements of hCG levels are not very informative. To assess the development of pregnancy, the dynamics of changes in the concentration of chorionic gonadotropin in the blood is important.

Days since last period	Gestational age	Nomes of the hCG level for this period mU / ml

human chorionic gonadotropin chart

Norms of human chorionic gonadotropin in blood serum

Note!

In the last table, the weekly norms are given for the terms of pregnancy "from conception" (and not for the terms of the last menstruation).

Anyway!
The above figures are not a standard! Each laboratory can set its own standards, including the weeks of pregnancy. When evaluating the results of the hCG norm by week of pregnancy, you need to rely only on the norms of the laboratory where you were tested.

Tests to determine the level of hCG

To determine the level of hCG, various laboratory blood tests are used that can detect pregnancy for a period of 1-2 weeks.

The analysis can be taken in many laboratories in the direction of a gynecologist and independently. No special preparation for the blood test is required. However, before you get a referral for a test, be sure to tell your doctor about all the medications you are taking, as some medications can interfere with the test results. The analysis is best taken in the morning, on an empty stomach. For a higher reliability of the test, it is recommended to exclude physical activity on the eve of the study.

By the way, home express pregnancy tests are also built on the principle of determining the level of hCG, but only in the urine, not in the blood. And it should be said that compared to a laboratory blood test, this one is much less accurate, since the level in the urine is two times lower than that in the blood.

A laboratory test for determining pregnancy in the early stages is recommended to be carried out no earlier than 3-5 days of delayed menstruation. The blood test for pregnancy can be repeated after 2-3 days to clarify the results.

To identify fetal pathology in pregnant women, an analysis for chorionic gonadotropin is taken from the 14th to the 18th week of pregnancy. However, in order for the diagnosis of possible fetal pathologies to be reliable, it is necessary to pass more than one blood test for hCG. Together with hCG, the following markers are given: AFP, hCG, E3 (alpha-fetoprotein, human chorionic gonadotropin, free estriol.)

Serum levels of AFP and CG during physiological pregnancy

Pregnancy period, weeks	AFP, average level	AFP, min-max	CG, medium level	CG, min-max
14	23,7	12 - 59,3	66,3	26,5 - 228
15	29,5	15 - 73,8
16	33,2	17,5 - 100	30,1	9,4 - 83,0
17	39,8	20,5 - 123
18	43,7	21 - 138	24	5,7 - 81,4
19	48,3	23,5 - 159
20	56	25,5 - 177	18,3	5,2 - 65,4
21	65	27,5 - 195
22	83	35 - 249	18,3	4,5 - 70,8
24			16,1	3,1 - 69,6

Can an hCG test “make a mistake” in determining pregnancy?

HCG levels that are out of the norm for a particular week of pregnancy can be observed if the gestational age is incorrectly established.

Laboratory analyzes can be wrong, but the probability of error is very small.

Decryption

Normally, during pregnancy, the level of human chorionic gonadotropin gradually increases. During the 1st trimester of pregnancy, the level of b-hCG rises rapidly, doubling every 2-3 days. At 10-12 weeks of pregnancy, the highest level of hCG in the blood is reached, then its content begins to slowly decrease and remains constant during the second half of pregnancy.

An increase in beta-hCG during pregnancy can occur with:

• multiple pregnancies (the rate increases in proportion to the number of fetuses)
• toxicosis, gestosis
• maternal diabetes
• fetal pathologies, Down syndrome, multiple malformations
• incorrect gestational age
• taking synthetic gestagens

An increase in human chorionic gonadotropin can be a sign of serious diseases in non-pregnant women and in men:

• production of hCG by the pituitary gland of the examined woman testicular tumors
  tumor diseases of the gastrointestinal tract
  neoplasms of the lungs, kidneys, uterus
  hydatidiform mole, recurrence of hydatidiform mole
  chorioncarcinoma
  taking hCG medications
  the analysis was done within 4–5 days after the abortion, etc.

  Usually chorionic gonadotropin is elevated if the test was performed on the 4-5th day after the abortion or due to the use of hCG preparations.

  Low hCG in pregnant women, it may mean an incorrect setting of the term for determining pregnancy or be a sign of serious violations:

  • ectopic pregnancy
  • non-developing pregnancy
  • fetal growth retardation
  • the threat of spontaneous abortion (reduced by more than 50%)
  • chronic placental insufficiency
  • true miscarriage
  • fetal death (in the II-III trimester of pregnancy).
  It happens that the results of the analysis show the absence of a hormone in the blood. This result can be if the test was performed too early or during an ectopic pregnancy.

  Whatever the result of the analysis for hormones during pregnancy is, remember that only a qualified doctor can give the correct decoding, determining which hCG is the norm for you in combination with the data obtained by other examination methods.

Video. Prenatal Screening - HCG

One of the main tests during pregnancy is the study of the level of the pregnancy hormone - hCG or human chorionic gonadotropin.

HCG is a protein with hormonal activity that begins to be produced during the formation of the embryo and is produced throughout pregnancy.

It was thanks to hCG and simple methods for its determination that pregnancy tests appeared - they are sensitive precisely to the appearance of this hormone in the urine (a test strip in the presence of a hormone in the urine gives color, the more hormone, the brighter the test strip will be).

general information

HCG is necessary for the development and maintenance of pregnancy, it blocks the menstrual cycle and activates the production of other hormones necessary to maintain pregnancy - estrogens and progesterone.

The pituitary gland produces the minimum amount of hCG even in the absence of pregnancy, but its concentration is so low that it is not detected by pregnancy tests.

The level of the hCG hormone in men and women outside of pregnancy is 0-5 IU, during menopause up to 9 IU is acceptable.

HCG during pregnancy can increase from the moment the fertilized egg enters the uterine cavity. Therefore, by the level of the hormone, it is possible to determine the presence or absence of pregnancy almost from the first weeks, even before the delay of menstruation. HCG can be determined in urine and blood, but its level in the blood rises faster and more actively than in urine.

In the first 2 weeks of pregnancy, the level of the hormone is still small to be detected by a pregnancy test in the urine, and the determination of the level of hCG in the blood is already possible.

In the future, monitoring of hCG is necessary for doctors to detect certain pathologies in the development of the fetus or the normal course of pregnancy.

The level of hCG rises not only during normal pregnancy, but also during ectopic, as well as within a few days after an abortion, and with some hormonally active tumors.

Preparation for analysis

A blood test is taken from a vein on an empty stomach, it is first necessary not to eat or drink for about 4-6 hours.

It is necessary to exclude on the eve of the study sexual contacts and physical activity.

When taking an analysis for hCG, it is necessary to warn the doctor about taking hormonal drugs - duphaston or utrogestan, other hormones and insulin.

The timing of the first analysis may vary - laboratories determine the level of hCG in the blood from 2-3 weeks of pregnancy, but a single analysis is not indicative and a repeat of the study is necessary after 2-3 weeks.

Additionally, an analysis is carried out for hCG at 14-18 weeks of pregnancy as part of a triple test (with estriol and AFP).

Values ​​during pregnancy

A significant increase in the level of hCG for diagnosis occurs already from the 10th day of implantation, and after 2-3 days from the moment of delay of menstruation, pregnancy can be confidently diagnosed by the level of hCG in urine and blood.

It is worth remembering that the level of hCG in the blood is 2-3 times higher than the level in the urine - with a slight delay, pregnancy tests can still be negative. While in the blood, the level of hCG is already high.

The amount of the hormone rises twice daily, and after 1-2 weeks from the onset of the delay, any pregnancy test will already show a clear positive result.

The level of hCG reaches its maximum values ​​by about 7-8 weeks of pregnancy, in the future, its level remains steadily elevated, slightly decreasing as the placenta develops and gestational age.

HCG decoding

This table shows the terms by weeks from CONCEPTION. If you count hCG by obstetric weeks (from the date of the last menstruation), then add 2 weeks.

• At 1-2 weeks, it is up to 300 IU,
• At 3 weeks - up to 5000 IU,
• At 4 weeks up to 30000 IU,
• At 5 weeks - 100,000 IU,
• At 6 weeks - 150,000 IU,
• At 7 weeks up to 200,000 IU,
• At 10 weeks 150-200000 IU,
• At 12 weeks - about 90,000 IU,
• At 14 weeks - 60000 IU,
• At 25 - 40,000 IU,
• At 35 weeks - 40000-60000 IU.

Low hCG

A low level of hCG that does not correspond to the gestational age can occur with some problems with pregnancy:

• with an ectopic pregnancy, when the hormone level drops by almost half of normal,
• with fetal death and missed pregnancy,
• with delayed fetal development,
• with the threat of termination of pregnancy,
• with chronic placental insufficiency and overdose.

However, the interpretation of the result should be made by the doctor, taking into account the norms of the laboratory, the data of the examination of the ultrasound results.

An ectopic pregnancy is the implantation of a fertilized egg in the tubes or abdominal cavity, which leads to abnormal development of pregnancy and serious abnormalities.

Usually, in this condition, the level of hCG first rises, but not as much as during a uterine pregnancy, it is usually 2/3 lower than the standard values. And from 5-6 weeks, hCG levels begin to progressively decrease. However, the data must be confirmed by examination with ultrasound and the detection of an ectopic embryo in the tube or abdominal cavity.

With a frozen pregnancy, the level of hCG begins to progressively decrease from the moment of fetal death and the cessation of pregnancy. Usually, with a decrease in the level of hCG, toxicosis also gradually disappears.

High hCG

An increase in hCG in men and non-pregnant women may indicate the development of a malignant tumor.

For the most part, a high level of hCG is not a pathology during pregnancy, it can be a sign of multiple pregnancy, toxicosis, but when combined with an elevated level of the hormone with other indicators, it can be a harbinger of preeclampsia or diabetes.

The combination of high hCG with low levels of AFP and estriol may indicate an increased risk of having a child with a genetic pathology.

Reliability of results

Laboratory analyzes are accurate and errors are rare. A false positive response may occur when taking hCG preparations in the treatment of infertility, with certain tumors and diseases. False negative - due to assembly or reagent defects.

Chorionic gonadotropin: instructions for use and reviews

Latin name: Gonadotrophin chorionic

ATX Code: G03GA01

Active substance: chorionic gonadotropin (Chorionic Gonadotropin)

Manufacturer: Moscow Endocrine Plant (Russia)

Description and photo update: 22.10.2018

Chorionic gonadotropin is a drug with gonadotropic, follicle-stimulating and luteinizing effects.

Release form and composition

The dosage form of Chorionic Gonadotropin is a lyophilizate for the preparation of a solution for intramuscular (i / m) administration: lyophilized almost white or white powder (in glass tube vials, in blister packs 5 vials complete with 5 1 ml solvent ampoules, in a carton pack 1 pack).

Composition of 1 vial:

• active substance: chorionic gonadotropin - 500, 1000, 1500 or 5000 IU (international units);
• auxiliary component: mannitol (mannitol) - 20 mg.

Solvent: 0.9% sodium chloride injection - 1 ml.

Pharmacological properties

Pharmacodynamics

Chorionic gonadotropin has a luteinizing, follicle-stimulating and gonadotropic effect, while luteinizing activity is higher than follicle-stimulating.

The active substance of the drug - human chorionic gonadotropin (hCG), is a gonadotropic hormone produced by the placenta during pregnancy (excreted by the kidneys unchanged). The method of obtaining a substance for the drug is extraction from urine with subsequent purification.

HCG is necessary for women and men for normal growth and maturation of gametes, as well as for the production of sex hormones.

The drug stimulates the development of the genital organs and secondary sexual characteristics. In addition, it promotes ovulation and stimulates the synthesis of estrogens (estradiol) and progesterone in women, and also stimulates spermatogenesis, the production of dihydrotestosterone and testosterone in men.

Pharmacokinetics

After the / m introduction is well absorbed. The half-life is 8 hours.

Achieving the maximum plasma concentration of hCG in the blood is observed after 4-12 hours. The half-life of chorionic gonadotropin is approximately 29-30 hours, with daily use, cumulation of the drug can be observed.

Chorionic gonadotropin is excreted by the kidneys. Approximately 10-20% of the administered dose is found unchanged in the urine, the main part is excreted as fragments of the β-chain.

Indications for use

Chorionic gonadotropin 1500, 1000 and 500 IU

• maintenance of the corpus luteum phase;
• amenorrhea, anovulatory ovarian dysfunction.

Men and boys:

• delayed puberty associated with insufficiency of the gonadotropic function of the pituitary gland;
• oligoastenospermia, insufficiency of spermatogenesis, azoospermia;
• cryptorchidism, which is not associated with anatomical obstruction;
• conducting a Leydig functional test to assess testicular function in hypogonadotropic hypogonadism before prescribing long-term stimulation therapy;
• conducting a differential diagnostic test for cryptorchidism / anorchism in boys.

• induction of ovulation in infertility, which is caused by anovulation or impaired maturation of follicles;
• preparation of follicles for puncture in programs of controlled ovarian hyperstimulation (for additional reproduction techniques);
• maintenance of the corpus luteum phase.

• hypogonadotropic hypogonadism;
• conducting a Leydig functional test to assess testicular function in hypogonadotropic hypogonadism before prescribing long-term stimulant therapy.

Contraindications

Absolute:

• hormone-dependent malignant tumors of the genital organs and breast (diagnosed or suspected), including ovarian cancer, breast cancer, uterine cancer in women, and prostate cancer, breast carcinoma in men;
• organic lesions of the central nervous system (tumors of the hypothalamus, pituitary gland);
• thrombophlebitis of deep veins;
• hypothyroidism;
• adrenal insufficiency;
• hyperprolactinemia;
• precocious puberty in boys (for 500, 1000 and 1500 IU);
• infertility that is not associated with hypogonadotropic hypogonadism in men;
• children's age up to 3 years (for 500, 1000 and 1500 IU);
• individual intolerance to the components of the drug.

Additional absolute contraindications for the use of the drug in women:

• bleeding or spotting from the vagina of unknown origin;
• improper formation of the genital organs, which is incompatible with pregnancy;
• primary ovarian failure;
• fibrous tumor of the uterus, which is incompatible with pregnancy;
• a history of ovarian hyperstimulation syndrome (OHSS) (for 5000 IU);
• infertility that is not associated with anovulation (for example, tubal or cervical origin, for 500, 1000 and 1500 IU);
• polycystic ovary syndrome (PCOS) (for 5000 IU);
• pregnancy and breastfeeding period.

Relative (diseases / conditions in the presence of which the appointment of Chorionic Gonadotropin requires caution):

• thrombosis risk factors (aggravated personal/family history, severe obesity with body mass index > 30 kg/m 2 , thrombophilia, etc.);
• prepubertal age in boys - for a dose of 500, 1000 and 15000 IU;
• latent or overt heart failure, impaired renal function, arterial hypertension, epilepsy, migraine, including indications of these diseases / conditions in history - for men;
• bronchial asthma.

Instructions for use Chorionic Gonadotropin: method and dosage

The drug is administered intramuscularly slowly, after the preliminary addition of the solvent to the lyophilisate.

The dosage regimen can be adjusted by the doctor individually.

Chorionic gonadotropin 1000, 500 or 1500 IU

• anovulatory cycles: 2-3 times with an interval of 2-3 days, 3000 IU, from 10-12 days of the menstrual cycle, or 6-7 injections - every other day, 1500 IU;

Men and boys:

• hypogonadotropic hypogonadism: 2-3 times a week for 1000-2000 ME. In cases of infertility, a drug containing follitropin (follicle-stimulating hormone) may be additionally prescribed. The duration of the course, in which any improvement in spermatogenesis can be expected, is at least 3 months. During the period of use of the drug, testosterone replacement therapy should be suspended. After improvement in order to maintain the result of a sufficiently isolated use of Chorionic Gonadotropin;
• delayed puberty due to insufficiency of the gonadotropic function of the pituitary gland: 2-3 times a week for 1500 ME course of at least 6 months;
• cryptorchidism not due to anatomical obstruction: 2 times a week, 500-1000 IU for children 3-6 years old or 1500 IU for children over 6 years old; if necessary, repeat the therapy;
• insufficiency of spermatogenesis, oligoasthenospermia, azoospermia: 500 IU daily in combination with menotropin (75 IU of follicle-stimulating and luteinizing hormone) or every 5 days, 2000 IU in combination with menotropin (150 IU of follicle-stimulating and luteinizing hormone) 3 times a week for a course of 3 month. In cases of insufficient effect or its absence, the drug is prescribed 2-3 times a week for 2000 IU in combination with menotropin (150 IU of follicle-stimulating and luteinizing hormone) 3 times a week for a course of 3-12 months. After improvement of spermatogenesis, maintenance doses of Chorionic Gonadotropin can be administered in some cases;
• differential diagnosis of anorchism / cryptorchidism in boys: a single dose of 100 IU / kg, the serum concentration of testosterone in the blood is determined before the start of the test and 72-96 hours after the injection. With anorchism, the test will be negative, which is evidence of the absence of testicular tissue; with cryptorchidism, in cases where even only one testicle is present, positive (5-10-fold increase in testosterone concentration). If the test is weakly positive, a search for the gonad (laparoscopy or abdominal ultrasound) is required, as there is a high risk of malignancy.

Chorionic gonadotropin 5000 IU

• induction of ovulation in infertility, which is caused by anovulation or impaired maturation of follicles, preparation of follicles for puncture in programs of controlled ovarian hyperstimulation: once 5000–10,000 IU to complete therapy with follicle-stimulating hormone preparations;
• maintenance of the corpus luteum phase: 2-3 injections of 1500-5000 IU for 9 days after ovulation or embryo transfer (for example, 1 time in three days).

• hypogonadotropic hypogonadism: 1500-6000 IU once a week. In cases of infertility, hCG can be administered with a preparation containing follitropin, 2-3 times a week. The duration of the course, in which any improvement in spermatogenesis can be expected, is at least 3 months. During this period, testosterone replacement therapy should be suspended. After improvement, in order to maintain the result, in some cases Chorionic Gonadotropin is used in isolation;
• Leydig functional test: 5000 IU daily for 3 days (at the same time). After the last injection, the next day, blood is taken and testosterone levels are tested. The sample is evaluated as positive in cases where there is an increase of 30–50% or more from the initial values. It is preferable to combine this test with another spermogram on the same day.

Side effects

• immune system: in rare cases - fever, generalized rash;
• local reactions at the injection site and general disorders: pain, bruising, redness, itching, swelling; in some cases - allergic reactions (rash / pain at the injection site), increased fatigue.

Chorionic gonadotropin 500, 1000 and 1500 IU

• nervous system: dizziness, headache;
• metabolism and nutrition: edema.

Men and boys:

• subcutaneous tissues and skin: acne;
• endocrine system: premature puberty;
• genitals and mammary gland: gynecomastia, penis enlargement, prostatic hyperplasia, increased sensitivity of the nipples of the mammary glands in men, with cryptorchidism - an increase in the testicles in the inguinal canal.

Chorionic gonadotropin 5000 IU

• nervous system: headache;
• respiratory system: hydrothorax in severe OHSS;
• vessels: in rare cases, thromboembolic complications associated with combined therapy of anovulatory infertility (in combination with follicle-stimulating hormone), complicated by severe OHSS;
• genitals and breast: breast tenderness, moderate to severe OHSS (ovarian diameter > 5 cm or large ovarian cysts > 12 cm in diameter, prone to rupture). Clinical manifestations of OHSS - arching abdominal pain, hemoperitoneum, diarrhea, feeling of heaviness in the lower abdomen, tachycardia, decreased hemostasis, blood pressure, increased activity of hepatic transaminases, acute renal failure, oliguria, respiratory failure, shortness of breath;
• digestive system: ascites in severe OHSS, abdominal pain and symptoms of dyspepsia, including nausea and diarrhea associated with moderate OHSS;
• psyche: anxiety, irritability, depression;
• metabolism and nutrition: weight gain (which is a sign of severe OHSS), edema.

• subcutaneous tissues and skin: acne;
• genital organs and mammary gland: gynecomastia, penis enlargement, prostatic hyperplasia, hypersensitivity of the nipples of the mammary glands.

Prolonged therapy may cause increased side effects.

Overdose

The drug is characterized by very low toxicity.

Against the background of an overdose in women, OHSS may occur. Depending on the severity, several types of this complication are distinguished:

• mild: the size of the ovaries usually does not exceed 8 cm; symptoms - abdominal discomfort, minor abdominal pain;
• medium: the average size of the ovaries is 8–12 cm; symptoms - moderate / slight enlargement of ovarian cysts, breast tenderness, moderate abdominal pain, diarrhea, vomiting and / or nausea, ultrasound signs of ascites;
• severe: the size of the ovaries usually exceeds 12 cm; symptoms - weight gain, clinical signs of ascites (sometimes - hydrothorax), in rare cases - thromboembolism; oliguria, hemoconcentration, hematocrit > 45%, hypoproteinemia, large ovarian cysts prone to rupture.

Basic principles of treatment of OHSS in case of overdose (depending on the severity):

• mild: bed rest, monitoring the patient's condition, drinking plenty of mineral water;
• moderate and severe (only in stationary conditions): monitoring the level of hematocrit, the function of the respiratory and cardiovascular systems, kidneys, liver, water / electrolyte balance (diuresis, changes in abdominal circumference, weight dynamics); intravenously drip crystalloid solutions (in order to maintain / restore the volume of circulating blood); intravenous drip colloidal solutions of 1.5-3 liters per day (with persistent oliguria and maintaining hemoconcentration); hemodialysis (in cases of development of renal failure); antihistamine, antiprostaglandin and corticosteroid drugs (to reduce capillary permeability); low molecular weight heparins, including clexane, fraxiparin (for thromboembolism); 1-4 sessions of plasmapheresis with an interval of 1-2 days (to improve the rheological properties of blood, reduce the size of the ovaries, normalize the acid-base state and gas composition of the blood); transvaginal puncture of the abdominal cavity and paracentesis (with ascites).

Overdose symptoms in men and boys:

• gynecomastia;
• degeneration of the gonads (in cases of unreasonably long therapy for cryptorchidism);
• changes in behavior in boys, similar to those observed during the first phase of puberty;
• a decrease in the number of spermatozoa in the ejaculate in men (in cases of drug abuse);
• atrophy of the seminiferous tubules (associated with inhibition of the production of follicle-stimulating hormone due to stimulation of the production of estrogens and androgens).

special instructions

During therapy, the likelihood of arterial / venous thromboembolism increases, and therefore, patients at risk should evaluate the benefits of in vitro fertilization therapy before prescribing the drug. It should also be noted that pregnancy itself is accompanied by an increased risk of thrombosis.

The use of Chorionic Gonadotropin increases the risk of multiple pregnancy. During therapy and for 10 days after stopping treatment, the drug can affect the values ​​​​of immunological tests, the concentration of hCG in plasma, urine and blood, which can cause a false positive pregnancy test result.

In male patients, chorionic gonadotropin can lead to an increase in androgen production, and therefore patients at risk need strict medical supervision.

Since hCG promotes precocious puberty or premature closure of the epiphyses, regular monitoring of skeletal development is required.

With a high content of follicle-stimulating hormone in men, treatment is not effective.

Long-term therapy may lead to the formation of antibodies to the drug.

An unreasonably long course with cryptorchidism, especially if there are indications for surgical intervention, can lead to degeneration of the gonads.

Influence on the ability to drive vehicles and complex mechanisms

It is recommended to refuse from driving vehicles during the treatment course.

Use during pregnancy and lactation

According to the instructions, chorionic gonadotropin is contraindicated for use during pregnancy and lactation.

Application in childhood

HCG therapy for children under 3 years of age is not prescribed.

drug interaction

When combined with drugs of human menopausal gonadotropin (MGCh) in cases of infertility treatment, it is possible to increase the symptoms of ovarian hyperstimulation, which occurred due to the use of MCG.

The combination with high doses of glucocorticosteroids is not recommended.

No other interactions were noted.

Analogues

Analogues of chorionic gonadotropin are: Horal, Ecostimulin, Horagon, Pregnil.

Terms and conditions of storage

Store in a place protected from light at temperatures up to 20 °C. Keep away from children.

Shelf life (depending on the dose): 500, 1000 and 1500 IU - 4 years; 5000 IU - 3 years.

Today, the hCG hormone is of great interest: what it is, what are the norm indicators and when preparations based on it are needed.

Contrary to popular belief, not only pregnant women should know about it, because its production in some situations means the development of neoplasms and other abnormalities in the body.

Human chorionic gonadotropin is a unique hormone with special functions.

It is produced in pregnant women, since the process of bearing a child is a kind of condition that involves additional regulatory mechanisms and restructuring of the body.

If you briefly answer the question of what it is - hCG, then we can say that it is a hormone that is produced by the tissues of the fetus, supports its growth and affects the course of the pregnancy process.

For reference!

It is this hormone that first informs a woman about her condition. It acts as the basis for pregnancy tests.

Since chorionic gonadotropin is synthesized by the membranes of the embryo, it is not possible to detect it outside the pregnancy process.

Thus, if this hormone is found not during pregnancy or in a man, this indicates a pathological condition, in particular, the presence of a tumor.

HCG functions

At the end of the first week after the connection of the egg with the sperm, the embryo can be attached to the uterine wall, although at this stage it is only a small bubble.

Already at this time, its cells actively produce chorionic gonadotropin, which is aimed at ensuring its normal growth.

The main part of the placenta is the chorion, formed with the help of the endometrium, to which the outer part of the embryo is attached.

It is the chorion that during all 9 months synthesizes hCG for the development of the unborn child and maintaining a certain state in his mother.

After conception, progesterone, originally produced by the corpus luteum, becomes the main regulatory hormone in the body.

To ensure the function of the last and continuous increase in the content of progesterone during pregnancy, hCG is necessary.

Thus, it becomes clear why the corpus luteum does not disappear during the bearing of a child, as in the presence of menstruation.

The chemical structure of this hormone is represented by units of alpha and beta. Alpha is absolutely identical to the analogous unit in some gonadotropic substances, while beta is unique.

This is due to the features of the functions that hCG performs, as well as the possibility of its detection in urine and blood.

Human chorionic gonadotropin performs the following main functions:

1. Provides normal adaptation of a pregnant woman to the period of bearing a child.
2. Supports corpus luteum and is responsible for the production of the hormone progesterone.
3. Helps the chorionic membrane to form in the right way.
4. Promotes an increase in the number of chorionic villi.
5. Provides villus nutrition.

Under the influence of chorionic gonadotropin, the production of hormones of the adrenal cortex increases, which allows the pregnant woman to adapt to her new condition.

Glucocorticoids help suppress its immune responses to fetal tissues (at the genetic level, the embryo is partly considered as a foreign body).

For reference!

When a woman is given hCG preparations, ovulation is stimulated and. It also increases the production of endogenous sex hormones. With the introduction of such funds to males, there will be an increase in spermatogenesis and increased production of testosterone.

HCG norm

The index of chorionic gonadotropin is affected by the following main factors:

• gestational age;
• the presence of neoplasms.

At the same time, in cases of the absence of pregnancy and for men, its optimal indicator is a figure not higher than 5 mU / ml.

In a pregnant woman, the substance begins to be produced approximately 7 days after conception.

The average hCG levels during pregnancy can be seen in the table.

Minor deviations from these data are usually not dangerous, but a significant difference requires urgent action.

week of pregnancy	Average value, honey/ml	The norm of hCG, honey / ml
1 — 2	150	50-300
3 — 4	2 000	1 500 — 5 000
4 — 5	20 000	10 000 — 30 000
5 — 6	50 000	20 000 — 100 000
6 — 7	100 000	50 000 — 200 000
7 — 8	70 000	20 000 — 200 000
8 — 9	65 000	20 000 — 100 000
9 — 10	60 000	20 000 — 95 000
10 — 11	55 000	20 000 — 95 000
11 — 12	45 000	20 000 — 90 000
13 — 14	35 000	15 000 — 60 000
15 — 25	22 000	10 000 — 35 000
26 — 37	28 000	10 000 — 60 000

It is noteworthy that the greatest increase in hCG or human chorionic gonadotropin in the body of a pregnant woman is observed before the start of the 2nd trimester.

This means that the hormone is most needed during the development of the placenta, which from the 2nd trimester begins to independently produce the necessary hormones.

However, the significance of hCG during this period is to activate testosterone production for optimal development of the gonads and to provide nutrition.

Why do you need an hCG test?

It may be necessary to establish the content of chorionic gonadotropin in the following situations:

• in order to establish pregnancy;
• with the likelihood of fetal defects and pathological changes in the tissue of the placenta;
• to control the course of pregnancy;
• for the purpose of establishing the quality of abortion;
• in the absence of menstruation with an unexplained cause;
• when detecting tumors that produce hCG.

Chorionic gonadotropin in males and non-pregnant women after the test is either not detected, or is present in low content.

If the indicator is high in a woman, it can be assumed that she has a pregnancy, and at least five days.

With the exclusion of conception and in males, the detection of hCG content may be required if neoplasia or some trophoblastic pathologies are suspected.

human chorionic gonadotropin (abbreviated as HCG, HCG, HCG in English, HGL in Ukrainian) is a hormone that, in the normal state of the body, is produced exclusively during pregnancy. The hCG hormone is produced after conception - it is synthesized by a fertilized egg, and after it is formed trophoblast (this is the precursor of the placenta), this hormone is produced by its tissues. That is why the level of hCG is determined only after conception.

Chorionic gonadotropin consists of two different subunits - alpha and beta . At the same time, alpha is identical with subunits of alpha hormones. When it comes to hCG - what it is, its B-subunit is considered. It is important to understand, when considering what beta hCG is, that it is a unique subunit and therefore cannot be confused with other hormones. Speaking about the study on human chorionic gonadotropin, we mean that there is no difference between hCG and beta-hCG.

What is hCG during pregnancy? Its definition and interpretation is a very important stage in the diagnosis of a number of pathologies of both the fetus and the woman. In some conditions, which will be described in this article, hCG values ​​​​are either greatly reduced or increased. Considering what kind of analysis this is, it must be taken into account that with small deviations from the norm, this study has no diagnostic value. Therefore, some diseases and conditions of the expectant mother ( prolongation of pregnancy , intrauterine infection, chronic placental insufficiency ) is determined by other methods.

After the results of hCG have been obtained, they are deciphered in dynamics, since each woman's hCG level during pregnancy changes in its own way. Therefore, one result cannot be used to judge the situation as a whole.

It is important that the result of the analysis of hCG for pregnancy must be considered by a qualified specialist. After all, decoding the hCG test is very important, as it allows you to correct some problems in the development of the fetus.

Since the free beta subunit of gonadotropin is unique, the test that determines the rate of hCG during pregnancy is also called beta-hCG. Normal - if during pregnancy HCGb appears in the blood a few days after conception. But, nevertheless, if, for example, hCG is 8, what it means, after the first analysis, it is definitely impossible to say. A repeat test will be required to confirm pregnancy. In general, the fb-HCG rate is a very important indicator of fetal development.

When handing over hCG to Invitro, Hemotest, Helix and other clinics, a woman needs to understand what kind of indicator it is, when such a test shows pregnancy, etc. This will be discussed in the article below.

What is HCG for?

When determining HCGb indicators, you need to understand why human gonadotropin is needed. Wikipedia says the following:

• this hormone at the beginning of pregnancy stimulates the synthesis process and;
• prevents disappearance corpus luteum ;
• prevents aggression maternal organism against fetal cells;
• initiates physiological and anatomical changes in the body of a pregnant woman;
• stimulates the adrenal glands and gonads of the fetus;
• participates in the process of sexual differentiation in male fetuses.

Why is this analysis ordered?

Analysis for women is prescribed for the purpose of:

• early diagnosis of pregnancy;
• monitoring the dynamics of how the pregnancy proceeds;
• definition of malformations (fetal anatomy);
• development exceptions ectopic pregnancy ;
• the need to assess whether the artificial was completely carried out;
• establishing that there is a threat;
• diagnostics and tumors .

For male patients, such an analysis is necessary to diagnose testicular tumors .

HCG levels during pregnancy

The function of chorionic gonadotropin in the body is very important. Its indicators in the early stages begin to increase, as it is produced by a fertilized egg. It is hCG that makes it possible for pregnancy to develop, since it starts all the processes necessary for bearing a baby.

Already 9 days after ovulation, hCG can be determined in the blood plasma. That is, even when the fertilized egg has invaded the endometrium, there is a slow increase in the indicators of this hormone. And if its low level is determined in the early stages, then the concentration doubles every two days. What exactly should be its level in a certain week, how hCG should grow, slow or rapid growth is noted, you can find out from the corresponding tables.

The growth of hCG during pregnancy occurs up to 8-10 weeks from the last menstruation, when its peak is noted - 50,000-10,000 IU / l. Further, the level of the hormone begins to decrease, by 18-20 weeks it is already reduced by half. Then the content of hCG remains stable for the entire duration of pregnancy.

Gonadotropin during pregnancy is excreted from the body by the kidneys, therefore, it is excreted in the urine. It can be determined by conducting a urinalysis, in the range of 30-60 days after the last menstruation. The highest rates are noted for 60-70 days. That is why, when hCG begins to be produced, you can do a pregnancy test strip or other urinary tests.

HCG levels during late pregnancy can reach repeated peak levels. Previously, such doctors considered a variant of the norm. However, it has now been proven that elevated hCG in the later stages may indicate a developmental pathology. In particular, a high hormone level in the last weeks of gestation sometimes means that there is a reaction of the placenta to placental insufficiency in the case of Rhesus conflict .

Therefore, it is necessary to identify this disease in a timely manner and treat it.

The main signs of hydatidiform mole are:

• Constant, indomitable vomit , much more painful than with the usual.
• Uterine bleeding (severe daubing) at an early stage.
• The size of the uterus is larger than normal at this time.
• Symptoms preeclampsia (sometimes).
• Trembling fingers, palpitations, weight loss (rare).

When the signs described above are noted, it is important to consult a gynecologist, undergo an ultrasound scan and be tested for hCG.

If the pregnancy develops normally, then the rate of this hormone rarely increases more than 500,000 IU / l. There is an approximate calculation of hormone norms for each period. But if a cystic drift develops, the level of hCG is different, several times higher than these norms.

To cure a hydatidiform mole, the entire trophoblast must be removed from the uterus. For this, curettage or other surgical interventions are carried out.

It may happen that a benign hydatidiform drift turns into malignant chorionic carcinoma . As a rule, with this tumor, metastases appear very quickly. But it responds well to treatment with chemotherapy .

There are the following indications for chemotherapy:

• HCG levels above 20,000 IU/L one month after the mole was removed.
• An increase in the level of this hormone after the mole has been removed.
• Metastases to other organs.

chorioncarcinoma

chorioncarcinoma may appear both after hydatidiform mole, and after childbirth or abortion. If a woman develops this disease, then 40 days after the pregnancy is completed, the level of hCG has not fallen, but its increase is noted. There may also be uterine bleeding, signs that indicate metastases. In such a situation, there are indications for chemotherapy, surgery. In the future, the patient should be under observation. How long it should last, the doctor decides.

The use of drugs with human chorionic gonadotropin

Like all human hormones, the level of human chorionic gonadotropin can depend on various factors. So, the result of the tests is affected by whether a woman takes drugs containing human gonadotropin orally.

As a rule, such drugs are prescribed to women during, as well as during the period when preparations for IVF are underway, in order to increase the level of the hormone.

In rare cases, such drugs are taken if there is a threat of miscarriage. In any case, if a woman uses such medications, then before taking any measurements and analyzes, you need to warn the doctor about this.

Taking a variety of drugs, many women are interested in whether they can affect the performance of this hormone. For example, it is often asked whether to the hCG level. According to experts, Duphaston may slightly affect the level of this hormone, since this drug controls the level progesterone . However, if the hCG norms do not comply, this cannot be attributed to the effect of the drug, since we can talk about a pathological condition.

The level of this hormone is not affected.

Hormonal drugs, the active ingredient of which is human chorionic gonadotropin, these are Profazi , Humegon , Horagon , Choriogonin , Menogon . They restore the ovulatory process, activate the hormonal activity of the corpus luteum. At what size of the follicle an injection is given, the doctor determines.

Initially, studies are carried out on hormones, their norm in women and deviations. If there are certain deviations, in particular, progesterone is below normal, what this means, the doctor will explain during the consultation and prescribe a specific treatment.

If necessary, to stimulate ovulation, hCG injections are prescribed from 5000 to 10000 IU, in order to maintain pregnancy - from 1000 to 3000 IU. Individual dose selection is important. Therefore, if an injection of 10,000 was given, when ovulation, if an injection of 5,000 was given, after how much ovulation, the specialist will explain.

Currently, human chorionic gonadotropin is also used by athletes, since under its influence it increases in the male body.

False positive test result

Those who are interested in how long a pregnancy test shows for this hormone should take into account that in some situations, tests can be false positive.

This happens in the following cases:

• Some experts argue that when taking oral contraceptives, the level of the hormone may increase. However, there is no proven evidence that contraception affects hCG.
• As a rule, after childbirth or abortion, the level of the hormone decreases for seven days. In some cases, the doctor waits 42 days, after which tests are taken, and he can make a diagnosis. If the analysis shows that hCG has not decreased or increased, then we can talk about a trophoblastic tumor.
• The level may remain elevated when metastases occur. chorioncarcinoma , hydatidiform mole .
• Other tumors can also develop from germinal tissues, but they rarely give an increase in the level of the hormone. Therefore, in the presence of education in the brain, stomach, lungs and a high level of human chorionic gonadotropin, first of all, there is a suspicion of trophoblastic tumors with metastases.

Thus, the hCG rate in non-pregnant women should not be higher than those that are normal. The norm of hCG in non-pregnant women is from 0 to 5. The level of this hormone in a non-pregnant woman may be higher in the first days after an abortion, when taking certain medications, and also with the development of certain pathological conditions.

Immunity against hCG

In rare cases (units) in the female body are produced to chorionic hormone. They are an obstacle to the normal attachment of a fertilized egg in the uterus and its subsequent development.

Therefore, if in two or more cases the pregnancy ended in a spontaneous miscarriage, it is important to take an analysis to determine antibodies to hCG and find out if there are any specific abnormalities. If the result is positive, treatment is carried out during the first trimester.

The woman is assigned glucocorticoids and low molecular weight heparins . However, it is important to consider that organisms that produce antibodies to hCG are rare. Therefore, in the absence of pregnancy, you must initially go through all the studies and exclude the influence of other factors on women's and men's health.

findings

Thus, an analysis for hCG is a very important study during the period of bearing a baby. It is quite understandable that after receiving the results of the studies, patients have many questions. For example, why hCG is growing, but not doubling, how to correctly decipher hCG according to DPO, etc., does fibroids affect hormone levels, etc. You need to ask a gynecologist about everything, who will help decipher the tests and give comprehensive answers to all questions.