Pregnancy tests detect human chorionic gonadotropin (HCG), commonly known as “the pregnancy hormone.” This hormone is generated from the placenta, an organ that connects the fetus to the mother. It begins to form and protect the egg once it’s implanted along the uterine wall, signaling pregnancy has begun. At first, HCG levels are low, but they increase at the beginning of the pregnancy before leveling off.
As HCG levels increase—often doubling every three days until reaching their peak within the first 8 to 11 weeks of pregnancy—they can be detected in both blood tests (conducted at a doctor’s office) and urine tests (most often taken at home).
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There are three types of at-home tests: strip, cassette and midstream. Strip tests require you to urinate into a cup and place the test strip directly into the urine. Cassette tests require you to urinate into a cup and then place drops of urine directly onto the test stick. Finally, midstream tests require you to urinate directly onto the test stick.
Your HCG levels must reach 25 milliInternational units (mIU) per millimeter (mL) to indicate a positive result—which often happens within 3 to 5 weeks after your last menstrual cycle. At-home pregnancy tests detect these HCG levels and most often reveal lines or a reading of “Pregnant” to indicate a positive result, depending on the type of test you take.
“Most home (urine) pregnancy tests detect HCG levels of 20 (mIU) or greater,” says Kelly Culwell, M.D.—known professionally as “Dr. Lady Doctor”—a board-certified OB-GYN and a previous medical officer for the World Health Organization in Geneva, Switzerland. “Blood tests detect HCG levels of 2 (mIU) or greater, so a blood test might be positive before a urine test is.”
While a typical urine test will show positive results at about 20 to 25 mIU, it’s dependent on your urine concentration—the less diluted the urine, the higher the concentration of HCG. Since urine is more concentrated in the morning, a test taken then is more likely to produce a positive result than one taken later in the day. Still, most urine tests will be positive by one to two days after a missed period.