Why is my hCG falling in pregnancy?

Black doctor examining pregnant patient's belly
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hCG is a hormone that is produced in pregnancy. Typically in early pregnancy your hCG levels will about double nearly every two to three days. This is a sign of a healthy pregnancy. 

Blood Work in Pregnancy

If you are having blood work done to test the levels of human chorionic gonadotropin (hCG), your practitioner will be looking at the rate of rise - how fast your hCG is rising over a specific period of time.

If your hCG is falling or not rising quickly enough, you may be having a miscarriage. You may ask yourself why is my hCG falling?

A falling hCG is never a positive sign. It is a solid indication that there is a problem in your pregnancy, including that your pregnancy may fail, meaning that you are having a miscarriage or other complication that would indicate your baby has died or will die soon. There are some cases where it is not the end of your pregnancy, but this is only something that time will tell.

"We were having twins, we'd seen two sacs on the screen," recalls one mother. "My doctor was great about reminding me not to panic. He said that it wasn't a huge drop and that it could be that one baby would survive. It was nice to feel even a ray of hope in that moment."

Problem Pregnancy

If you are also experiencing other problems with your pregnancy like cramping or bleeding, it is almost always a sign of miscarriage.

Your practitioner may have been looking specifically for this drop if you were having other symptoms, or you may have a history of miscarriage or medical complication that made looking at your hCG levels important.

"My pregnancy had been just plain weird," said Paula, mother of two. "I had had one and off spotting from early on, but a good ultrasound at 6 weeks, even though you couldn't see much.

So they did a series of blood tests. That's when they saw that the hCG was dropping. A week later and the next ultrasound wasn't so hot. A few days after that I started bleeding and it was all over. I was surprised at how long it takes to get a good read on if a pregnancy is viable or not. Medicine just isn't there yet. My doctor was great about explaining everything to me and being patient."

Typically your practitioner will continue to draw your blood until the levels have returned to zero. If you have not had miscarriage symptoms, you may be sent home to await a miscarriage, or offered oral medication to help complete the process, or you may be offered a dilation and curettage (D & C). There are very few reasons why the decision of which is best has to happen immediately. You have time to ask questions, wait and even decide later what you wish to do.

Robin remembers the oddity of waiting for the hCG to fall, "I went for multiple blood tests early on. I would get a number and pray that the number would go up.

Then we found out I had an ectopic pregnancy. More blood tests, but this time I was praying the number would fall. So strange..."

This is a difficult time, remember to stay in touch with your doctor or midwife. Ask questions. Be patient. Take care of yourself.


Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Fifth Edition.

Konrad G. Can Fam Physician. 2007 May;53(5):831-2. First-trimester bleeding with falling HCG: don't assume miscarriage.

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