hCG, Qualitative (Urine Pregnancy Test)
A urine test that says only whether hCG, the pregnancy hormone, is present above the test's cutoff. It is reported as positive or negative.
AI-verified against cited sources. Awaiting expert reviewAlso called UPTLOINC 2106-3
What it is
Human chorionic gonadotropin (hCG) is a hormone made by the placenta after a fertilized egg attaches inside the uterus. A urine pregnancy test, either at home or in a clinic or lab, gives a yes or no answer: hCG was found, or it wasn't. It does not tell you how much. Urine tests are quick, low cost and very accurate when done a week or two after a missed period (MedlinePlus).
Why it matters
A positive result usually means pregnancy, so the next step is to contact a clinician to confirm it and plan care. A negative result can be wrong if the test is done too early or the urine is diluted. Home and clinic urine tests are similar in how well they detect hCG (FDA). A blood test finds smaller amounts and can show a pregnancy earlier. If you need to know how much hCG is present, a quantitative blood test measures it.
If it’s low
A negative result means hCG wasn't found above the test's cutoff. If you aren't pregnant, that is the expected result. If you could still be pregnant, testing too early or using diluted urine can give a false negative. Because hCG rises every day in early pregnancy, repeating the test a week later is a good idea.
Common causes
- Not being pregnant
- Testing too soon after a fertilized egg implants
- Diluted urine from drinking a lot of fluid
- Ovulation or implantation later than you thought
- An extremely high hCG that reads falsely low (the hook effect, rare)
What can help
- Test with your first morning urine and use a timer
- Repeat the test about a week later if your period hasn't started
- Call your provider if you get two negative tests and still think you are pregnant
If it’s high
A positive result means hCG was found above the test's cutoff. That usually means you are pregnant. Rarely, a test is positive when you are not pregnant. A clinician can confirm the result with a blood test or an ultrasound.
Common causes
- Pregnancy
- A very early pregnancy loss, where hCG briefly rises and falls
- Fertility medicines
- Pituitary hCG in some women near or after menopause
- Gestational trophoblastic disease or some tumors (rare)
What can help
- Contact your clinician soon to confirm the result and plan care
- Tell your clinician about any fertility medicines you use
- Ask whether a blood hCG test or an ultrasound should come next
If this applies to you
Urine Pregnancy Test means a little more for some people. Open the one that fits you.
Taking isotretinoin
Isotretinoin can cause life-threatening birth defects. Under iPLEDGE, people who can get pregnant have two pregnancy tests before starting, then one before each prescription, at the end of treatment and 1 month after stopping. Tests can be urine or blood, and the label allows a home test during and after treatment.
What can affect your result
- Timing: hCG can't be found until after implantation, and it rises quickly after that
- How diluted the urine is: first morning urine has the most hCG
- The test's cutoff, which differs between brands
- Fertility medicines, which can cause a false positive
- Following the instructions: expiration date, timing and control line
- Very high hCG, which can read falsely low on some tests
- Diluted urine: drinking large amounts of fluid before the test can dilute hCG so that it doesn't show up (MedlinePlus). Urine hCG can range from about twice to one-tenth of the blood level, depending on fluid intake (Cole 2009).
- Testing too early: a fertilized egg must implant before hCG appears. FDA says 10 to 20 pregnant women out of every 100 won't detect their pregnancy on the first day of a missed period. A home test can be negative early in a pregnancy and positive a few days later.
- Different tests detect different amounts. Published sensitivities for over-the-counter urine tests range from about 6 to 50 mIU/mL (Cole 2009).
- Fertility medicines can affect pregnancy test results (MedlinePlus).
- Hook effect: an extremely high hCG, as in a molar pregnancy, can read falsely low or negative (Cole 2009).
- Reading the test outside the time window in the instructions can give a wrong answer. Use a timer, and check the control line and the expiration date (MedlinePlus).
First morning urine is best, because it usually has more hCG than urine later in the day (MedlinePlus, FDA). hCG rises quickly in early pregnancy, almost doubling every 3 days (MedlinePlus). In a 28-day cycle it can usually be detected in urine 12 to 15 days after ovulation (FDA).
When to talk to a clinician
If the result is positive and you have vaginal bleeding, pain in your lower back or belly, or cramping on one side of the pelvis, contact a clinician promptly. These can be symptoms of an ectopic pregnancy (a pregnancy that starts outside the uterus), which can be a medical emergency (MedlinePlus, ACOG). If you feel faint, call 911 or your local emergency number. If you get two negative home tests but still think you are pregnant, call your provider (MedlinePlus).
Questions you could ask
- Could any medicine I take affect this result?
- Should I have a blood hCG test or an ultrasound to confirm?
- When should I schedule my first prenatal visit?
- Should I repeat the test, and how many days should I wait?
- Would a blood hCG test give a clearer answer?
Questions people ask
How soon can a urine test detect pregnancy?
In a 28-day cycle, hCG can usually be detected in urine 12 to 15 days after ovulation (FDA). Some tests can show a pregnancy before a missed period, but FDA notes that 10 to 20 pregnant women out of 100 won't detect it on the first day of a missed period. If a first test is negative, test again several days later.
Why does the test say to use the first morning urine?
First morning urine usually has more hCG than urine later in the day, so it is easier for the test to detect. Drinking a lot of fluid before the test can dilute the urine and cause a false negative.
Can a urine pregnancy test be positive when I'm not pregnant?
It can, but it is uncommon. Fertility medicines can cause it, and so can a very early pregnancy loss, a small amount of pituitary hCG after menopause, or, rarely, a tumor or abnormal growth of pregnancy tissue. If you think the result is wrong, talk with your provider.
Show the science and sources
For clinicians and researchers
Urine pregnancy tests are usually lateral-flow sandwich immunoassays that report positive at a fixed hCG cutoff. Cole 2009 reports that FDA rules limit point-of-care urine tests to a sensitivity of 20 mIU/mL, that available tests range from 20 to 50 mIU/mL, and that over-the-counter tests have published sensitivities of about 6.3, 20 and 50 mIU/mL. Urine hCG varies from about twice to one-tenth of the serum level with fluid intake. On the day of a missed period the median urine hCG is about 49 mIU/mL (range under 1 to 2,132) (Cole 2009). A negative urine test with a positive serum hCG supports interference from heterophile antibodies (Oyatogun 2021), because these large antibodies generally do not pass into urine. Hook effect above about 500,000 mIU/mL can cause a falsely negative result (Cole 2009).
LOINC 2106-3 (primary), 2112-1, 80384-1. Specimen: urine.
Sources
- Pregnancy Test, MedlinePlus (National Library of Medicine)
- Pregnancy (home use tests), U.S. Food and Drug Administration
- New discoveries on the biology and detection of human chorionic gonadotropin, Reproductive Biology and Endocrinology (Cole) (2009)
- A rational diagnostic approach to the "phantom hCG" and other clinical scenarios in which a patient is thought to be pregnant but is not, Therapeutic Advances in Reproductive Health (Oyatogun et al.) (2021)
- ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy, American College of Obstetricians and Gynecologists (Obstetrics & Gynecology) (2018)
AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.