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What does a Negative Pregnancy Test Mean?

Many women rely on the over the counter pregnancy tests to see if they are pregnant.  Pregnancy tests have come a long way in the past few decades so you don’t have to wait until you are 4 days late or 5 days late in order to have a positive result.  But what if you have a negative pregnancy test but feel pregnant?

Pregnancy tests, especially over the counter tests can have false negatives.  Especially when you are 2 days late or 3 days late and take the test in the evening after being too well hydrated, you can have low levels of HCG in the urine and the test can be negative when you are still pregnant.  This why it is recommended that you take a urine pregnancy test first thing in the morning with a first-morning urine specimen.  Even then there can be false negatives when you are already 6 days late or 7 days late.  It all depends on the test and on the pregnancy.  Not every placenta releases huge amounts of the pregnancy hormone and you can have negative urine pregnancy tests as late as 2 weeks late.

Many women rely on the over the counter pregnancy tests to see if they are pregnant.  Pregnancy tests have come a long way in the past few decades so you don’t have to wait until you are 4 days late or 5 days late in order to have a positive result.  But what if you have a negative pregnancy test but feel pregnant?

Pregnancy tests, especially over the counter tests can have false negatives.  Especially when you are 2 days late or 3 days late and take the test in the evening after being too well hydrated, you can have low levels of HCG in the urine and the test can be negative when you are still pregnant.  This why it is recommended that you take a urine pregnancy test first thing in the morning with a first-morning urine specimen.  Even then there can be false negatives when you are already 6 days late or 7 days late.  It all depends on the test and on the pregnancy.  Not every placenta releases huge amounts of the pregnancy hormone and you can have negative urine pregnancy tests as late as 2 weeks late.

What to do if you have a negative pregnancy test

If you have a negative pregnancy test, it’s certainly possible that you’re not really pregnant.  Some pregnancy tests come in two packs so you can recheck the results of a negative pregnancy test.  If you get one positive one negative pregnancy test in a two pack, you may be so early in the pregnancy that you are right on the border of the level required to have a strongly positive pregnancy test.  Don’t wait until you’re 8 days late or 9 days late before rechecking the test.  Get a blood pregnancy test from your doctor, which is much more sensitive than a urine pregnancy test.  By the time you are 10 days late or 12 days late, the HCG levels in the blood will be sky high and there will be no question that you are pregnant.

By the time you are 13 days late or 15 days late, you will begin to have unmistakable signs of pregnancy, such as nausea, sore breasts, sore nipples, and morning sickness.  While you can have these symptoms for other reasons, pregnancy is the most likely cause of the symptoms.  Don’t be alarmed if you experience some spotting as spotting doesn’t necessarily mean you are having a miscarriage.  Spotting during the first month of pregnancy can represent implantation bleeding (when the zygote implants in the uterine lining) or decidual bleeding (from the edge of the placenta).  Usually, the zygote is completely safe and you won’t have any more bleeding while pregnant.

Sometimes spotting can be a sign of an ectopic pregnancy.  In an ectopic pregnancy, the zygote has implanted somewhere other than the uterus.  The most common location for an ectopic pregnancy is in the Fallopian tube.  You will have a positive pregnancy test and will have pregnancy signs but they won’t be very robust symptoms of pregnancy, the HCG levels in a blood HCG test will rise slowly and may eventually fall off.  If you develop excruciating pain in one or the other side of the pelvis, have a positive pregnancy test and bleeding, seek medical attention right away as this can become a life threatening situation.

Read also:

Dealing with Pregnancy Symptoms

Dealing with a False Negative Pregnancy Test

What happens when you miss a period?

What if you have a negative pregnancy test but pregnant symptoms persist?

If you have a negative pregnancy test but have all the signs of pregnancy, you can have a blood pregnancy test or an ultrasound of the uterus.  The ultrasound of the uterus will look for an embryo in the uterus, a thickened uterine lining, and will check to make sure you don’t have an ectopic pregnancy.  An ectopic pregnancy can be one of the reasons a pregnancy test could be negative because, in general, ectopic pregnancies have much lower HCG levels than a normal pregnancy.  Hopefully, the ectopic pregnancy is caught early enough so that methotrexate can be given.  When this is given for an early ectopic pregnancy, the products of conception are resorbed and there is little damage to the Fallopian tube.

The Dilemma of having a Negative Pregnancy Test but Feel Pregnant

Especially when a woman has been pregnant before, she knows the signs of pregnancy and is undaunted by a negative urine pregnancy test.  When the classic symptoms appear, she can always have a blood pregnancy test, which is more sensitive and will confirm the pregnancy.  If you get a negative blood pregnancy test, you could have a condition called pseudocyesis.  This is essentially a false pregnancy that happens in some women who really want to be pregnant but can’t get pregnant.  It’s essentially a hysterical pregnancy—a sort of mental illness that is difficult to treat because the woman is convinced she is really pregnant.

Can you be pregnant and have a negative pregnancy test?

You hear about cases all the time where a woman didn’t know she was pregnant until she delivered a healthy full term baby.  In many cases, she would have had several negative pregnancy tests and just thought she was putting on weight.  The surprise comes when she goes into labor after carrying a baby for nine months.  These are inexplicable cases that continue to fascinate people.  How can a woman not know she is pregnant after all?  Wouldn’t she have felt the baby move or show some symptoms?  Fortunately, this kind of problem is uncommon and most people know they are pregnant throughout their entire pregnancy.

Can you get a negative pregnancy test at 4 weeks?

Yes, you can get a negative pregnancy test at four weeks for all of the reasons discussed above.  You may not have done the test right or may not have interpreted it correctly.  You may have lower than expected HCG levels in your urine so that the test does not register the hormone on the test strip.  An ectopic pregnancy can yield lesser values of HCG values so the pregnancy test will be negative but an ectopic pregnancy is brewing.  Some pregnancy tests are designed to give you positive results even before the four-week mark.  These tests can be deceiving, however, because there can be a positive urine pregnancy test in a pregnancy that is not viable.  Instead of experiencing rising HCG levels, the levels actually go down and the woman experiences bleeding at the time she would have had a normal menstrual bleeding.  The miscarriage happened so early that she wouldn’t have even known she was pregnant if she hadn’t had a positive pregnancy test before the bleeding occurred.

Can a negative pregnancy test be wrong?

Many women wonder if a negative pregnancy test can be wrong.  Yes it can and it can be a risky situation if a pregnant woman doesn’t know she is really taking and continues to drink alcohol, use illicit drugs or even take medications during the unexpected pregnancy.  These early pregnancy behaviors can cause birth defects or fetal demise, especially in the first trimester.  If you are trying to get pregnant and have a missed period, the first step is to do a home pregnancy test.  If that test says you’re not pregnant, you have a couple of options.  You can wait a few days and take another pregnancy test or you can see your doctor for a quantitative HCG test, which is a blood test that measures the amount of HCG in your blood. Ideally, you have no HCG in your blood if you are really not pregnant but urine pregnancy tests do not become positive until the urine HCG level reaches a certain number, such as 25-50 mIU/ml.  Some women just have low HCG levels in their pregnancy and the test can be negative.  In such cases, it is better to have an ultrasound at 5 to 6 weeks gestational age.  The dating of the pregnancy can be really accurate at this time and, although you won’t see a heartbeat at that stage of the pregnancy, the size and appearance of the embryo will be able to tell you that you have a healthy pregnancy.

What can cause a negative pregnancy test?

A negative pregnancy test can really mean you’re not pregnant even if you missed your period.  From time to time, a woman can have an irregular menstrual cycle and can skip a period or have the period several days later than expected because she ovulated late in the cycle.  The time between ovulation and the expected period is usually exactly 14 days; however, the first half of the cycle, before ovulation, can be variable from a few days to several weeks.  Women who have these kinds of cycles have a harder time getting pregnant because they cannot predict when they’re going to ovulate.  The pregnancy test can be negative because it would have been done too early.

Another reason why a negative pregnancy test can occur is if you don’t do the urine pregnancy test on a first morning specimen.  The urine can be very dilute later on in the day so that the HCG level is diluted and the test will show up as negative.  The best way to remedy the situation is to re-do the test the following day using a first morning urine specimen.  If this test is also negative but you feel you might be pregnant, see your doctor about getting a qualitative pregnancy test using the blood or a blood HCG level, which will quantitate the amount of HCG in the urine.  Ideally the HCG level will double every 48 hours during this stage of pregnancy so, if the value is low but still positive, another test can be done 48 hours later.  If there is no doubling of the HCG or the HCG goes down or remains the same, it may indicate that the pregnancy is destined to be lost to miscarriage at some point in the future.  It is the doubling of the HCG every 48 hours that is more important than the absolute value of the quantitative HCG.

How can I improve the odds of having an early positive pregnancy test?

First of all, you can improve your odds of having a positive pregnancy test before a missed period by doing an ovulation test to see exactly when you ovulated.  The time of ovulation to the time of the missed period is solidly a 14 day time window so that you can do the test about 11 days after ovulation, when the zygote has definitely implanted in the uterus.

The specimen of urine you use to take your pregnancy test should be a first morning specimen.  This is when the urine is technically the most concentrated so that the HCG level will be the highest during that time.  If you wait until you’ve had a few cups of coffee or wait until evening, the urine might be too dilute and the HCG levels will be too low to be detected.

Make sure you read the directions very carefully before taking the test as the method of collection and the reading of the test can be different from test to test.  Some test strips have you urinate directly on the stick, while others have you urinate into a cup and then put the stick into the cup for a specified period of time.  Some tests will simply be a plus or minus sort of thing, while others will be digitized and will say “pregnant” or “not pregnant” based on the urinary HCG levels.  To make matters more complicated, other pregnancy tests will just have two lines.  You have to know which line represents the control value and which one represents the levels of HCG in the urine.  Make sure you look at the picture of a “negative test” and the picture of the “positive test” as they can often look somewhat alike.  You won’t be able to verify your pregnancy if you can’t interpret the results of the test.

 

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