3 days before missed period negative test

Y​ou may suspect that you are pregnant when you have unusual symptoms of pregnancy or if you have missed your period. If you have regular periods and have missed your period by a week, it is likely that you are pregnant. However, if you have irregular menstrual cycles, look out for other symptoms of pregnancy​. 

For a start, confirm your suspicion by buying an over-the-counter urine pregnancy test kit. There are many brands of pregnancy test kits available in the market, which are quite reliable. These are available at our local pharmacies. Alternatively, you could go to your doctor for a test.​ 

What is a Pregnancy Test Kit? 

During pregnancy, a hormone called human chorionic gonadotrophin (hCG) is produced, which circulates in the blood and is also present in the urine. 

The pregnancy test kit detects the presence of hCG in your urine. It is a qualitative test. Some pregnancy test kits are more sensitive than the others but most will be​ ​​​able to detect hCG between the fourth to fifth week of your pregnancy. This means that for those with regular cycles, the test should be positive once you have missed your period by a few days. 

Although almost all over-the counter pregnancy test kits detect pregnancy by measuring hCG in the urine, you have to read the instructions for the test kit because instructions for usage are different for different test kits. 

An indicator will show if you are pregnant. For example, some kits will show two bold lines if positive (Figure 6.2) and one bold line if negative (Figure 6.3). These indicators are different for various kits.​

​How Accurate are the Pregnancy Test Kits? 

Pregnancy tests are rarely wrong. It is more than 99% accurate. Thus, if your test is negative, it means that you are not pregnant; However, if you are very early in your pregnancy and the test is done too early, there could be insufficient amount of hCG in the urine for the test to detect. 

So, if a test comes back negative but you strongly suspect that you are pregnant, repeat the test in a few days’ time. 

There are rare examples when the hCG level is raised transiently and then drops to zero. This is known as “biochemical pregnancy” and could be the cause of a false positive result of the test kit. This initial rise of hCG levels would soon drop in “biochemical pregnancy” and result in a negative test result. Vaginal bleeding occurs soon after, which would coincide with “delayed menses”. Also rarely, there could be occasional ovarian tumors which secrete hCG and the false positive result could be wrongly interpreted as a pregnancy.​ 

​​​Frequently Asked Questions

1. Do I have to test with first morning urine? 

Although you can test any time of the day, your first morning urine specimen is usually the most concentrated of the day and would have the most pregnancy hormones in it. 

2. When should I take the test if I suspect that I am pregnant? 

You can test your urine as early as six days past ovulation but the first day of your missed period is recommended for greatest accuracy. 

3. Do I need a blood test for hCG to confirm my pregnancy? 

Blood tests for hCG are more accurate in detecting HCG and they can also measure the actual levels of the hormone. These tests may be useful to differentiate a miscarriage when the blood hCG will drop with time or a healthy pregnancy when the blood hCG level will double every two days. Occasionally, we need to follow-up the hCG levels to help us diagnose an early ectopic pregnancy (pregnancy that is ​outside the womb), which could be potentially life-threatening or confirm a miscarriage.

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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For couples trying to conceive, the missed period is often the first exciting sign of a positive pregnancy. But what should you think, then, when the pregnancy test is negative?

Causes of a Negative Pregnancy Test

There are a several possible explanations for a negative pregnancy test with a missed period that may occur in the absence of pregnancy.

Anovulation

When you are trying to conceive, it is important to determine whether you are successfully ovulating each month, as ovulatory dysfunction or anovulation may play a role in your missed period and can affect your ability to conceive.

There are many causes for ovulatory dysfunction or anovulation. Just a handful of these causes include:

• Polycystic ovary syndrome (PCOS)
• Thyroid dysfunction
• Being over/underweight
• Stress

Primary Ovarian Insufficiency (POI)

Some women may have a condition known as primary ovarian insufficiency (POI). In POI, the symptoms experienced are similar to those of menopause. As the ovarian follicle count is depleted prematurity, falling estrogen levels lead to hot flashes, vaginal dryness, and an absence of menses as the woman prematurely enters menopause.

Miscalculating Your Period

The average menstrual cycle is 28 days, but far too often we forget to note day 1 of our cycle. Additionally, cycles can sometimes vary in length from month to month. Charting Basal Body Temperature or using Ovulation Prediction Kits (OPKs) can help you get a firm grasp on your menstrual cycle to predict when you are most likely to conceive.

Second, there are a few reasons why your pregnancy test may read negative when you are, in fact, pregnant. Some reasons for this may include:

Home Pregnancy Test with a Low Sensitivity

A home pregnancy test will only detect pregnancy when the level of “pregnancy hormone,” also known as human chorionic gonadotropin (hCG), reaches a certain threshold, and it simply may not be sensitive enough to produce a positive result. Certain brands state that they can detect lower thresholds of hCG; depending on how soon you are taking the pregnancy test after the missed period, it may be worth trying again with a more sensitive brand, ensuring you are using the first morning urine for your test (hCG concentrations are highest in the first morning urine).

Taking a Home Pregnancy Test Too Soon

Another reason for a false negative pregnancy test may simply be that you took the test too early. Pregnancy tests vary in how soon they can detect hCG in your urine. It is possible that although an egg may be fertilized, your body has not started secreting enough hCG to register as positive on a test. Your body needs time for the hormone to rise to a high enough level to be detected. Most brands instruct you to wait until the first day of your missed period to test. Remember, hCG rises differently in each woman. If you suspect you are pregnant, even though the test is negative, the test should be repeated in one week.

If you are trying to conceive and your period is more than one week late with a negative pregnancy test, you should consider consultation with a fertility doctor so that you can be properly evaluated and treated, if necessary.

Dr. Jenna Friedenthal is a Fellow in Reproductive Endocrinology and Infertility at Reproductive Medicine Associates of New York. Dr. Friedenthal completed her undergraduate education at Yale University. She went on to complete her medical degree from the Albert Einstein College of Medicine with Distinction in Research. While in medical school, she received the Senior Research Fellowship award for her research accomplishments in reproductive endocrinology and immunology. Dr. Friedenthal then completed her residency training in Obstetrics and Gynecology at New York University. During her residency training, Dr. Friedenthal received the Mortimer Levitz Best Basic Science Award for her research on pre-implantation genetic testing.

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