Q. Should I be worried about my stable estradiol levels during the fourth month of pregnancy, as I had recurrent miscarriages in the past?

Answered by
Dr. Sameer Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 28, 2023

Hello doctor,

I am four weeks and four days pregnant and have had recurrent miscarriages. I had three blood tests for hCG this week. The first was 76 mIU/mL, the second was 223 mIU/mL, and the third was 596 mIU/mL, all within 48 hours of each other. I am on progesterone 200 mg vaginally per day. My concern is that my estradiol levels do not seem to be increasing. I have been testing my hormone levels, and my progesterone has stayed pretty consistent since being on the supplement, but the estradiol seems all over the place. My levels are around 200 to 250 pg/mL and have been that way since I tested positive. Is this normal or an indication of a potential problem?

Thank you.



Welcome to

There has been a rise of 63 percent above in each hCG (human chorionic gonadotrophin) value done after 48 hrs each, which confirms a viable pregnancy and that you are progressing naturally. Estriol levels tend to lower with increasing weeks, and the hCG levels serve as a marker for viability which is fine in your case.

Thank you.

Hello doctor,

Since I am so early, I thought it would still be estradiol instead of estriol, and everything I saw said they were supposed to increase. Is there a “normal” range of estradiol levels at this point?

Thank you.



Welcome back to

Estrogen plays a role in initiating an LH (luteinizing hormone) surge before ovulation and also have been known to play a role in better endometrialization and implantation. Still, as the pregnancy grows, the early placenta starts secreting hCG (human chorionic gonadotrophin), which is adequate to maintain the pregnancy, and progesterones secreted by corpus luteum, which, if more than 21 to 40 ng/dl, is considered healthy for developing pregnancy. Although estrogen levels in normal, natural cycles reach 300 to 400 pg/ml before ovulation, a study on donor cycles revealed that the E2 (estradiol) requirement for embryo implantation is low (less than 100 pg/ml). But high peak estriol levels have been associated with lower implantation rates and a higher rate of miscarriages. Hence high estriol levels are not considered good in clinical practice. However, studies are still correlating the rising estradiol levels during pregnancy to viability and healthy progression of pregnancy, but no definite conclusion has been drawn yet.

In clinical practice, HCG support is offered until seven weeks of gestation and followed by progesterone support once the fetal heartbeat arrives to support the pregnancy further.

Hope this helps.

Thank you.

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