Positive pregnancy test: 11 steps to guide you through what happens next

I’m pregnant, now what?: Initial testing, vitamins and diet 

If you’ve just discovered you’re pregnant—first and foremost, congratulations! That moment of seeing two pink lines or getting a positive blood test can be overwhelmingly joyful, confusing, and a little bit scary. This is the beginning of a new chapter, and while there’s a lot to think about, the most important thing to know is that you are not alone. Whether your pregnancy came naturally, through intrauterine insemination (IUI), in vitro fertilization (IVF), or another assisted method, we’re here to guide you through your next steps.

This post is the first in a multi-part series where we’ll walk you through early pregnancy care, what to expect during the first trimester, and the many common questions we receive at Markham Fertility Centre.

This article will answer commonly asked questions about what happens after you have a positive pregnancy test:

1. Confirming pregnancy with hCG testing
2. The role of TSH and thyroid health in early pregnancy
3. What to expect at your first (7-week) viability ultrasound
4. Prenatal genetic screening and testing 
5. The importance of the 12-week ultrasound and what it measures
6. Understanding miscarriage risk through the first trimester
7. How we transition your care to an OB or midwife
8. Key prenatal supplements and vitamin recommendations
9. What foods and drinks to avoid in early pregnancy?
10. Which herbal and non-herbal teas are safe during pregnancy?
11. Are artificial sweeteners safe during pregnancy?
    

1. Confirming Pregnancy: What’s Up With hCG?

The first step after a positive home pregnancy test is confirming it with a blood test that measures hCG, or human chorionic gonadotropin. This hormone is produced by the placenta shortly after implantation, and its presence in your blood confirms pregnancy. We typically test your hCG levels twice—48 hours apart—to monitor if the levels are rising appropriately. Ideally, hCG should roughly double every 48 to 72 hours in early pregnancy.

hCG (human chorionic gonadotropin): A hormone produced by the placenta after implantation. It’s what pregnancy tests detect and helps sustain the uterine lining in early pregnancy.

What we don’t focus on is the specific number of your hCG result—because there’s no single “normal” number. These values can vary widely between pregnancies. The rate of increase is far more important than the starting number.

2. Checking Thyroid Health: Why TSH Matters

In addition to hCG, we also check your TSH (thyroid-stimulating hormone) levels. This is a critical hormone that regulates how your thyroid gland functions. During pregnancy, especially the first trimester, your thyroid needs to work harder to support your baby’s development—especially the brain and nervous system.

TSH (thyroid-stimulating hormone): A hormone that tells your thyroid gland to produce hormones essential for metabolism and baby’s brain development.

If your TSH is elevated, it may mean you need thyroid hormone replacement therapy and additional follow-up with an endocrinologist. Guidelines around what’s considered “normal” TSH in pregnancy are evolving, so it’s something we monitor closely.

3. Your First Look: The 7-Week Viability Ultrasound

At around seven weeks pregnant, we’ll schedule your first ultrasound, often called the viability ultrasound. This helps confirm the location and development of your pregnancy.

You might be surprised to learn that your pregnancy is timed from the first day of your last menstrual period (LMP)—even if you conceived through IUI or IVF. So, although your embryo transfer might have been just five weeks ago, your pregnancy is officially dated at seven weeks.

Viability ultrasound: An early pregnancy scan (typically done between 6.5–8 weeks) that checks for a gestational sac, fetal pole, and heartbeat.

At this appointment, if there’s a heartbeat, we’ll show it to you. Afterward, you’ll meet with a nurse to review the findings, go over symptoms, discuss medications, and plan your next steps.

4. Follow-Up Visits and Genetic Screening

Because we know how anxious the time between ultrasounds can be—especially after infertility or loss—we often offer a follow-up ultrasound around 9–10 weeks. This scan isn’t medically required but can provide much-needed reassurance.

It’s also around this time that we begin to introduce prenatal genetic screening. You’ll hear about your options, which include blood tests and ultrasounds to assess for genetic and chromosomal conditions in your baby.

Prenatal genetic screening: Tests performed during pregnancy to assess the risk of genetic disorders such as Down syndrome, trisomy 18, or certain inherited conditions.

Our genetics team offers free webinars to explain the options, and we also recommend checking out Episode 42 of our podcast (link) for a full deep dive.

5. The 12-Week Ultrasound: Graduation Time

At Markham Fertility Centre we care for patients up until their 12 week ultrasound. The 12-week ultrasound, also known as the nuchal translucency (NT) scan, happens between 11 and 13 weeks. This is a medically indicated scan that measures the thickness of fluid at the back of your baby’s neck. An abnormal measurement could suggest chromosomal conditions or congenital heart problems.

Definition: Nuchal translucency (NT): A measurement taken during a 11–13 week ultrasound that assesses fluid at the back of a baby’s neck. It helps screen for genetic abnormalities.

Following this scan, you’ll meet with your physician to review:

• The results of the scan and genetic testing
• Your health and symptoms
• Your plan of care moving forward

This appointment marks your official graduation from Markham Fertility Centre. It’s often bittersweet, joyful for how far you’ve come, but emotional as you say goodbye to a team that’s been with you through the ups and downs. You’ll receive a baby onesie, a signed card, and a whole lot of love from the team at MFC! 

6. Understanding Miscarriage Risk Through the First Trimester

One of the most common concerns we hear is about miscarriage risk. The good news is that the risk decreases as the pregnancy progresses.

Here’s how the risk typically drops:

• Around 4–5 weeks (just after a missed period): 25–30%
• After seeing a heartbeat on ultrasound: 5–10%
• After your 12-week scan: Less than 1%

This is why many people wait until the end of the first trimester to announce their pregnancy—because by then, the likelihood of miscarriage is very low.

Miscarriage: The spontaneous loss of a pregnancy before 20 weeks, most commonly occurring in the first trimester.

7. Transitioning to Your Prenatal Care Provider

At your 7-week appointment, we’ll ask who you’d like to continue your pregnancy care with—an obstetrician (OB) or midwife. We make the referral early because appointments fill up fast, and we want to make sure you have your preferred provider.

Definition: Obstetrician (OB): A doctor specializing in pregnancy, labor, and delivery.
Midwife: A healthcare provider trained to support pregnancy and birth, often offering a more holistic approach.

While it can feel scary to “graduate” from fertility care, we do everything we can to make the transition seamless and supportive.

8. What Supplements Should You Be Taking?

Add prenatal vitamins EP link

Prenatal vitamins are foundational in early pregnancy. Here’s a breakdown of the most important ones:

• Folic acid: 400 mcg (low risk) to 5,000 mcg (high risk). Prevents neural tube defects.
• Vitamin D: 1,500–2,000 IU/day. Supports bone health and immune function.
• Omega-3 fatty acids: 1,500 mg/day. Supports fetal brain development.
• Choline: 450 mg/day. Helps reduce neural tube defects and supports fetal development.

Neural tube defects: Birth defects of the brain, spine, or spinal cord, often preventable with adequate folic acid and choline.

Most prenatal vitamins don’t contain enough vitamin D, omega-3s, or choline, so check your labels and consider additional supplements.

9. What to Avoid Eating and Drinking

During pregnancy, your immune system is slightly suppressed, making it easier to contract foodborne illnesses that can affect your baby.

Avoid:

• Raw or undercooked meat, fish, or eggs (e.g., sushi, steak tartare)
• Unpasteurized dairy and soft cheeses (unless labeled pasteurized)
• Deli meats (unless reheated until steaming)
• High-mercury fish (e.g., shark, swordfish)
• Raw sprouts (e.g., alfalfa, clover)
• Alcohol

Listeria, Salmonella, E. coli: Bacteria that can cause foodborne illnesses— dangerous during pregnancy.

Safe fish like salmon, tilapia, shrimp, and sardines offer healthy omega-3s. Follow the “small fish = less mercury” rule and choose options like skipjack tuna over albacore.

10. Coffee and Teas: What’s Safe?

Caffeine is safe in small amounts—about 200–250 mg per day. That’s equivalent to one small coffee or two cups of black tea.

Caffeine: A stimulant found in coffee, tea, chocolate, and some soft drinks. Excess intake in pregnancy may increase the risk of miscarriage or low birth weight.

Herbal teas are caffeine-free, but some are not well-studied for use in pregnancy. Safe choices include:

• Peppermint
• Ginger
• Lemon balm

Avoid or use with caution:

• Red raspberry leaf (only after first trimester)
• Chamomile, dandelion, alfalfa (lack of safety data)

11. Are Artificial Sweeteners Safe?

Many people want to cut back on sugar during pregnancy but are unsure about artificial sweeteners. Here’s a quick guide:

Considered safe in moderation:

• Stevia
• Acesulfame potassium (Sunnett)
• Aspartame (Equal)
• Sucralose (Splenda)

Best avoided:

• Saccharin (Sweet’N Low): It crosses the placenta and may accumulate in fetal tissue.

Artificial sweetener: Sugar substitutes that provide sweetness without calories. Some are safe in pregnancy, while others are not.

Always check product labels and talk to your care provider if you’re unsure.

From confirming that very first positive test to your 12-week graduation appointment, the first trimester is filled with milestones, learning curves, and emotional highs and lows. It’s okay to feel everything all at once—and we’re here to support you through it all.

Stay tuned for Part 2 of this series, where we’ll explore lifestyle choices, safe exercise, managing weight gain, and more.

Until then, take a deep breath, sip some (approved!) tea, and know that you’re doing amazing.