The answer that a pregnancy test gives is a life-changing one, so you need an accurate, clear answer. After performing more than 50 hours of research, talking to a pregnancy hormone (hCG) expert and an ob-gyn, drinking too many cups of tea, and getting three of our female editors to pee on a total of 60 pregnancy tests, we think the First Response manual test is the pregnancy test you’ll want to take. It’s the most sensitive over-the-counter test you can buy, plus it gives accurate results among the fastest of all the tests we considered. It’s just as easy to read as a digital test, and much less likely to give you an error message. It’s also easy to use, and for about $4 a pop, it won’t break the bank either.
In the incredibly unlikely event that you can’t find a First Response test, our runner-up choice is the Clearblue Plus Pregnancy Test, another manual test. It’s well-designed, with a big absorbent pad and thin gripping end, but not as easy to hang onto as our top pick. It’s also not as sensitive and can’t pick up on very early pregnancies as well as the First Response manual test.
Manual tests handily beat the digital tests in terms of how fast they could provide an accurate reading. Digital tests were prone to erroneous readings.
After taking a few apart, we also learned that the digital tests actually use the exact same strips you find in manual tests, only the digital test has a sensor to detect the darkened line for you—often about a minute after you would be able to eyeball it yourself.
I’m a science writer with a PhD in chemistry, so I know how to read lots of papers and deconstruct the science. I also have 10-plus years of lab experience, so I can accurately make solutions and test them (although I am not really used to doing it with my own pee). I’ve also been pregnant twice, once at the time of writing this guide, so I know what it’s like to take a pregnancy test when you really want to know what it says. That also means that I was able to give a practically endless supply of positive pregnancy pee for testing.
For this guide, I also interviewed Laurence Cole, a researcher who’s done extensive research on home pregnancy tests and hCG and runs the USA hCG Reference Service. Additionally, I interviewed Dr. Tania Basu, an ob-gyn at Cedars-Sinai Medical Center in Los Angeles.
A quick interjection about pregnancy terminology—ever heard someone say that they are x weeks pregnant? Doctors count these weeks starting on the first day of the woman’s last period before she gets pregnant. Because ovulation happens roughly two weeks after this date, you basically get two weeks worth of pregnancy free, as far as the terminology goes. So a woman who has a period that starts on February 1, then gets pregnant on her ovulation cycle immediately following that, can say that she’s four weeks pregnant on March 1. The day of pregnancy varies from person to person—you don’t get pregnant on the day you ovulate, but later, after the egg is fertilized (which can take a few days) and the fertilized egg implants (which can take up to five days after fertilization). I will use this terminology for the whole of this guide. To learn why some tests can give earlier results than others, read How pregnancy tests work.
Pregnancy tests should be four things: sensitive enough to pick up on pregnancy early on, easy to use, easy to read, and relatively cheap. Is this combo too much to ask for? Nope.
There are a number of best pregnancy test lists out there. However, the ones from the bump and Livestrong are not very rigorous. The reviews from Preconception Weekly (now defunct) and Early Pregnancy tests.com both list inaccurate numbers for how sensitive certain tests are (and that last one seems to only be trying to sell its own tests). Consumer Reports looked at pregnancy tests in 2003, although the results are not online anymore (available here from cbs.com), and the tests have changed slightly since then. So a new guide was definitely needed.
We lucked out in terms of testing, because there is a wealth of scientific data on the accuracy of home pregnancy tests. That being the case, we did not run our own accuracy tests, but instead relied on the experts. And the most expert-y of experts we could find was biochemist Laurence Cole, who runs the USA hCG Reference Service. He’s done extensive research on home pregnancy tests and hCG (the chemical that pregnancy tests detect, and more on that in How pregnancy tests work). And from testing the most common home pregnancy tests found in drugstores, here’s what he found:
First Response digital and manual tests are the most sensitive, and can detect hCG-h, the kind of hCG that women produce only very early on in pregnancy, to determine pregnancy sooner.
Clearblue Easy and EPT are both less sensitive than First Response, but more sensitive than other tests on the market. They also detect the early kind of hCG, but not as well as First Response.
Other pregnancy tests available are copies of Clearblue Easy and work about as well, or are less sensitive and wouldn’t be able to detect a pregnancy until you are further along.
So we decided to test these tests for usability and readability. In other words, we peed on these to determine which ones were the best to use.
As far as cost goes, the manual tests run about the same from one to the next, around $4 to $6 a test. The digital tests tend to be a bit more expensive than the manual versions.
Cole made it easy for us to choose which models to bring in for usability tests. These are the ones that Cole tested and found to be the most sensitive, using non-pregnant women’s pee and added hCG and hCG-h, and also testing the urine of women who were trying to get pregnant (prices are current as of this writing):
So there you have it.
Basically, we discounted the rest of the commercially available tests, since they’re not as sensitive. It wasn’t published in this paper, but I asked Cole about these other types of tests, and he says that he’s tested some and they all generally can pick up about 25 mIU/mL of hCG in urine. Since sensitivity is number one on our pregnancy test wish list, that leaves out all of these other tests.
While sensitivity is the most important thing in a pregnancy test, it’s not the only thing. Design is important too—how easy it is to use, and how easy it is to read. So that’s what we looked at in our testing.
I took six of each of our contenders and put them through the paces. I tested them multiple times using both the midstream and pee-in-a-cup-and-dip methods. I pried the digital ones apart to see what was going on behind the curtain. Since I was nine months pregnant at the time of testing, I dipped them in water (and, in one case, had my husband pee on one) to get negatives. I diluted my own urine down by 1,000 times in water to see what a barely positive looked like.1 I held them upside down while waiting for the results (a big no-no, according to the packaging), just to see what happened. In short: I totally abused these things.
Two of our female editors, both not pregnant at the time of testing, also tested each of these in both the midstream and dip methods, and added their feedback.
None of these tests gave what are known as evaporation lines, which are lines that your pee sometimes makes on manual tests that can be mistaken for a positive pregnancy line.
For our 2015 update, I also took a look at the newly designed First Response test to compare usability against the old model.
For its high sensitivity, accuracy, and speedy results, a First Response manual pregnancy test is the one you’ll want to get. It’s the most sensitive over-the-counter pregnancy test you can buy. It also is more likely to tell you “yes” when you’re actually pregnant, and can do it in as little as 30 seconds. It’s just as easy to read as a digital test, and much less likely to give you an error message. In addition, it gave the clearest “yes” reading to a very dilute solution of pregnancy positive pee. Results came in quickly, around 40 to 45 seconds.
Unlike the Clearblue Easy and the EPT tests, there’s no control line, but we found the strong dark pink lines easy to decipher for both positive and negative results.
To mimic the earliest days of pregnancy, I prepared a very dilute solution of positive urine. As you can see in the photo, the First Response manual test showed a very clear positive response with a strong fuchsia line, while the other pregnancy tests barely registered.
The First Response stick was redesigned in May of this year and it’s a keeper. Nothing about the hCG-measuring materials has changed, but the tip and stick were given a new ergonomic, user-friendly shape. It has a nice wide tip, so hitting that target over the toilet is a little bit easier. It also has a curved handle with grippy texture on the back that makes it easy to both hold onto and pick up from a table. Plus the handle is big enough to wrap your whole hand around, not just pinch between thumb and forefinger. That made me feel that I was less likely to drop the whole dang thing in the toilet bowl.
The First Response test is easy to read in my opinion, although the varying darkness of the two lines can be a little confusing. In one test, with full-strength, positive urine, the line on the right was much, much lighter than the positive line. (It does say in the brochure that this can happen.) This changed when I tested the diluted solutions of urine. In this case, the line on the right was much brighter than the positive line. However, there was no mistaking the positive line.
Some people have complained that the curved window in the redesigned test makes it harder to read. And, yes, depending on how the light hits that plastic window, there can be a reflection that some people might mistake for a second line. But seeing how this goes away if you pick the test up and move it slightly, this is a pretty minor flaw.
While it was not as sensitive as the First Response manual test, the Clearblue Plus manual test did come in second due to its easy to use design. It has a grip-friendly thin handle, making it easier to hold than the EPT test. Like the First Response test, it has a nice fat tip, making it easier to hit with a stream of pee. The absorbent pad on the Clearblue Easy manual test also turns pink when it gets wet, so you can see when it starts working. I got a positive from the Clearblue Plus test in as little as 10 seconds on one occasion, but the average was more like 45 to 50 seconds, for either positive or negative. The Clearblue digital tests took anywhere from 1.5 to 3 minutes to give results. For both of the Clearblue tests, the box says it takes 3 minutes for the result.
As far as the war between manual and digital tests goes, there’s really no contest: Manuals were the clear winners. I was pretty surprised by this; the two times I took pregnancy tests, I made a beeline for the digital tests. Why? I did not want any ambiguity about a positive or a negative test. I wanted the thing to tell me a clear yes or no.
But I found that the manual tests did give a clear yes or no. At least in all the ones I tested, I didn’t think there was any question of the result. Also, the manual tests are much less likely to go poof on you. I did have a couple of problems with the digital tests, but none with the manual tests. They are also much faster at giving a result: 40 seconds versus 3 minutes? Um, yeah. In the grand scheme of things, 3 minutes is not long to wait at all. But when you’re waiting to find out if you’re growing a tiny human inside your body, you really want to know as soon as possible what the verdict is.
The funny thing is that digital tests are really just manual tests with a battery and a sensor that reads the lines for you. I cracked open all three brands of digital tests, and they look just like the manual ones on the inside.
See that strip in there? Look familiar? Yep, that’s the same as what the manual tests show you. There’s a little sensor in the three squares in a row a bit to the right of where the test strip is above (I peeled it back from there). So basically, it just reads those lines for you and tells you in English if you’re pregnant or not. But it takes longer than you would to do so.
Digital tests also tend to be less sensitive than manual tests. According to the boxes of all these tests, these are the stats:
First Response: The manual test picks up on 76 percent of pregnancies five days out, while the digital test says yes to only 60 percent of women who are actually pregnant. By the time it’s the day you expect your period, both give a positive to >99 percent of women who are pregnant.
Clearblue Easy: The manual tests give a positive to 56 percent of women who are actually pregnant four days before a missed period, and the digital gives a positive to 51 percent of pregnant women. These numbers are 98 percent and 95 percent respectively, for the day of a missed period.
EPT says that its manual tests give a pregnant result to pregnant women 53 percent of the time four days before a missed period, and the digital test 53 percent of the time. On the day of a missed period, these numbers jump to 99 percent.
I had some problems with the First Response Gold Digital Pregnancy Test. I got a negative for one of these, a midstream test. At first I thought that maybe I hadn’t gotten enough pee on it, but if that were the case, it shouldn’t have worked at all. I also had one test go wonky on me. There’s a little clock on there that’s supposed to start flashing when you take it out of the wrapper, and it didn’t right away. When the clock finally did appear, I took the test, but then it stopped flashing, then started again. That test did finally give me a positive result, but only after waiting for 6.5 minutes. For reference, the other tests gave results in 3 to 3.5 minutes. The box says it should take 3 minutes.
The Clearblue Easy Digital Pregnancy Test with Smart Countdown has little bars that start blinking when the test is going; Clearblue calls it the “countdown indicator.” The digital test is a bit clunkier and heavier than the manual test, and I was a bit surprised that I preferred the manual version. I thought both were really easy to read, but the manual test gave results much faster than the digital.
The EPT Early Pregnancy Test is sometimes advertised as the “error proof test.”2 To this I would like to say: ha. All of the tests say that you’re not supposed to hold the absorbent tip pointing up while testing, but the EPT manual test was the only one that gave me any trouble when I did this. The control line went sideways, although it later corrected itself. It also did still give me the expected positive. There really weren’t any more unexpected results, though. The design is much like that of the First Response tests—that is, nothing special, but not bad. The manual tests took a speedy 20 to 30 seconds, although it usually took up to 40 seconds for the test line to appear. Like the other manual tests, this is much shorter than the box literature says it should take. (EPT suggests not reading the test before 2 minutes have gone by.)
The EPT Digital Early Pregnancy test was the speediest of the lot, too, giving results in less than 2 minutes, either positive or negative. (The digital tests are supposed to be read after 3 minutes, although the brochure says some results show up in as little as 1 minute.) However, its design is somewhat clunky, and it’s not as sensitive to hCG as First Response. Also, the first digital EPT test I took was a dud, even though I’m sure I did nothing wrong.
At CES 2016, First Response launched its Bluetooth-enabled Pregnancy Pro test, which features the ability to pair with a smartphone. Besides being loaded with a host of dubious choices (the test offers a three-minute timer on your phone, where you’re supposed to either select “Educate Me,” “Entertain Me,” or “Calm Me” options while you wait) this new test costs more than three times as much as one of our current top pick, the First Response’s manual test. As best as we can tell, there’s really no reason to spend the extra money.
I should mention the Wondfo tests—these are popular on Amazon because they’re uber cheap. No bells and whistles here—they are just strips that you dip in your pee. It’s a bummer that they’re also not very sensitive. Cole told me that he tested these, and they can pick up hCG only when it’s at about 25 mIU/mL—so, not that early in pregnancy, depending on the person. Some women like to get these to watch their pregnancy “progression.” By taking the tests every so often, they watch the lines get darker to make sure that their hCG level is continuing to go up; a drop is a sign of a lost pregnancy. That’s all fine and good, but for an initial “Am I pregnant?” test, these strips are not a great choice.
Getting pregnant is not as easy as your eighth grade health teacher led you to believe. Besides having to have sex at the right time of the month, the egg has to get where the sperm can access it, the sperm has to randomly hit the egg within the 12- to 24-hour fertilization window, it has to get inside, then this fertilized egg has travel back up to implant itself in the uterus. There’s a whole lot of fail that can happen at any of these steps. According to the UCSF Medical Center, about half of all fertilized eggs don’t make it to being a fetus. Either they don’t implant or don’t make it to the blastocyst stage (which is where the cells that eventually turn into the fetus differentiate from those that will be the placenta), or the blastocyst doesn’t grow or stops developing for some reason. Getting pregnant is hard.3
What pregnancy tests do is measure the small amount of hormones that your body produces when the fertilized egg is implanting and beginning to grow. Specifically, they contain antibodies that can pick up the presence of human chorionic gonadotropin (hCG) in your pee. According to Cole, there are two types of hCG that are important in early pregnancy. The first, hCG, is a hormone responsible for forming the mechanism where the placenta give nutrients to the fetus. The second, called hyperglycosylated hCG (or hCG-h), is a whole different, unrelated molecule.4 “In pregnancy, it has the function of driving implantation of pregnancy, or burial of the placenta within the uterus tissue. That’s its job,” so it’s very critical, Cole said.
The two hCGs also differ in when they’re present in your pee in early pregnancy. In very early pregnancy, weeks three and four, only hCG-h is present, Cole said. This makes sense, as this is the molecule that drives implantation of the egg.
Regular hCG, the hormone, is not produced until you’re about four to five weeks pregnant. According to the American Pregnancy Institute, amounts of this stuff double about every 72 hours in early pregnancy, reaching their peak around eight to eleven weeks, then level off for the remainder of the pregnancy. Levels of hCG in pee can vary a lot as well. If you’re pregnant and it’s been three weeks since the start of your last period, you can have anywhere from 5 to 50 mIU/mL in your pee. (That’s in milli-International Units per milliliter, a standardized unit that doesn’t really tell you much. Regardless, that’s how levels of this stuff are measured.) At six weeks past your last menstrual period, this spread is from 1,080 to 56,500 mIU/mL. According to studies done by Cole and others, premenopausal women have low levels of hCG present in their bodies at all times. This amount peaks at about 1.5 mIU/mL around the time of ovulation, then sinks back down.5
It’s important that pregnancy tests pick up on this kind of hCG, too, since that’s also made in early pregnancy. However, since women have the stuff in their bodies at all times, albeit in very small amounts, the tests can’t be too sensitive to hCG, or they might register pregnant when you’re really not. Fortunately, pregnancy tests currently available over the counter are nowhere near this sensitive.
In fact, getting a false positive reading, a positive pregnancy test when you’re not really pregnant, is vanishingly rare. Women who are menopausal do have a higher amount of hCG in their bodies, and in some circumstances might get a positive reading on a pregnancy test. However, in general, women who are menopausal know they’re menopausal, and wouldn’t take a pregnancy test, so it’s not much of a worry for companies that make pregnancy tests.
Another way you might get a false positive is if you have a chemical pregnancy, which is relatively rare. This is where you have a fertilized egg that either doesn’t implant or doesn’t grow after implantation. When this happens, your hCG levels still rise, but there’s no fetus. Eventually, hCG levels will return back to normal.
False negatives, where you are pregnant but get a negative reading on a pregnancy test, are much more common. According to Basu at Cedars-Sinai, this can happen when you take a test too early, and it can’t pick up on the hCG levels in your pee yet. She said that if you think you’re pregnant and take the test prior to a missed period and get a negative result, wait a week and take the test again. The most accurate time to take a test is after you miss your period, and the longer you wait after you miss your period, the more accurate the test becomes.
First of all, read the dang directions. While they do tend to be similar, not all of them are the same. You don’t necessarily have to use the first pee of the morning, and the directions in many tests say as such. This urine does have a high concentration of hCG though, so if you’re testing really early, you might want to go this route.
There are two ways to take a test: Either urinate on the absorbent strip for around 5 seconds (the midstream method), or pee in a cup and dip the absorbent strip in there, from anywhere from 5 to 20 seconds.
For our testing, we used both methods. And personally, I recommend the pee in the cup and dip method for a couple of reasons. First of all, if you’re like me, you’re bad at peeing on things. It’s sometimes easy to miss. Also, if you screw up taking the test this way or there’s something wrong with the test, you’ll have to wait until the next time you have to pee to try again. Also, there’s always the chance you’ll drop the thing in the toilet. (This did not happen to me, but I had a couple of close calls.) However, the midstream method is the quickest since it doesn’t have the extra pee in a cup step. So if you’re in a hurry, or a practiced pee aimer, go for the midstream.
The pee and dip method does require that you find a clean cup first. But it is nice in that if you screw up a test, or it goes flop on you, you can try another test right away (most tests come with two or three in a box). It also works well if you want to test with first-thing-in-the-morning pee. You can collect your pee in a cup, then shower or have your coffee or whatever, then go back and test it when you’re a bit more awake. This method also gives you a bit more control, and again you can retest right away if you wish.
The directions for the models we tested all said about the same thing: Keep the tip pointing downward, then lay the whole thing flat while you wait for the tests to develop. This takes anywhere from 30 seconds to 3.5 minutes depending on the test. The manual ones are faster, the digital slower. Then, read result and be happy/sad/freak out as required.
For the manual tests we tested, the directions all said NOT to read the result after 10 minutes. But looking at the ones I did, they still had the same result days after testing. For the digital tests, all of the First Response ones were dead after two days, as were the negative Clearblue tests. For some reason, if you have a positive Clearblue test, it holds its battery life for up to six months? That’s what it says in the directions. I’ll keep mine around, but it’s been a couple of weeks so far and those positive tests are still blazing on with their “Pregnant” message. I guess this is in case someone wants to keep the test to show people? Whatever floats your boat.
Update: Yep, the Clearblue digital tests still sing out “pregnant” nearly seven months after I took them. The baby’s almost six months old now.
Also, don’t stick the test in your vagina! It’s not a tampon. Or a thermometer. Yeah, I’m trying to imagine the person who thinks this is how you take a pregnancy test. But I guess it’s someone, since it says not to do this on all of the instructions I read.6
Originally published: August 27, 2015
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