Defining the rise of serum HCG in viable pregnancies achieved through use of IVF

Chung, Karine; Sammel, Mary D.; Coutifaris, Christos; Chalian, Raffi; Lin, Kathleen; Castelbaum, Arthur J.; Freedman, Martin F.; Barnhart, Kurt T.

doi:10.1093/humrep/dei389

Cited by 55 publications

(43 citation statements)

References 16 publications

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“…The median rate of two-day increase in hCG was 126%, consistent with our prior work reporting a two-day increase of 124% (4). The association between hCG rise and birth weight was confounded by three important factors, infant gender, type of embryo transfer ("fresh" vs. frozen/thawed), and gestational age at delivery.…”

Section: Discussionsupporting

confidence: 89%

“…Our focus was the rise of hCG within the first six weeks of gestation, when the natural log-transformed hCG is considered linear (4). Values of hCG greater than 10,000 mIU/mL or values obtained from women of a gestational age greater than six weeks, or more than 28 days from egg retrieval, were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…While the expected rate of increase in hCG has been defined for an ongoing intrauterine gestation in both the assisted reproductive and medically unassisted pregnancy populations (3, 4), the association between rise in serial hCG and pregnancy outcome, in particular adverse outcome at the time of delivery, remains unclear. Previous studies have shown that low initial serum hCG levels following ET are negatively associated with pregnancy viability (5, 6) and that initial level and rise of hCG may predict live delivery rate (7).…”

Section: Introductionmentioning

confidence: 99%

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Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization

Morse

Barnhart

Senapati

et al. 2016

Fertility and Sterility

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Objective To determine if very early serum hCG, a marker of trophoblast differentiation, is associated with adverse perinatal outcomes in singleton pregnancies. Design Retrospective cohort study Setting University fertility program Patients 360 singleton IVF live births Interventions Serial hCG measurements were used to determine the within-woman slope for hCG (hCG rise). Main Outcomes Measures Primary outcomes included birth weight and gestational age at delivery. Statistical comparisons utilized t-test, chi-square test, and linear and logistic regression as appropriate. Results hCG rise was positively associated with birth weight but not gestational age at delivery. Infant gender, gestational age, and type of embryo transfer ("fresh" vs. frozen/thawed) were significantly associated with birth weight and confounded the associations of interest. hCG rise was slower among subjects delivering an infant with low birth weight (slope: 0.386 ±0.05 vs. 0.407 ±0.06,) or small for gestational age (slope: 0.371 ±0.07 vs. 0.406 ±0.06,). Analysis of hCG rise by quartile showed that, when compared to the first quartile (slowest), subjects with a rate of hCG rise in the fourth quartile (fastest) had a significantly decreased risk of delivering an infant of low birth weight [OR = 0.32, 95% CI (0.11–0.92)]. No relationship was noted between hCG rise and hypertensive disorders of pregnancy. Conclusions Slower, very early first trimester hCG rise is associated with low birth weight but not gestational age at delivery among singleton IVF conceptions. The rate of increase in serum hCG may reflect early trophoblast differentiation and placentation and, possibly, predict subsequent development.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization

Morse

Barnhart

Senapati

et al. 2016

Fertility and Sterility

Self Cite

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“…Several studies have demonstrated the importance of b-hCG doubling time, showing a strong correlation between this variable and pregnancy outcome. Doubling time in viable IVF pregnancies appears to be similar to that in spontaneous conceptions, in which early levels double in slightly less than 2 days (25,26). Doubling times are significantly slower in abnormal conceptions, and a decline in b-hCG essentially confirms an abnormal gestation (27,28).…”

Section: Discussionmentioning

confidence: 68%

Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: An analysis of 6021 pregnancies

Shamonki

Frattarelli

Bergh

et al. 2009

Fertility and Sterility

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“…The younger gestational age observed here placed the hCG data more comfortably within the range of 39 days gestational age in which the linear model provides the best fit (13). …”

Section: Disscussionmentioning

confidence: 57%

Temporal refinement does not affect predicted human chorionic gonadotropin rise in early pregnancy

Fisher

Sammel

Senapati

et al. 2016

Fertility and Sterility

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Objective To examine the impact of validation and temporal resolution on estimation of hCG increase as patients’ hCG values are not obtained at precise daily increments, or always in the same laboratory Design This study was a retrospective cohort study of women presenting with non-diagnosed, symptomatic first trimester pregnancies who had serial hCG levels over time. Setting Not applicable Patients 171 women presenting between September 2007 and February 2010 with first trimester pregnancy pain and/or bleeding for whom a normal intrauterine pregnancy was ultimately confirmed. Interventions None Main Outcome Measure(s) Serial hCG values, time period between hCG measurements, hCG rise Results After data verification, 118 subjects contributing 327 values met inclusion criteria and passed data verification for analysis with improved temporal precision. The more precise data showed a steeper hCG rise, and the predicted 2 day hCG increase at the 1st percentile was slightly faster (1.68 vs. 1.56) than the “raw” clinical data and previous models. Conclusions Data verification and improved temporal precision suggested a faster hCG increase in early intrauterine gestation than previously demonstrated. As laboratory variation and temporal imprecision are common, these data demonstrate that current modeling of the expected rise of hCG in a normal gestation is valid and appropriately conservative in the determination of a non-viable gestation. No change in the minimal threshold for potential viability is recommended.

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Defining the rise of serum HCG in viable pregnancies achieved through use of IVF

Abstract: The HCG profile of viable pregnancies conceived with IVF is quadratic with an earlier plateau than has been reported for non-IVF pregnancies. The average rate of rise is comparable to previous estimates in symptomatic spontaneous conceptions.

Cited by 55 publications

References 16 publications

Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization

Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization

Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: An analysis of 6021 pregnancies

Temporal refinement does not affect predicted human chorionic gonadotropin rise in early pregnancy

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