Predictive value of human chorionic gonadotrophin in the outcome of early pregnancy after in-vitro fertilization and spontaneous conception

Abstract

This prospective study analyses the value of the beta-subunit of human chorionic gonadotrophin (beta-HCG) in 120 pregnancies obtained after in-vitro fertilization (IVF)--embryo transfer. Spontaneous conception cycles (n = 16) were also analysed allowing a comparison between these two forms of conception. Of the 120 clinical pregnancies, 48 started as single gestations and 50 started with two or more sacs. There were 14 clinical abortions and eight ectopic pregnancies. All subjects had blood samples taken under a fixed protocol on days 11, 14, 17, 20 and 23 after follicular aspiration. Weekly samples were obtained thereafter until day 60 from ovum retrieval. Transvaginal ultrasounds were performed at weekly intervals, starting on day 23 after follicular aspiration. In spontaneous conception cycles blood samples were obtained daily, starting on the day of follicular rupture. In spontaneous conception cycles and in IVF-embryo transfer conceptions, the doubling time (DT) of beta-HCG was 1.4 +/- 0.3 and 1.6 +/- 0.4 days respectively. This difference was not significant. In multigestations, the DT was 1.5 +/- 0.3 days. The absolute values of beta-HCG in early spontaneous gestations were significantly higher than in IVF-embryo transfer cycles, suggesting that the blastocyst implants with less cellular mass when initiated in vitro as compared with the in-vivo condition. The early prediction of ectopic pregnancy and spontaneous clinical abortion was analysed by the beta-HCG profile as well as the absolute values in comparison to normal pregnancies. Both parameters showed significant differences as early as the interval between days 11 and 23 from follicular aspiration.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of vitrification versus slow freezing of human day 3 embryos on β-hCG levels

“…A number of studies have reported that β-hCG level represents trophoblastic mass and function and is predictive of pregnancy outcomes [1,[3][4][5][6][7], yet early β-hCG values after frozen embryo transfers have not studied. We further evaluated whether vitrification of day 3 embryos have an effect on β-hCG level of early pregnancy.…”

“…The embryos were washed and cultured in cleavage medium (G-1, Vitrolife Sweden AB, Sweden) with 12 % SSS and incubated at 6 % CO 2 , 37 o C incubators for 48 h before being frozen. Embryonic development was assessed on Day 3 after oocyte retrieval with an inverted microscope using routine examination of: [1] the number of blastomeres; [2] the degree of cytoplasmic fragments; [3] the uniformity of blastomeres. Embryos morphology was scored as: grade 1, equal blastomeres with no obvious fragmentation; grade 2, <20 % fragmentation and/or unequal blastomeres; grade 3: 20-50 % cytoplasm fragmentation; grade 4: >50 % cytoplasm fragmentation.…”

“…Since hCG is the first observable signal of trophoblast proliferation in maternal blood, it is used for the early detection of pregnancy [2]. Earlier studies have demonstrated that β-hCG measurements in early pregnancy have proven to be predictive of pregnancy outcome [3][4][5]. However, when considering the diagnostic efficacy of β-hCG values, one must consider that advances in assisted reproduction techniques might have possible effects on initial serum β-hCG concentrations [6,7].…”

Early serum β-human chorionic gonadotropin in pregnancies after in vitro fertilization: contribution of treatment variables and prediction of long-term pregnancy outcome

“…Our means to monitor normal pregnancy development are mainly by ␤hCG measurements at the early stages of pregnancy and ultrasound parameters at later stages. Pregnancies with low initial ␤hCG values were previously shown to have a poor prognosis in a multitude of studies (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Ultrasonographic parameters have also been stressed as predictors of early pregnancy outcome (19 -27).…”

“…Human chorionic gonadotropin level dynamically increases during early gestatation. Low levels of serum hCG in early pregnancy have been reported as a predictor of poor pregnancy outcome such as chemical and ectopic pregnancies as well as spontaneous miscarriage (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, the contribution of patients' characteristics and IVF treatment variables to low serum hCG level in early pregnancy has not been investigated.…”