Serum oestradiol and β-HCG measurements after day 3 or 5 embryo transfers in interpreting pregnancy outcome

Abstract

The aim of this study was to assess the clinical value of serum oestradiol concentration 8 days after embryo transfer (D8E2) and beta-human chorionic gonadotrophin (HCG-beta) concentration 12 days after embryo transfer (D12HCG-beta) in the prediction of pregnancy and the outcome of pregnancy following assisted reproduction, taking into account the day of transfer, which was either day 3 (D3) or day 5 (D5). The objective was to improve patient counselling by giving quantitative and reliable predictive information instead of non-specific uncertainties. A total of 2035 embryo transfer cycles performed between January 2003 and June 2005 were analysed retrospectively. Biochemical pregnancy, ectopic pregnancy and first-trimester abortions were classified as non-viable pregnancies; pregnancies beyond 12 weeks gestation were classified as ongoing pregnancies (OP). Significantly higher D8E2 and D12HCG-beta were obtained in D5 transfers compared with D3 transfers with regard to pregnancy and OP (P<or=0.001). For D3 embryo transfers, the cut-off value of D8E2 in predicting OP was 130 pg/ml (sensitivity 80%, specificity 72%), compared with 98 mIU/ml (sensitivity 89%, specificity 69%) for D12HCG-beta. For D5 embryo transfers, the values were 179 pg/ml (sensitivity 79%, specificity 84%) and 257 mIU/ml (sensitivity 78%, specificity 81%) respectively. It appears that serum post-embryo transfer D8E2 and D12HCG-beta concentrations provided clear information regarding pregnancy and the outcome of pregnancy following IVF-embryo transfer.

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

“…As expected, regardless of cryopreservation method, the approximately doubled hCG level in twin pregnancies is consistent with the results of previous studies [29,30]. Low hCG concentration is always associated with non-viable pregnancy in the first trimester [31,32].…”

Human chorionic gonadotropin levels are equally predictive for pregnancy outcome after fresh and vitrified-warmed blastocyst transfer

“…Different conditions and duration of embryo cultivation may explain the observations that values of early β-hCG measurements are different following cleavage or blastocyst stage ET. However, the results are conflicting; Zhang et al [12] and Papageorgiou et al [8] have demonstrated lower values after blastocyst cultivation of embryos compared to cleavage stage ET. But subsequently published data on β-hCG levels after cleavage and blastocyst stage ET have shown higher or comparable β-hCG levels after blastocyst transfer compared to cleavage stage ET [7,8].…”

“…However, the results are conflicting; Zhang et al [12] and Papageorgiou et al [8] have demonstrated lower values after blastocyst cultivation of embryos compared to cleavage stage ET. But subsequently published data on β-hCG levels after cleavage and blastocyst stage ET have shown higher or comparable β-hCG levels after blastocyst transfer compared to cleavage stage ET [7,8]. One of the explanations could be that significant development of embryo culture media in the last decade and improved embryo development environment exerted less negative influence on trophoblast production in cultivated embryos in these studies.…”

“…It is well documented in the literature that levels of β-hCG in early pregnancy are highly predictive for pregnancy outcome after fresh ET, however prognostic values and β-hCG thresholds are not consistent [1,[4][5][6][7][8][9][10][11]. The most important factor for inconsistent results is different timing of the β-hCG sampling.…”

“…Several studies have investigated the value of β-hCG in the prediction of viable pregnancy after MAR and found correlation between β-hCG levels and pregnancy outcome [1,[4][5][6][7][8][9][10][11]. The threshold levels of β-hCG with best prediction as well as the reliability of prediction, however, vary between studies.…”