The predictive value of hCG beta subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: An international collaborative study

Purpose We retrospectively examined a large cohort of females who underwent single blastocyst transfer to determine if initial β-human chorionic gonadotrophin (β-hCG) levels on day 7 after single vitrified-warmed blastocyst transfer (SVBT) could be used to predict pregnancy outcome. Methods The treatment cycles that gave rise to the early pregnancies included in this study were performed from 2004 to 2011 in a private infertility center. In SVBT cycles, embryos were transferred during a natural cycle or after endometrial preparation with exogenous estrogen and progesterone. A total of 11,458 cycles with β-hCG levels ≥1.0 UI/ml on day 7 after SVBT were evaluated. The proportion of live births per positive β-hCG cycle was established for 10 β-hCG ranges in 3 different age groups (Group A: 21-34 years old; Group B: 35-39 years old; Group C: 40-44 years old). Results The proportion of live births gradually increased from 1.5 to 93.7 %, 0.8 to 87.9 %, and 0.6 to 76.2 % in Groups A, B, and C, respectively. For each range of β-hCG levels, the proportion of live births was higher for the younger age group, which reflected the increased risk of early pregnancy loss with advancing female age. Conclusions β-hCG levels on day 7 after SVBT, in conjunction with maternal age, may be used to predict pregnancy outcomes.

Section: Patients Groupsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Maternal age and initial β-hCG levels predict pregnancy outcome after single vitrified-warmed blastocyst transfer

Ueno¹,

Ezoe²,

Abe³

et al. 2014

“…Single and serial serum hCG-β values have been reported to be reliable predictive markers to assess pregnancy progression after ART cycles [2,12,13,21,25,30,38]. In this study, we investigated serial hCG-β levels on POD 12 and 14 to predict pregnancy outcome, which were significantly earlier than previous studies, in which hCG-β levels were tested on POD 15-19 [35,39].…”

Section: Discussionmentioning

confidence: 99%

“…Biochemical pregnancy was defined as a pregnancy that fails to progress to the point of ultrasound confirmation of gestational sac in spite of a positive pregnancy test. It is characterized by a positive pregnancy test which is not maintained, manifested with a low peak and rapid fall of hCG-β levels [29,30]. Clinical pregnancy was defined as the presence of a gestational sac using ultrasonography between 5 and 6 weeks of gestation.…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

Serum hCG-β levels of postovulatory day 12 and 14 with the sequential application of hCG-β fold change significantly increased predictability of pregnancy outcome after IVF-ET cycle

Sung

Kwak‐Kim

Koo

et al. 2016

Purpose To investigate hCG-β level on postovulatory day (POD) 12 and its fold increase as predictors for pregnancy outcome after in vitro fertilization (IVF) cycles. Methods A retrospective cohort study was performed in total 1408 fresh and 598 frozen cycles between November 2008 and October 2011, which resulted in biochemical pregnancy, early pregnancy loss, or live birth of singleton pregnancy. The serum hCG-β levels of POD 12 and 14 were compared among biochemical pregnancy, early pregnancy loss, and live birth groups. The cutoff values of POD 12 and 14 hCG-β levels and the degree of hCG-β increase from POD 12 to 14 were determined for each pregnancy outcome. Results POD 12 and 14 hCG-β levels stratified based on pregnancy outcomes were significantly different among the biochemical pregnancy, early pregnancy loss, and live birth in both fresh and frozen cycles. Serum hCG-β levels of POD 12 and 14 and the fold increase of hCG-β levels from POD 12 to 14 significantly predict pregnancy outcomes after fresh and frozen cycles. Among these, the cutoff value of POD 14 hCG-β had the highest sensitivity and positive predictive value (PPV). In fresh cycles, the cutoff values of POD 12 and 14 serum hCG-β levels for clinical pregnancies were 30.2 mIU/ mL (sensitivity 81.3 %, specificity 79.6 %, and PPV 92.3 %) and 70.5 mIU/mL (sensitivity 88.4 %, specificity 85.2 %, and PPV 94.7 %). In pregnancies with POD 12 serum hCG-β levels ≥30.2 mIU/mL, the cutoff level of increase of hCG-β for clinical pregnancy was 2.56 (sensitivity 73.6 %, specificity 72.4 %, and PPV 97.8 %). Sequential application of cutoff values such as POD 12 hCG-β and fold increase of hCG-β improved predictability of pregnancy outcome as compared with that of POD 12 hCG-β alone. The cutoff values of POD 12 and 14 serum hCG-β levels for live birth were 40.5 mIU/ mL (sensitivity 75.2 %, specificity 72.6 %, PPV 78.9 %) and 104.5 mIU/mL (sensitivity 80.3 %, specificity 74.1 %, PPV 80.8 %). In the frozen cycles, the cutoff values of POD 12 and 14 serum hCG-β level for clinical pregnancy were 31.5 IU/L (sensitivity 80.4 %, specificity 71.1 % and PPV 90 %) and 43.5 mIU/mL (sensitivity 72.6 %, specificity 71.7 %, PPV 77.2 %). In pregnancies with POD 12 serum hCG-β level ≥31.5 mIU/mL, the cutoff value for fold increase of hCG-β was 2.38 for clinical pregnancy (sensitivity 81.6 %, specificity 71.4 % and PPV 87.9 %). The cutoff values of POD 12 and 14 for live birth were 43.5 mIU/mL (sensitivity 72.6 %, specificity 71.7 %, PPV 77.2 %) and 101.6 mIU/mL (sensitivity 79.6 %, specificity 71.1 %, PPV 78.4 %). Sequential application of cutoff values for POD 12 hCG-β level and fold increase of hCG-β significantly increased PPV for live birth but not clinical pregnancy in frozen cycles. Conclusions Early prediction of pregnancy outcome by using POD 12 and 14 cutoff levels and sequential application of cutoff value of fold increase could provide appropriate reference to health care providers to initiate earlier management of Capsule Early prediction of pregnancy outcome...

“…However, while several studies conclude that a single hormone measurement in early pregnancy can reliably predict pregnancy outcome (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), other reports suggest that serial hormone determinations for differential diagnosis of early pregnancy are superior to single measurements with regard to diagnostic power (15)(16)(17)(18). On the other hand, while most of those previous reports relied on the use of HCG as a single marker in early pregnancy (5)(6)(7)(8)(9)(10)12,14,15,17,18), others investigated also the prognostic value of serum progesterone and estradiol as predictors of early gestational normalcy (11,16,19). Therefore, this study was undertaken to investigate the relative power of HCG, estradiol, and progesterone determinations in the prediction of pregnancy outcome after IVF.…”

Section: Introductionmentioning

confidence: 99%

Early Hormonal Markers of Pregnancy Outcome After In Vitro Fertilization and Embryo Transfer

Carmona

Balasch

Creus

et al. 2003

Purpose : To investigate the relative power of HCG, estradiol, and progesterone determinations in the prediction of pregnancy outcome after IVF. These prognostic hormonal factors were studied as single and combined predictors. Methods : Serum concentrations of β-HCG, progesterone, and estradiol were measured 12-13 days after embryo transfer (study point 1) and 7 days later (study point 2) in a series of 20 consecutive infertile patients having a first-trimester spontaneous clinical abortion after an IVF-embryo transfer cycle. As a control group (n = 60), the next three IVF-embryo transfer cycles resulting in an ongoing pregnancy after each miscarried IVF cycle in our assisted reproduction program was used. The discrimination attained between the two study groups (ongoing pregnancies and miscarriages) was evaluated by logistic regression and receiver operating characteristic (ROC) curve analysis. Results : Mean hormone concentrations at study points 1 and 2 were higher in the ongoing pregnancy than in the abortion group. Regarding pregnancy outcome the percentage increment of HCG serum levels (≥1321%), with an accuracy (predictive value of pregnancy outcome) of 81.2% (sensitivity 98%, specificity 50%), had the best prognostic reliability but no significant differences were found when this parameter was compared with the predictive value of HCG concentration (≥72 IU/l) at study point 1 (diagnostic accuracy 80.5%; sensitivity 70%; specificity 80%). When ROC analysis was used, the best predictor of ongoing pregnancy according to the AUC ROC was HCG concentration at study point 2 but again no significant differences were found when this parameter was compared with the predictive value of HCG serum levels at study point 1. A multiple marker strategy did not help distinguish viable from nonviable pregnancies. Conclusion : A single, early (days 12-13 after embryo transfer) HCG quantitative serum measurement in IVF cycles not only is diagnostic but also has good predictive value for pregnancy outcome.