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

Abstract

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.

Predictive value of early serum β‐hCG levels after single blastocyst transfer

“…Our study shows significantly lower mean β‐hCG levels in women with early pregnancy loss at a particular time compared to women delivering at term. This is line with previously published data (3, 4, 10–25). For our data, calculated cut‐off values to discriminate between ongoing pregnancies and abortion mirrored standardized time intervals after OR.…”

“…A series of reports have suggested that analysis of early hCG values helps to discriminate between intact and pathological pregnancies in women even before verification of vital intrauterine pregnancy by sonography: in successful pregnancies several times higher mean hCG levels were demonstrated as compared to unsuccessful pregnancies terminating in miscarriages (3, 4, 8, 10–25). A number of these studies bear some imprecision, as the day of sampling was related to the day of ET independently of the embryonic developmental day, resulting in variations of up to three days.…”

Value of Post-transfer Day-12 Beta Human Chorionic Gonadotropin Levels for Pregnancy Outcome Prediction of Intracytoplasmic Sperm Injection Cycles

“…Serum β-hCG levels represent trophoblastic mass and function, which play a critical role in early pregnancy, as they sustain the corpus luteum and have a role in endometrial regulation, placental syncytium formation and implantation ( 22 ). It has been proposed that the absolute β-hCG value may reflect the quality of implantation ( 23 ) and may be used as a marker of implantation success ( 24 ). Although various serum markers were investigated as predictors of pregnancy outcome after assisted reproduction, serum β-hCG was shown to be a reliable and the earliest indicator of pregnancy outcomes in IVF cycles (25, 26 ).…”

Lower embryonic loss rates among twin gestations following assisted reproduction

“…A good candidate for this interaction is a superior hormonal support of the uterine milieu, produced by the well-recognized greater placental mass observed in early twin pregnancies. Some support to this speculation comes from the fact that twin placentas produce more hCG and progesterone than singleton placentas, and that both hormones are known to be associated with a reduction of the incidence of pregnancy loss (10)(11)(12).…”