Predictive value of serum HCG concentrations in pregnancies achieved after single fresh or vitrified-warmed blastocyst transfer

Oron, Galia; Shavit, Tal; Esh-Broder, Efrat; Son, Weon-Young; Tulandi, Togas; Holzer, Hananel

doi:10.1016/j.rbmo.2017.05.011

Cited by 21 publications

(21 citation statements)

References 42 publications

(47 reference statements)

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“…A few previously reported studies investigated the prediction of pregnancy outcomes by serum β-hCG levels over various days following vitri ed-warmed blastocyst transfer. Oron et al, demonstrated that for β-hCG that was measured 11 days after single blastocyst transfer, the optimal cut-off value for predicting clinical pregnancy was 137 IU/L with a PPV of 85% and an NPV of 75% [6]. The study by Xiong et al, determined that optimal thresholds were 152.2 IU/L and 211.9 IU/L respectively in predicting clinical pregnancy and live births in patients that had β-hCG tests 11 days after vitri ed-warmed blastocyst transfer [7].…”

Section: Discussionmentioning

confidence: 99%

“…In fresh embryo transfer cycles, the thresholds of serum β-hCG levels to predict clinical pregnancy and live births were 111-213 IU/L and 160-222.8 IU/L respectively 10-12 days after transfer [2][3][4][5][6][7]. For frozen embryo transfer, the cut-off value was 137-399 IU/L for clinical pregnancy and 212-411 IU/L for live births 11-12 days after embryo transfer [6][7][8]. Higher β-hCG levels are indicative of better pregnancy outcomes including higher rates of clinical pregnancy and live births [9].…”

Section: Introductionmentioning

confidence: 99%

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Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

Liu²

2020

Preprint

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Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. Live birth rates were higher in the <38 years of age group as compared those > 38 years (19.0% vs.16.6%; P=0.045). ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

Liu²

2020

Preprint

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show abstract

Section: Introductionmentioning

confidence: 99%

Possibility of live birth in patients with low serum β-hCG 14 days after blastocyst transfer

Liu

2020

J Ovarian Res

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Background Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer. Methods A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5–299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results 312 patients had serum β-hCG levels < 300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 h, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%. Conclusions Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG > 58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

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“…Recently, some researches assessed the early prediction of pregnancy outcomes as early as 5-7 days after embryo transfer [12][13][14]. As the blastocyst transfer has become highly popular in recent years, several scholars studied the prediction of pregnancy by maternal serum β-hCG after blastocyst transfer, with the cut-off value of 152-527 mIU/ml 11-13 days after embryo transfer [2,8,[15][16][17][18].…”

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confidence: 99%

Pregnancy Outcomes of Patients with Low Serum β-hCG Level 14 Days After Fresh Embryo Transfer

Wu¹,

Liu²

2020

Preprint

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Background: Although previous studies had successfully illustrated different pregnancy outcomes by different serum β-hCG levels after embryo transfer, prognosis of pregnancy outcomes remains elusive when the serum β-hCG level is extremely low (e.g., < 100 mIU/ml 14 days after embryo transfer). Therefore, the purpose of our study is to investigate the pregnancy outcomes of patients with low serum β-hCG level 14 days after day 3 embryo transfer. Methods: A retrospective study was performed with 723 patients with a serum β-hCG level between 5 and 100 mIU/ml 14 days after day 3 fresh embryo transfer. Pregnancy outcomes (ongoing pregnancy, early miscarriage, biochemical pregnancy loss, and ectopic pregnancy) were analyzed according to the female patients’ age. Receiver operating characteristic (ROC) curves were plotted to indicate the threshold for prediction of clinical pregnancy and ongoing pregnancy. Sensitivity and specificity were calculated according the ROC curves as well. Results: Of the 723 patients with serum β-hCG level <100 mIU/mL 14 days after day 3 embryo transfer, 85.6% (619) had biochemical pregnancy, and only 14.4% (104) had clinical pregnancy (including 4.7% with ongoing pregnancy, 3.7% with ectopic pregnancy, and 5.9% with early miscarriage). The rate of ongoing pregnancy was significantly lower in ≥ 38-year group compared with < 38-year group (1.3% vs. 5.6%, P =0.029). The serum β-hCG level to predict clinical pregnancy was 44.7 mIU/ml (sensitivity, 91.3%; specificity, 82.1%; area under the ROC curve (AUROC), 0.908). For ongoing pregnancy, the serum β-hCG level was 53.7 mIU/ml (sensitivity, 94.1%; specificity, 81.4%; AUROC, 0.902). Conclusions: Initially low serum β-hCG level 14 days after day 3 embryo transfer indicated poor prognosis with minimal likelihood of ongoing pregnancy. Keywords: assisted reproductive technology; human chorionic gonadotropin; pregnancy; live birth; embryo transfer

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Predictive value of serum HCG concentrations in pregnancies achieved after single fresh or vitrified-warmed blastocyst transfer

Cited by 21 publications

References 42 publications

Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

Possibility of live birth in patients with low serum β-hCG 14 days after blastocyst transfer

Pregnancy Outcomes of Patients with Low Serum β-hCG Level 14 Days After Fresh Embryo Transfer

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