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Sung N, Kwak-Kim J, Koo HS, Yang KM. 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. J Assist Reprod Genet 2016; 33:1185-94. [PMID: 27262839 DOI: 10.1007/s10815-016-0744-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022] Open
Abstract
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 high-risk pregnancies and precise follow-up of abnormal pregnancies.
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Fatemi HM, Garcia-velasco J. Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger. Fertil Steril 2015; 103:870-3. [DOI: 10.1016/j.fertnstert.2015.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 01/20/2023]
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Almog B, Al-Shalaty J, Sheizaf B, Shehata F, Son WY, Tan SL, Tulandi T. Difference between serum beta-human chorionic gonadotropin levels in pregnancies after in vitro maturation and in vitro fertilization treatments. Fertil Steril 2011; 95:85-8. [DOI: 10.1016/j.fertnstert.2010.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 05/07/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
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Shamonki MI, Frattarelli JL, Bergh PA, Scott RT. Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: An analysis of 6021 pregnancies. Fertil Steril 2009; 91:1760-4. [PMID: 18455162 DOI: 10.1016/j.fertnstert.2008.02.171] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/27/2008] [Accepted: 02/27/2008] [Indexed: 11/15/2022]
Affiliation(s)
- Mousa I Shamonki
- Division of Reproductive Endocrinology and Infertility, University of California-Los Angeles, Los Angeles, California, USA
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Ganesh A, Goswami S, Chattopadhyay R, Chakraborty C, Chaudhury K, Chakravarty BN. Luteal phase estradiol level: a potential predictive marker for successful pregnancy in in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 2009; 91:1018-22. [DOI: 10.1016/j.fertnstert.2008.01.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 01/16/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
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Delbaere I, Vansteelandt S, Gerris J, De Sutter P, De Bacquer D, Temmerman M. Human chorionic gonadotropin levels in early IVF/ICSI pregnancies are higher in singletons after single embryo transfer compared with singletons after double embryo transfer. Hum Reprod 2008; 23:2421-6. [DOI: 10.1093/humrep/den289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carmona F, Balasch J, Creus M, Fábregues F, Casamitjana R, Cívico S, Vidal E, Calafell JM, Moreno V, Vanrell JA. Early hormonal markers of pregnancy outcome after in vitro fertilization and embryo transfer. J Assist Reprod Genet 2004; 20:521-6. [PMID: 15035553 PMCID: PMC3455308 DOI: 10.1023/b:jarg.0000013654.85531.ac] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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 beta-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 (> or = 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 (> or = 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.
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Affiliation(s)
- Francisco Carmona
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Juan Balasch
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Montserrat Creus
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Francisco Fábregues
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Roser Casamitjana
- Hormonal Laboratory, Faculty of Medicine-University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salvadora Cívico
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Ester Vidal
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Josep M. Calafell
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Vicenta Moreno
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
| | - Juan A. Vanrell
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
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Abstract
OBJECTIVE To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles. DESIGN Retrospective cohort study. SETTING Academic IVF program. PATIENT(S) Women with a history of unsuccessful IVF attempts undergoing IVF. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test. CONCLUSION(S) Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.
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Affiliation(s)
- G Wright Bates
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Abstract
The clinical efficacy of luteal phase hormones including estradiol and progesterone in the prediction of pregnancy and its outcome in ICSI-ET cycles was evaluated. In 121 ICSI-ET cycles, serial estradiol and progesterone levels were measured in the luteal phase. The day of ovum pick-up was designated as day 0. All the patients had luteal support with vaginal progesterone suppositories after embryo transfer (ET). Serial estradiol measurements were performed on days 8, 11 and 13 and progesterone level on day 11. A single dose of hCG was given for corpus luteum rescue 5000 IU, if day 8 estradiol level <200pg/ml; 2000IU, if estradiol between 200 and 800pg/ml; no hCG if estradiol level >800pg/ml). On day 15, beta-hCG level was measured to detect pregnancy and if positive, injected on day 17. Fifty-seven pregnancies were achieved in 121 cases after ET (47%). Clinical pregnancy rate and ongoing pregnancy rate per ET were 37.1 and 30%, respectively. While there was no difference between progesterone levels measured on day 11, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. In 40 patients taking only progesterone and in 81 cases taking hCG plus progesterone, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. Progesterone levels on day 11, in progesterone treated groups, did not differ between pregnant and non-pregnant patients. Estradiol and progesterone levels on day 11 and estradiol levels on day 13 showed a big overlap between pregnant and non-pregnant patients. The efficacy of serial testing was evaluated. An increase in estradiol level from day 11 to 13 was associated with 71% pregnancy rate (72% ongoing). In the case of a decrease in estradiol level, the pregnancy rate was 18% of which 80% had to implant. Rising estradiol in the late luteal phase is associated with higher pregnancy rate and more successful pregnancy outcome.
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Affiliation(s)
- K Vicdan
- Assisted Reproductive Technologies Center, Bayindir Hospital, Menevis Sokak 30/6, 06540 A. Ayranci, Ankara, Turkey.
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Ertzeid G, Tanbo T, Dale PO, Storeng R, Mørkrid L, Abyholm T. Human chorionic gonadotropin levels in successful implantations after assisted reproduction techniques. Gynecol Endocrinol 2000; 14:258-63. [PMID: 11075296 DOI: 10.3109/09513590009167691] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To assess successful implantation and early post-implantation embryonic development in assisted reproduction techniques, serum human chorionic gonadotropin (hCG) levels in early gestation in pregnancies with a singleton live birth as the outcome were evaluated. The study was performed as a prospective cohort study of patients undergoing in vitro fertilization (IVF) or artificial insemination by husband (AIH) following ovarian stimulation. Serum hCG levels on days 14, 16, 20 and 27 following ovulation induction with hCG were examined. Serum hCG values were significantly lower in early gestation in IVF compared with AIH, but no difference in hCG doubling times was observed. No difference in serum hCG values between IVF treatment with or without gonadotropin-releasing hormone agonist (GnRHa) was observed. Significantly lower hCG values but no difference in doubling times in early gestation in IVF compared with AIH may be explained by late but successful implantation in IVF. The mechanism for this assumed late implantation is not clear. Altered endometrial receptivity or factors of embryonic origin might explain the observed variation in hCG values and the assumed late implantation.
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Affiliation(s)
- G Ertzeid
- Department of Obstetrics and Gynecology, National Hospital, University of Oslo, Norway
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Abstract
This study was conducted to compare early serum human chorionic gonadotrophin (HCG) concentrations in singleton pregnancies achieved after intracytoplasmic sperm injection (ICSI), with those achieved after conventional in-vitro fertilization (IVF). Early serum HCG, 14-16 days after embryo transfer, was analysed in 99 IVF pregnancies achieved after ICSI (group A), and compared to 105 conventional IVF pregnancies (group B). All women were treated at the IVF Unit, Lis Maternity Hospital. Records were studied retrospectively. The mean +/- SE serum HCG concentration on day 14 after embryo transfer in group A was 190.5 +/- 17.4 mIU/ml, compared to 195.7 +/- 14.03 mIU/ml in group B. HCG concentration 14 days after embryo transfer in both groups A and B was higher in women with mechanical factor than in couples with male factor infertility or unexplained infertility (246 +/- 31.4, 183.3 +/- 16.4, 177.98 +/- 14.3 mIU/ml respectively). On the 16th day after embryo transfer, the HCG concentration increased, and the difference between the groups was maintained. Only in the subgroup of unexplained infertility did we find a difference in concentrations of HCG between ICSI and conventional IVF: on the 16th day following embryo transfer in this group there was a significant difference in HCG concentrations (395. 8 +/- 21 and 545.6 +/- 45.7 respectively; P = 0.04). HCG concentrations did not differ overall in the conventional IVF pregnancies compared with those achieved by ICSI. However, a statistical difference in early serum HCG concentrations was found in relation to the aetiology of infertility.
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Affiliation(s)
- R S Gold
- The Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel
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12
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Abstract
The practice of assisted reproduction technology today is the result of the dedicated patient care, observation, research, and experimentation undertaken by previous generations of physicians. The building blocks of progress have been assembled over past decades, by scientists whose primary objective has been to push forward the frontiers of knowledge, in order to offer more effective methods of infertility treatment. And fortunately that process continues today. Amongst the many scientific developments that have led to the modern practice in assisted reproductive technology, a small number stand out as having had a unique importance. This historical review redraws the path through which in vitro fertilization went from an experimental to an accepted infertility treatment.
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Affiliation(s)
- S J Fasouliotis
- Department of Obstetrics and Gynecology, Hadassah Medical Center-Hebrew University, Jerusalem, Israel
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SU LIMING, PALERMO GIANPIEROD, GOLDSTEIN MARC, VEECK LUCINDAL, ROSENWAKS ZEV, SCHLEGEL PETERN. TESTICULAR SPERM EXTRACTION WITH INTRACYTOPLASMIC SPERM INJECTION FOR NONOBSTRUCTIVE AZOOSPERMIA: TESTICULAR HISTOLOGY CAN PREDICT SUCCESS OF SPERM RETRIEVAL. J Urol 1999. [DOI: 10.1016/s0022-5347(01)62079-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- LI-MING SU
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
| | - GIANPIERO D. PALERMO
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
| | - MARC GOLDSTEIN
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
| | - LUCINDA L. VEECK
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
| | - ZEV ROSENWAKS
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
| | - PETER N. SCHLEGEL
- James Buchanan Brady Foundation, Department of Urology, Center for Reproductive Medicine and Infertility, and Department of Obstetrics and Gynecology, The New York Hospital-Cornell Medical Center, and The Population Council, Center for Biomedical Research, New York, New York
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Hsu MI, Kolm P, Leete J, Dong KW, Muasher S, Oehninger S. Analysis of implantation in assisted reproduction through the use of serial human chorionic gonadotropin measurements. J Assist Reprod Genet 1998; 15:496-503. [PMID: 9785197 PMCID: PMC3455044 DOI: 10.1023/a:1022534521019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Our purpose was to examine implantation of singleton pregnancies achieved following various assisted reproductive technologies (ARTs) through the appearance and rising titers of serum human chorionic gonadotropin (hCG) levels. METHODS A total of 114 singleton pregnancies resulting from in vitro fertilization and intrauterine insemination was analyzed. Patients were divided into five groups according to the type of ovarian stimulation protocol [gonadotropin stimulation with/without the use of gonadotropin-releasing hormone agonist (GnRHa), long protocol, or flare-up technique] and to the day of embryo transfer (day 2 or day 3 after oocyte retrieval). Serial serum hCG levels were measured between 10 and 25 days after fertilization and log-transformed. Linear regression analyses were performed and extrapolated to hCG = 10 mIU/ml (hCG10), which was used as an estimate of detectable implantation. The slopes of the regression lines were used to estimate the rising speed of hCG. RESULTS There were no significant differences in the days of hCG in maternal serum to reach 10 mIU/ml (implantation) or in the slopes of the regression lines for all five studied groups. CONCLUSIONS The appearance of hCG in maternal serum was used to assess the time of clinically detectable implantation. Furthermore, because hCG production is a marker of trophoblastic activity, its serum doubling time was used as an indicator of embryo quality. Results showed that in various ART protocols with and without GnRHa, there were no significant differences in implantation time or embryo quality. Embryo development in early pregnancy follows a preprogrammed-timing schedule and depends mainly on the embryonic age of the healthy, successfully implanted conceptus.
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Affiliation(s)
- M I Hsu
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507, USA
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Qasim SM, Callan C, Choe JK. The predictive value of an initial serum beta human chorionic gonadotropin level for pregnancy outcome following in vitro fertilization. J Assist Reprod Genet 1996; 13:705-8. [PMID: 8947817 DOI: 10.1007/bf02066422] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Our purpose was to assess the predictive value for pregnancy outcome of an initial serum quantitative beta-hCG measurement obtained 11 or 12 days after embryo transfer in an in vitro fertilization program. METHODS A prospective, descriptive study of 153 pregnancies achieved via in vitro fertilization-embryo transfer was performed. Initial beta-hCG levels and subsequent pregnancy outcomes were compared. RESULTS The overall mean initial beta-hCG level was 91 +/- 85.8 mIU/ml for normal (singleton, multiple-gestation) pregnancies and 29 +/- 24.9 mIU/ml for abnormal (miscarriage, ectopic) pregnancies (P < 0.01; power, > 80%). While 93.9% of patients with initial beta-hCG levels > or = 42 mIU/ml had normal pregnancies, 56.4% of those with initial levels < 42 mIU/ml experienced abnormal outcomes. With 42 mIU/ml as the cutoff level for predicting a normal pregnancy, this screening test yielded a sensitivity of 79.3% and a specificity of 83.8%. CONCLUSIONS Initial serum beta-hCG levels obtained 11 or 12 days after embryo transfer may be predictive of pregnancy outcome in an in vitro fertilization program.
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Affiliation(s)
- S M Qasim
- Cooper Center for Reproductive Endocrinology, Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, Marlton, New Jersey, USA
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Awonuga AO, Pittrof RJ, Zaidi J, Dean N, Jacobs HS, Tan SL. Elective cryopreservation of all embryos in women at risk of developing ovarian hyperstimulation syndrome may not prevent the condition but reduces the live birth rate. J Assist Reprod Genet 1996; 13:401-6. [PMID: 8739056 DOI: 10.1007/bf02066172] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Our goal was to evaluate the use of elective cryopreservation of all embryos to prevent the development of ovarian hyperstimulation syndrome in patients at risk while undergoing in vitro fertilization treatment. DESIGN We analyzed 117 treatment cycles in which the serum E2 concentration on the day of hCG administration was > 10,000 pM and in whom > or = 15 oocytes were retrieved at ultrasound-directed follicle aspiration. The incidence of ovarian hyperstimulation syndrome, pregnancy, and live birth in 65 patients who had elective cryopreservation of all embryos and 52 patients who had fresh embryo transfer were compared. Independent t test and chi-square test (with Yates' correction) was used as appropriate. RESULTS The clinical pregnancy (35 vs 17%; P < 0.03) and the live birth (27 vs 12%; P < 0.05) rates in patients receiving fresh embryo transfer was significantly higher than in those who had elective cryopreservation of all embryos. The incidence of moderate and severe ovarian hyperstimulation syndrome was similar in both groups (3.8 and 6.2%). CONCLUSIONS Elective cryopreservation of all embryos does not reliably protect against the development of ovarian hyperstimulation syndrome but may reduce the clinical pregnancy and live birth rate.
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Abstract
The relatively high rate of early pregnancy loss in artificial reproductive technology-induced conceptions has driven researchers to seek for an efficient diagnostic tool for estimating the gestational risk in these cases. Monitoring early gestation normalcy using serial beta-human chorionic gonadotrophin (beta hCG) measurements requires several days before diagnosis can be established. The objective of this study was to determine whether placental isoferritin (PLF) can be used as a predictive marker of normal pregnancy development during early stages of in vitro fertilization (IVF)-induced pregnancy. Ninety-three consecutive IVF cycles were investigated. Blood samples for PLF (enzyme linked immunosorbent assay; ELISA) and beta hCG (radio-immunoassay; RIA) determination were obtained from all women on days 11, 13 and 15 following embryo transfer. Placental isoferritin was detectable in the serum 11 days after embryo transfer in IVF conception cycles. These levels were significantly higher in normally developing pregnancies (n = 18) than in cases which eventually aborted spontaneously (n = 9) during the first trimester (mean +/- s.d.; 33 +/- 28 U/mL as compared with 1 +/- 2 U/mL; P = 0.0004; Wilcoxon test; sensitivity 94.5 per cent, specificity 88.9 per cent, positive predictive value 89.9 per cent, negative predictive value 94.5 per cent). Moreover, in those patients who later aborted, lower than normal PLF levels were detected long before the decline in beta hCG titres was evident. Considering its suppressor activity, it is expected that PLF levels would be high at the initiation of normal pregnancy. This may explain the present finding of low PLF levels in abnormally developing IVF-induced pregnancies. These preliminary data suggest that PLF can be used as a sensitive marker for detecting those cases destined to abort at a very early stage. However, further studies are still required on spontaneous conceptions, before this test can be recommended for routine clinical application.
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Affiliation(s)
- B Fisch
- Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah-Tikva, Israel
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Glatstein IZ, Hornstein MD, Kahana MJ, Jackson KV, Friedman AJ. The predictive value of discriminatory human chorionic gonadotropin levels in the diagnosis of implantation outcome in in vitro fertilization cycles. Fertil Steril 1995; 63:350-6. [PMID: 7843442 DOI: 10.1016/s0015-0282(16)57367-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine if early serum hCG levels are predictive of implantation outcome in patients undergoing IVF-ET. DESIGN Retrospective study of IVF cycles using receiver operator characteristic curve (ROC) analysis. SETTING Tertiary-care, university hospital-affiliated IVF program. PATIENTS Three hundred fifty-one conception cycles were studied. INTERVENTIONS None. MAIN OUTCOME MEASURE Implantation failure, defined as chemical pregnancies, ectopic gestations, and first trimester abortions, or implantation success, defined as delivered singleton and multiple pregnancies, and second trimester abortions. RESULTS For each post-ET day 14 to 20, mean hCG levels of the implantation success group were significantly greater than implantation failure outcomes (P < 0.0001). Using ROC curve analysis, hCG cutoff values for each post-ET day were calculated for optimal discrimination of implantation failure from implantation success cycles. A patient with an hCG measurement greater than the calculated cutoff value had a > or = 90% chance of having an implantation success after IVF-ET. CONCLUSION Discriminatory hCG cutoff values may be useful in predicting implantation outcome in IVF-ET cycles and may guide clinicians in identifying those pregnancies at risk for adverse outcomes and instituting more intensive surveillance in this population. This information also may be useful in providing counseling to IVF patients regarding pregnancy prognosis and result in cost savings.
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Affiliation(s)
- I Z Glatstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Guth B, Hudelson J, Higbie J, Solomon B, Polley S, Thomas S, Gentry WL. Predictive value of hCG level 14 days after embryo transfer. J Assist Reprod Genet 1995; 12:13-4. [PMID: 7580002 DOI: 10.1007/bf02214122] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE It has been reported that the quantitative serum hCG level 14 days after embryo transfer (ET) correlated with pregnancy outcome as well as a likelihood of a multiple gestation pregnancy. This prospective study was designed to assess the predictive value of a 14-day post-ET hCG level with pregnancy outcome and multiple gestation pregnancies. METHODS Patients undergoing in vitro fertilization (IVF) and ET were monitored by serum quantitative hCG levels 14 days after ET. If positive, serial values of hCG were obtained and transvaginal ultrasound was performed 3 weeks after ET and weekly until fetal cardiac activity was seen. Ongoing pregnancies were defined as greater than 20 weeks. RESULTS One hundred eleven patients had positive serum quantitative hCG levels 14 days post-ET; 89/111, or 80.2%, had ongoing pregnancies. The spontaneous miscarriage rate was, therefore, 19.8% (22/111). If the level was less than 300, the ongoing multiple pregnancy rate was 9% (5/57). If the level was between 300 and 600, the ongoing pregnancy rate was 40% (10/25). If the hCG level was greater than 600, the multiple pregnancy rate was 100% (7/7). CONCLUSIONS These data support the hypothesis that hCG levels greater than 200 mIU/ml on 14 days post-ET are more likely to have ongoing pregnancies; hCG levels greater than 600 have a high likelihood of a multiple gestation pregnancy.
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Affiliation(s)
- B Guth
- Advanced Fertility Institute, Methodist Hospital of Indiana, Inc., Indianapolis 46202, USA
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20
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Chan YF, So WW, Yeung WS, Lau EY, Ho PC. The value of a single sensitive urine pregnancy test in prediction of pregnancy outcome. Asia Oceania J Obstet Gynaecol 1994; 20:401-5. [PMID: 7832673 DOI: 10.1111/j.1447-0756.1994.tb00488.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A simple and reliable indicator for pregnancy outcome will be valuable clinically for patient management and for counselling women whose pregnancies are results of subfertility treatment. This study aimed at evaluating the ICON II test, a simple semiquantitative sensitive urine pregnancy test, in predicting pregnancy outcome in women who conceived after various forms of subfertility treatment. The ICON II test was performed on day 20 after the ovulating dose of hCG administration or spontaneous LH surge. One hundred and forty-five consecutive pregnancies were studied, 99 being viable and 46 nonviable which included subclinical abortion, clinical abortion and ectopic pregnancies. There was a significant difference in the luteal serum progesterone and hCG levels between viable and nonviable pregnancies. There was also a significant difference in the ICON II test result, i.e. either weakly positive (hCG of 25-50 IU/l) and positive (hCG > 50 IU/l) and the pregnancy outcome (p < 0.0001). The specificity of a weakly positive ICON II test in predicting poor pregnancy outcome was 98.8% whereas the sensitivity was 28.6%. In conclusion, a weakly positive ICON II test is useful in predicting poor pregnancy outcome.
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Affiliation(s)
- Y F Chan
- Department of Obstetrics and Gynaecology, University of Hong Kong
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21
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Schmidt LL, Asch RH, Frederick JL, Rojas FJ, Stone SC, Balmaceda JP. The predictive value of a single beta human chorionic gonadotropin in pregnancies achieved by assisted reproductive technology. Fertil Steril 1994; 62:333-8. [PMID: 8034081 DOI: 10.1016/s0015-0282(16)56887-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate whether a single serum beta-hCG in pregnancies achieved by assisted reproductive technologies (ART) can accurately predict pregnancy viability and, in viable pregnancies, multiple gestation. DESIGN Four hundred sixty-one consecutive successful ART pregnancies were studied retrospectively. Seventy-one of the 461 patients were excluded because their beta-hCG was either drawn on the incorrect day or outside our facility. Three hundred ninety subjects had a serum beta-hCG drawn 14 days after ET or 16 days after gamete transfer. The beta-hCG samples were analyzed by immunoradiometric assay based on the Third International Reference Standard (IRS) (First International Reference Preparation (IRP)). Pregnancy status was followed, at minimum, through the first trimester. RESULTS One hundred fifty (38%) of the 390 were found to be nonviable, resulting in spontaneous abortion (n = 38, 10%), ectopic pregnancy (n = 27, 6%), or biochemical pregnancies (n = 85, 22%). A statistically significant difference by the Scheffe F-test was found between the mean beta-hCG value of the nonviable (115 mIU/mL) (conversion factor to SI unit, 1.00) and viable (428 mIU/mL) pregnancies. The positive predictive value of a single beta-hCG > 100 mIU/mL in distinguishing viable from nonviable pregnancies was 0.83 (sensitivity 91%, specificity 71%). Of the 240 viable pregnancies, 74 (32%) were multiple gestations (57 twins, 14 triplets, and 3 quadruplets). The mean beta-hCG of the singleton pregnancies (266 mIU/mL) was significantly different from that of the multiple gestations (792 mIU/mL). The positive predictive value of a single serum beta-hCG < or = 400 mIU/mL in distinguishing singleton from multiple gestations was 0.92 (sensitivity 86%, specificity 82%). CONCLUSION A single early serum beta-hCG may be used in ART pregnancies to predict which pregnancies will continue beyond the first trimester and to identify multiple gestations. Early reassuring tests may reduce anxiety.
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Affiliation(s)
- L L Schmidt
- Department of Obstetrics and Gynecology, UCI Center for Reproductive Health, Orange 92613-1491
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22
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Dicker D, Goldman JA, Levy T, Feldberg D, Ashkenazi J. The impact of long-term gonadotropin-releasing hormone analogue treatment on preclinical abortions in patients with severe endometriosis undergoing in vitro fertilization-embryo transfer. Fertil Steril 1992; 57:597-600. [PMID: 1740204 DOI: 10.1016/s0015-0282(16)54906-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the relationship between endometriosis and preclinical abortions and to evaluate the effect of gonadotropin-releasing hormone analogue (GnRH-a) therapy on these pregnancies. DESIGN AND PATIENTS Of 67 women with severe endometriosis referred to us for in vitro fertilization-embryo transfer (IVF-ET), 32 underwent ovarian stimulation for oocyte retrieval with menotropins (protocol A), whereas the other 35 were admitted for the procedure after a 6-month period of hormonal suppression with a GnRH agonist (protocol B). The clinical impact of the preclinical and clinical pregnancies in both treatment protocols were evaluated on the basis of oocyte classification and embryo quality score. SETTING All patients were treated in our IVF Unit. MAIN OUTCOME MEASURE Clinical pregnancy was used as our main outcome measure of success. RESULTS A significantly higher number of preclinical pregnancies (P less than 0.0001) occurred in patients treated by protocol A. After GnRH-a treatment, the preclinical pregnancy rate declined significantly (P less than 0.0001), whereas the clinical pregnancy rate per cycle and per transfer rose significantly (P less than 0.0001 and P less than 0.0001, respectively). Furthermore, clinical pregnancies had a significantly better mean embryo quality score in comparison with preclinical pregnancies (P less than 0.0001). CONCLUSIONS It is concluded that combining GnRH-a therapy before IVF-ET provides an improved treatment modality for preclinical abortions and infertility associated with severe endometriosis.
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Affiliation(s)
- D Dicker
- Sherman Fertility Institute, Department of Obstetrics-Gynecology, Golda Meir Medical Center, (Hasharon Hospital), Petah-Tikva, Israel
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Levy T, Goldman JA, Dicker D, Ashkenazi J, Feldberg D. Very early pregnancy wastage in in vitro fertilization and embryo transfer (IVF-ET). J In Vitro Fert Embryo Transf 1991; 8:250-3. [PMID: 1757737 DOI: 10.1007/bf01139779] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The occurrence and incidence of early pregnancy wastage in an in vitro fertilization and embryo transfer (IVF-ET) program have been studied in 750 patients. In 297 (39.6%) a pregnancy was diagnosed; of these, 14.8% were biochemical and 24.8% clinical pregnancies. In the latter group 23.6% aborted, while 75.8% had clinical ongoing pregnancies. The mean embryo quality score of the biochemical pregnancy group was similar to that of the clinical ongoing pregnancy group but statistically different from that of the clinical abortion group (P less than 0.005). Furthermore, the clinical ongoing pregnancy rate in women with previous biochemical pregnancy was 24.7%, a significantly higher percentage compared to clinical ongoing pregnancies achieved in IVF-ET cycles (P less than 0.05). It is possible that biochemical pregnancy does not represent an index for infertility but rather an intact stage of reproduction leading toward implantation. The high clinical pregnancy rate in subsequent cycles may probably serve as an encouraging sign or a marker for future clinical pregnancy.
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Affiliation(s)
- T Levy
- Sherman Fertility Institute, Department Obstetrics-Gynecology, Golda Meir Medical Center, Petah-Tikva, Tel-Aviv University Medical School, Israel
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Liu HC, Davis O, Berkeley A, Graf M, Rosenwaks Z. Late luteal estradiol patterns are a better prognosticator of pregnancy outcome than serial beta-human chorionic gonadotropin concentrations. Fertil Steril 1991; 56:421-6. [PMID: 1894019 DOI: 10.1016/s0015-0282(16)54534-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Since the corpus luteum (CL) is known to play an important role in early pregnancy, its activity could possibly be a marker for pregnancy outcome. DESIGN The late estradiol (E2) concentration in 48 viable pregnancies and 39 pregnancies which resulted in spontaneous abortions after in vitro fertilization and embryo transfer were used to evaluate such predictability. SETTING All patients studied were of the Center for Reproductive Medicine at Cornell University Medical College. PATIENTS, PARTICIPANTS Eighty-seven patients. INTERVENTIONS None. MAIN OUTCOME MEASURE Serum E2 and human chorionic gonadotropin (hCG) concentrations on day +11, +13, +15 (day +1 = day of ovum pick-up) were measured and studied. RESULTS The late luteal CL activity after rescue had a positive correlation with the number and quality of the implanted embryos. Reduced CL activity was indicative of abortion. The late luteal E2 pattern when compared with hCG doubling time had a better abortion predictability (37.8% versus 63.9%, respectively). CONCLUSION Corpus luteum activity demonstrated to be a better prognosticator of abortion than serial beta-hCG titers.
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Affiliation(s)
- H C Liu
- Department of Obstetrics and Gynecology, Cornell University College, New York, New York 10021
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25
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Abstract
OBJECTIVE The purpose of the study was to describe and to compare the rate of rise of human chorionic gonadotropin (hCG) in vanishing twin and normally progressing twin pregnancies during the first trimester. DESIGN All patients with twin pregnancies between 1985 and 1989 were prospectively studied. Human chorionic gonadotropin was measured one to three times per week between days 12 and 52 after luteinizing hormone (LH) surge or day of hCG administration (day 0). Pelvic ultrasound (US) was performed weekly beginning on day 24. SETTING The study was performed at Rush-Presbyterian-St. Luke's Medical Center in an academic private practice setting of the Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology. PATIENTS Forty patients who conceived after treatment of infertility and who had two gestational sacs on US examination were included in the study after the following criteria were met: (1) both sacs progressed to exhibit a fetal pole and (2) day of LH surge and/or day of hCG administration was known. MAIN OUTCOME MEASURE The rate of rise of hCG was slower in vanishing twin pregnancies than in normally progressing twin gestations for the entire time period studied (P less than 0.05). RESULTS A vanishing twin occurred in one third of the twin pregnancies. Forty-six percent of these losses occurred after fetal heart activity had been established. CONCLUSIONS Vanishing twin phenomenon occurred in a large proportion of twin pregnancies in this infertility population. Fetal heart activity was not a reliable predictor of continuing fetal viability in early twin gestations. Vanishing twin conceptions were characterized by a slower rate of rise of hCG than normally progressing twin pregnancies.
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Affiliation(s)
- M P Kelly
- Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois
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Levy T, Dicker D, Ashkenazi J, Feldberg D, Shelef M, Goldman JA. The prognostic value and significance of preclinical abortions in in vitro fertilization-embryo transfer programs. Fertil Steril 1991; 56:71-4. [PMID: 1712324 DOI: 10.1016/s0015-0282(16)54419-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
UNLABELLED Preclinical abortions occur in natural conceptions as well as in in vitro fertilization-embryo transfer (IVF-ET) cycles. Nevertheless, although known, this entity is ill defined. OBJECTIVE The purpose of this study was to propose a classification of these pregnancies on the basis of pathophysiological evidence and to evaluate their future clinical impact. DESIGN Of 970 IVF-ET cycles, 114 cycles (11.7%) terminated in preclinical abortions. Abortions were divided according to peak beta human chorionic gonadotropin (beta-hCG) values into chemical abortions (52%) occurring 2 weeks after ET with beta-hCG values not higher than 21 mIU/mL and peri-implantation abortions (47%) terminating spontaneously 4 weeks after ET; the latter had higher beta-hCG values for a longer period of time but without any sonographic evidence of gestational sac. No woman in the two groups needed curettage. RESULTS After a chemical abortion, the pregnancy outcome had better ongoing pregnancy rates (24.7%) in comparison with the 17% achieved in the total IVF-ET cycles. CONCLUSIONS It is concluded that these two groups most probably have different pathophysiological backgrounds and concomitantly different future clinical impacts.
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Affiliation(s)
- T Levy
- Sherman Fertility Institute, Department of Obstetrics-Gynecology, Golda Meir Medical Center (Hasharon Hospital), Petah-Tikva, Israel
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Abstract
Human in vitro fertilization is characterized by a low efficiency of implantation. Possible mechanisms for pregnancy loss are discussed. Embryo viability or quality, abnormal implantation, and delayed or absent corpus luteum rescue may all play a role in pregnancy wastage. Defining the possible mechanism for these losses may allow hormonal treatment to correct specific abnormalities.
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Affiliation(s)
- H C Liu
- Cornell University Medical College, Department of Obstetrics and Gynecology, New York, New York 10021
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Tur-Kaspa I, Confino E, Dudkiewicz AB, Myers SA, Friberg J, Gleicher N. Ovarian stimulation protocol for in vitro fertilization with gonadotropin-releasing hormone agonist widens the implantation window*†*Presented in part at the 36th Annual Meeting of The Society for Gynecologic Investigation, San Diego, California, March 15 to 18, 1989.†Supported in part by The Foundation for Reproductive Medicine, Inc., Chicago, Illinois. Fertil Steril 1990. [DOI: 10.1016/s0015-0282(16)53522-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Acosta AA, Oehninger S, Hammer J, Muasher SJ, Liang HM, Jones DL. Preclinical abortions: incidence and significance in the Norfolk in vitro fertilization program. Fertil Steril 1990; 53:673-6. [PMID: 2318326 DOI: 10.1016/s0015-0282(16)53462-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Clinical and prognostic significance of preclinical abortions in assisted reproduction is ill defined. Strict diagnostic criteria include a transient and synchronous elevation of serum beta-human chorionic gonadotropin (hCG), estradiol, and progesterone levels 13 days after hCG administration, ending in a bleeding episode no more than 14 days after the missed period. The preclinical abortion study group (54 patients, 178 cycles) was compared with matched control groups A (54 patients, 132 cycles) and B (54 patients, 155 cycles), representing normal term pregnancies and all outcomes, respectively. Control group C included the overall population during the study period. The abortion rate per transfer (preclinical abortion and total miscarriage rates) and total pregnancy wastage in the study group were significantly higher; the ongoing pregnancy rate was significantly lower. Preclinical abortion should be considered as a true reproductive failure with similar implications.
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Affiliation(s)
- A A Acosta
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk
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