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Chu J, Guan S, Ma R, Zhang X, Ning S, Song W, Yao G, Shi S, Jin H. Relationship between fresh single embryo morphology scores and serum HCG values at 14 days and 14-18-day doubling values. Reprod Biomed Online 2024; 49:104325. [PMID: 39222558 DOI: 10.1016/j.rbmo.2024.104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 09/04/2024]
Abstract
RESEARCH QUESTION What is the effect of embryo morphology score on 14-day β-HCG levels and 14-18-day β-HCG doubling values, and do they have differences in day-3 embryo or day-5 blastocyst transfers? DESIGN Retrospective analysis of 4434 fresh cycles of single embryo transfers (SET) with β-HCG ≥15 mIU/ml on day 14 after transfer via IVF and ICSI. The correlation between embryo morphology score and 14-day β-HCG was examined. Doubling of 14-18 day β-HCG was analysed in 2628 cycles to determine correlations with embryo morphology score. RESULTS In day-3 SET, number of embryonic cells was positively correlated with 14-day post-transfer β-HCG values (R = 0.076; P = 0.013). No significant correlation was observed between the grade of the transferred embryos and the 14-18-day serum β-HCG doubling values. In day-5 single blastocyst transfers, the degree of blastocyst expansion, trophoblast cell and inner cell mass (ICM) grades demonstrated a significant positive correlation with 14-day post-transfer β-HCG (P < 0.001, P = 0.014, P = 0.003). Degree of blastocyst expansion was significantly correlated with 14-18-day β-HCG doubling values (R = -0.051, P = 0.027). Grades of the ICM and trophoblast cells showed no significant correlation with 14-18-day β-HCG doubling values. CONCLUSION In fresh SET, embryo morphology score influences 14-day β-HCG values in day-3 embryos and day-5 blastocyst transfers. Embryo morphology score in day-3 SET does not affect 14-18-day β-HCG doubling values. Degree of blastocyst expansion significantly affects 14-18-day β-HCG doubling values in day-5 blastocyst transfers.
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Affiliation(s)
- Junting Chu
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Shanyue Guan
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ruonan Ma
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiangyang Zhang
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Song Ning
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wenyan Song
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guidong Yao
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Senlin Shi
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Haixia Jin
- Centre for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China..
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Mourad A, Antaki R, Rowen M, Lévesque É, Lapensée L. The POPI-Plus tool: prediction model of outcome of pregnancy in in vitro fertilization from a large retrospective cohort. Fertil Steril 2024; 121:489-496. [PMID: 38043845 DOI: 10.1016/j.fertnstert.2023.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To create a tool that accurately predicts live birth chances after a positive pregnancy test after elective single embryo transfer (ET). DESIGN Retrospective cohort. SETTING CHUM hospital and Ovo clinic in Montreal, Canada. PATIENT(S) Patients with a positive pregnancy test result who underwent their first single ET after in vitro fertilization (IVF) at the CHUM hospital and Ovo clinic in Montreal, Canada, from 2012 to 2016 were selected. A total of 1,995 patients were included in this study. INTERVENTION(S) The data from both centers were combined and divided into training (70%, n = 1,398) and validation (30%, n = 597) sets. The predictive model was developed using backward selection method for the following variables: age of patient at egg retrieval; log β-human chorionic gonadotropin (β-hCG) (β-hCG) 1; log β-hCG 2; and IVF treatment type. Moreover, the classification tree, random forest, and neural network models were generated. MAIN OUTCOME MEASURE(S) The measured outcomes were live birth (live fetus ≥24 weeks of gestation) and nonviable pregnancies. The performance of all models was evaluated by area under the receiver operating characteristic curve (AUC). RESULT(S) Advancing age was negatively correlated with live birth. The odds ratio (OR) of age of patient at the time of egg retrieval was 0.95 (95% confidence interval [CI], 0.91-0.99). The log β-hCG 1 and log β-hCG 2 were positively correlated with live birth in the univariate analysis (OR, 4.15 [95% CI, 3.19-5.39], and OR, 3.84 [95% CI, 2.99-4.93], respectively). The β-hCG 1 level needed for a successful pregnancy was lower in frozen ET and modified natural IVF than in simulated IVF (OR, 0.55 [95% CI, 0.34-0.91], and OR, 0.49 [95% CI, 0.26-0.95], respectively). The best performance in terms of the AUC was the updated logistic model: POPI-Plus. The AUC values were 0.76 (95% CI, 0.73-0.79) and 0.78 (95% CI, 0.74-0.82) for the training and validation data, respectively. The other models (classification tree, random forest, and neural network) also performed adequately, with an AUC of ≥0.7, but remained below POPI-Plus. An open-access calculator was generated and can be found on the website of the University of Montreal on the following link: https://deptobsgyn.umontreal.ca/departement/divisions/medecine-et-biologie-de-la-reproduction/the-popi-plus-tool/. CONCLUSION(S) The POPI-Plus tool offers individualized counseling for patients after an initial positive β-hCG test result. Future studies will assess its impact on patient anxiety while awaiting viability ultrasound and perform prospective validation on new patients.
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Affiliation(s)
- Ali Mourad
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Roland Antaki
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada
| | - Mélanie Rowen
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Étienne Lévesque
- Faculty of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Louise Lapensée
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada; Reproductive Endocrinology and Infertility, Ovo Fertility Clinic, Montreal, Quebec, Canada.
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Hughes LM, Schuler A, Sharmuk M, Schauer JM, Pavone ME, Bernardi LA. Early β-hCG levels predict live birth after single embryo transfer. J Assist Reprod Genet 2022; 39:2355-2364. [PMID: 36074224 PMCID: PMC9596620 DOI: 10.1007/s10815-022-02606-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Specific serum beta human chorionic gonadotropin (β-hCG) parameters that can predict live birth after an embryo transfer have yet to be defined. METHODS We performed a retrospective cohort study of 1,028 patients with a detectable β-hCG who underwent a single embryo transfer between 2002 and 2019 at a large academic center. Two β-hCG parameters were examined in relation to live birth: 1) "doubling" defined as β-hCG doubling over 48 h and 2) "reaching 100" defined as a β-hCG ≥ 100 mIU/mL by 15 days after oocyte retrieval (AOR). RESULTS One thousand three hundred forty cycles involving a single embryo were analyzed. Two thirds were frozen embryos and 86% were blastocyst transfers. Preimplantation genetic testing was performed in almost 30% of cycles. When β-hCG levels "doubled," a live birth occurred in 80.7% of cycles and when β-hCG levels "reached 100" by 15 days AOR, live birth occurred in 81.6% of cycles. When β-hCG levels both doubled and reached 100 by 15 days, AOR 85.4% cycles resulted in live birth. A multiple logistic regression model to control for patient and cycle level factors revealed a live birth odds ratio (OR) of 8.0 (95% CI 5.7-11.1) when β-hCG "doubled" and an OR of 21.2 (95% CI 14.3-31.5) when β-hCG "reached 100." When both these latter parameters were met, the OR was 12.5 (95% CI 8.9-17.8). CONCLUSION β-hCG parameters of "doubling" and "reaching 100" by 15 days AOR are robust predictors of live birth and can aid in patient counseling regarding pregnancy outcomes soon after single embryo transfer.
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Affiliation(s)
- Lydia M Hughes
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA.
- Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA.
| | - Adrienne Schuler
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
| | - Maxwell Sharmuk
- Department of Obstetrics and Gynecology, Northwestern University, 250 E Superior St, Suite 5-2177, Chicago, IL, 60611, USA
| | - Jacob Michael Schauer
- Department of Obstetrics and Gynecology, Northwestern University, 250 E Superior St, Suite 5-2177, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
| | - Lia A Bernardi
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA
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Harlev A, Pariente M, Har-Vardi I, Friger M, Levitas E. Pregnancy outcomes of fresh IVF conceived pregnancies after embryo transfer at different stages of early embryonic development. J Matern Fetal Neonatal Med 2020; 35:235-241. [PMID: 31964214 DOI: 10.1080/14767058.2020.1716215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To compare pregnancy outcomes between pregnancies following day 2, day 3, and days 5/6 fresh embryo transfer (ET).Methods: A retrospective cohort study including all pregnancies following fresh IVF/intracytoplasmic sperm injection (ICSI) ET cycles performed between January 2014 and December 2015 at Fertility and In Vitro Fertilization (IVF) Unit of the tertiary Soroka University Medical Center. The study groups consisted of 48, 72, 120, and 144 hours embryos. Pregnancies were confirmed by a serum beta-human chorionic gonadotropin measurement. Data regarding patients' medical history, infertility workup, fertility treatment characteristics, and outcome, as well as obstetrical outcome, were collected from patients' medical records and IVF Laboratory database. Multiple regression models were constructed to control for confounders. Patients who underwent fertility preservation treatment, cycles of oocyte donation or in vitro maturation oocytes, and cases of preimplantation genetic testing were excluded.Results: A total of 534 pregnancies following fresh IVF/ICSI ET on day 2 (n = 189, 35.4%), day 3 (n = 200, 37.5%), and days 5 or 6 (n = 145, 27.2%) were included. Live birth rate demonstrated a linear association to the developmental stage at ET with the highest rates in blastocysts and gradually lower in day 3 and day 2 ET (79.2, 65.8, and 60.6%, respectively, p = .001). A positive linear association was also observed between ET age and clinical pregnancy rate (77.3, 87.5, and 90.3% for days 2, 3, and 5/6, respectively, p = .002), as well as with combined pregnancy complication rate (29, 37.3, and 43.3%, p = .026). However, using multivariate logistic regression model controlling for ET age, maternal age, smoking, obesity, initial HCG level and peak E2 level, live birth rate was comparable between the study groups regardless of ET age. Pregnancy complications were comparable between the groups; however, a composite pregnancy complications variable was higher in the blastocyst pregnancies compared to cleavage embryos pregnancies.Conclusions: The common approach of blastocyst transfer, as high quality of the embryo, has not proven beneficial in terms of live birth rate. Moreover, cleavage stage embryos were not associated with adverse perinatal outcomes. The current data suggest maternal age has an independent effect on live birth.
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Affiliation(s)
- Avi Harlev
- Department of Obstetrics and Gynecology, Fertility and IVF Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Maayan Pariente
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Iris Har-Vardi
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Michael Friger
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eliahu Levitas
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
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Wang Z, Gao Y, Zhang D, Li Y, Luo L, Xu Y. Predictive value of serum β-human chorionic gonadotropin for early pregnancy outcomes. Arch Gynecol Obstet 2019; 301:295-302. [PMID: 31758302 DOI: 10.1007/s00404-019-05388-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the relationship between serum β-human chorionic gonadotropin (HCG) levels and early pregnancy outcomes in women who became pregnant using assisted reproductive technologies (ARTs). METHODS In this study, we retrospectively analyzed 523 pregnancies after ART use, with respect to the early clinical outcomes based on the serum β-HCG levels. The significance of using serum β-HCG levels to predict outcomes in early pregnancy was evaluated by the receiver operating characteristic (ROC) curve and cutoff values of serum β-HCG. RESULTS We found that elevated serum β-HCG levels resulted in decreased biochemical pregnancy rates, increased multiple rates, and decreased ongoing and ectopic pregnancy rates. The cutoff values of serum β-HCG levels for the prediction of biochemical pregnancy were 213.15 IU/L, 986.65 IU/L, and 2206.5 IU/L for singletons, multiples, and twins or triplets, respectively. CONCLUSION The serum β-HCG level 14 or 12 days after D3 or D5 embryo transfer (conducted 3 or 5 days after oocyte retrieval), respectively, predicts biochemical/clinical pregnancy and singleton/multiple pregnancy with robust sensitivity and specificity.
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Affiliation(s)
- Zengyan Wang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China.
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China.
| | - Yong Gao
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
| | - Dan Zhang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
| | - Lu Luo
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China.
- The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Zhongshan 2nd Road, No. 58, Guangzhou, 510080, Guangdong, China.
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Kuspinar G, Kasapoglu I, Cakır C, Ata B, Uncu G, Avcı B. What is the effect of embryo morphology on serum β-hCG levels? Eur J Obstet Gynecol Reprod Biol 2018; 233:107-113. [PMID: 30590226 DOI: 10.1016/j.ejogrb.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/23/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the effect of embryonic factors on serum beta human chorionic gonadotropin (β-hCG) levels in pregnancy and live birth resulting after a single fresh cleavage embryo and blastocyst transfer. STUDY DESIGN This was a retrospective cohort study conducted at a tertiary care hospital. All fresh single embryo transfers (sETs) between September 2011 and December 2016 were included. The correlation analysis was performed to determine the association of embryo morphological parameters on mean serum β-hCG levels on day 12 after the transfer of a fresh single cleavage embryo and a fresh single blastocyst embryo. RESULTS Out of a total of 455 fresh sETs, 60 positive β-hCG results after the transfer of a single fresh cleavage-stage embryo and 82 after the transfer of a single fresh blastocyst. The mean β-hCG level resulting from a single fresh blastocyst ET was 371.7 ± 52.7 IU/L, which was similar to the mean β-hCG level resulting from a cleavage ET (314.5 ± 36.9 IU/L) (p = .70). Interestingly, serum β-hCG levels resulting from a single fresh blastocyst ET showed a correlation with day 5 blastocoele expansion, trophectoderm cell number and blastocyst quality score in ongoing pregnancy (r = .33, p = .02; r = .29, p = .04; and r = .31, p = .03, respectively). Moreover, day 5 blastocoele expansion and blastocyst quality score showed a correlation with the serum β-hCG levels resulting from a single fresh blastocyst ET in live birth (r = .36, p = .02; r = .31, p = .04, respectively). CONCLUSION Our study suggests that serum β-hCG levels resulting from a single fresh blastocyst ET showed a correlation with day 5 blastocoele expansion and blastocyst quality score in both ongoing pregnancy and live birth.
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Affiliation(s)
- Goktan Kuspinar
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkey
| | - Isıl Kasapoglu
- Department of Gynecology and Obstetric ART Center, Uludag University School of Medicine, Bursa, Turkey
| | - Cihan Cakır
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkey; Department of Gynecology and Obstetric ART Center, Uludag University School of Medicine, Bursa, Turkey
| | - Barıs Ata
- Department of Gynecology and Obstetric, Koc University School of Medicine, Istanbul, Turkey
| | - Gurkan Uncu
- Department of Gynecology and Obstetric ART Center, Uludag University School of Medicine, Bursa, Turkey
| | - Berrin Avcı
- Department of Histology and Embryology, Uludag University School of Medicine, Bursa, Turkey; Department of Gynecology and Obstetric ART Center, Uludag University School of Medicine, Bursa, Turkey.
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Soni S, Krantz DA, Blitz MJ, Vohra N, Rochelson B. Elevated maternal serum-free β-human chorionic gonadotropin (β-hCG) and reduced risk of spontaneous preterm delivery . J Matern Fetal Neonatal Med 2018; 32:3191-3196. [PMID: 29642747 DOI: 10.1080/14767058.2018.1459554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To evaluate the relationship between first and second trimester maternal serum-free β-hCG and the risk of spontaneous preterm delivery (PTD). Study design: This was a case-control study of women evaluated and delivered at our institution from 2011 to 2015. Spontaneous PTD was defined as delivery before 37 weeks due to spontaneous preterm labor or premature rupture of membranes. Patient with multifetal gestation and those with medically indicated term or PTD were excluded. Results: Of 877 women meeting the inclusion criteria, 173 delivered preterm and 704 delivered at term, and 8.1% had high free β-hCG in one or both trimesters. High maternal first and/or second trimester free β-hCG (≥95th percentile) was associated with lower rates of PTD. Thirty-two women with high free β-hCG in both first and second trimesters delivered at term. Gestational age at delivery and birth weights were lower in women who did not have high free β-hCG in any trimester. Low free β-hCG (≤5th percentile) in either trimester was not associated with an increased or decreased likelihood of PTD. Logistic regression demonstrated an independent association of high free β-hCG (≥95th percentile) with a reduced likelihood of PTD. Stratified analysis revealed a stronger impact of this association in women with no prior history of PTD. Conclusions: High free β-hCG, in the absence of risk factors for medically indicated PTD, is associated with a reduced likelihood of spontaneous PTD and may represent a marker indicating lower risk.
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Affiliation(s)
- Shelly Soni
- a Zucker School of Medicine at Hofstra/Northwell , Manhasset , NY , USA
| | | | - Matthew J Blitz
- a Zucker School of Medicine at Hofstra/Northwell , Manhasset , NY , USA
| | - Nidhi Vohra
- a Zucker School of Medicine at Hofstra/Northwell , Manhasset , NY , USA
| | - Burton Rochelson
- a Zucker School of Medicine at Hofstra/Northwell , Manhasset , NY , USA
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Pontré JC, Ryan JP, Tan A, Hart RJ. The interval transfer of a frozen-thawed embryo is more successful than a fresh embryo transfer for women undergoing IVF with recurrent implantation failure after cleavage stage embryo biopsy. Aust N Z J Obstet Gynaecol 2018; 59:134-139. [PMID: 29551013 DOI: 10.1111/ajo.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/11/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs). AIMS To identify predictive embryonic markers of implantation in RIF, following pre-implantation genetic screening (PGS) of cleavage stage embryos, after accounting for male and female factors. MATERIALS AND METHODS Retrospective analysis of RIF patients undergoing PGS after correction of modifiable causes. RESULTS Eighty-four patients underwent 140 in vitro ferilisation cycles. Forty-one cycles were excluded: 12 (no embryo for transfer), four (double ETs) and 25 (no biopsy). Sixty-three patients underwent 99 single euploid ETs (48 fresh, 51 frozen) resulting in 11 biochemical pregnancies, 36 clinical pregnancies (CP), and six miscarriages and 30 live births (LB). Frozen ET was more successful than fresh; respective live birth rate (LBR) and clinical pregnancy rate (CPR), 39.2% versus 20.8%, (P = 0.02), 45.1% versus 27.1% (P = 0.04). LBR and CPR were lower when 5-6 blastomeres were present at embryo biopsy, compared to embryos with ≥7 blastomeres: 15.4% versus 32.6% (P = 0.185) and 15.4% versus 39.5% (P = 0.074) respectively. Serum β human chorionic gonadotropin (βhCG) concentration was greater when a more developed embryo was biopsied (r = 0.448, P = 0.017 and r = 0.476, P = 0.118, fresh and frozen transfers, respectively). Embryo morphokinetic analysis demonstrated faster development to blastocyst stage when more cells were present at biopsy: mean 103.3, 102.2 and 96.0 h for biopsy at the 5-6, 7-8 or ≥9 cell stage respectively (P = 0.040 for difference between 7-8 cells vs ≥9). CONCLUSIONS After cleavage stage biopsy, frozen ET was more successful than fresh ET. Chance of conception and serum βhCG concentration correlated with number of cells present at time of biopsy.
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Affiliation(s)
- Jennifer C Pontré
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - John P Ryan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andy Tan
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia
| | - Roger J Hart
- Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia, Australia
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Predictive value of serum HCG concentrations in pregnancies achieved after single fresh or vitrified-warmed blastocyst transfer. Reprod Biomed Online 2017. [DOI: 10.1016/j.rbmo.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Hobeika E, Singh S, Malik S, Knochenhauer ES, Traub ML. Initial maternal serum human chorionic gonadotropin levels in pregnancies achieved after assisted reproductive technology are higher after preimplantation genetic screening and after frozen embryo transfer: a retrospective cohort. J Assist Reprod Genet 2017. [PMID: 28639180 DOI: 10.1007/s10815-017-0987-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Few published articles have compared initial hCG values across all different types of ART cycles, including cycles with fresh or frozen embryo transfer. No articles have compared initial hCG values in cycles utilizing preimplantation genetic screening (PGS). The purpose of this study is to compare initial hCG values after fresh embryo transfer, frozen embryo transfer, and after PGS. METHODS This was a single-center retrospective cohort study at an academically affiliated private IVF center. All fresh and frozen embryo transfers between January 2013 and December 31, 2015 were included. We compared mean initial serum hCG values 14 days after oocyte retrieval for fresh cycles and 9 days after frozen embryo transfer. We examined cycles of single embryo transfer (SET) and double embryo transfer (DET). RESULTS Two hundred elven IVF (fresh embryo transfer), 128 FET (frozen embryo transfer cycles, no PGS), and 111 PGS cycles (ovarian stimulation with embryo cryopreservation, PGS, and frozen transfer in a subsequent estrogen-primed cycle) with initial positive hCG values were analyzed. In patients achieving a positive hCG after SET, initial hCG values were higher after PGS compared to FET (182.4 versus 124.0 mIU/mL, p = 0.02) and IVF (182.4 versus 87.1 mIU/mL, p < 0.001) as well as FET compared to IVF (124.0 versus 87.1 mIU/mL, p < 0.01). After DET, initial hCG values were higher after PGS (222.8 mIU/mL) compared to FET (182.1 mIU/mL, p = 0.02) and IVF (131.1 mIU/mL, p = 0.001). CONCLUSIONS Our study suggests that initial serum hCG values are higher after using PGS and higher after the transfer of a frozen embryo compared to a fresh embryo. This suggests that initial hCG values relate to the chromosomal status of embryos. Initial hCG values may help determine intervention and monitoring later in pregnancy.
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Affiliation(s)
- Elie Hobeika
- Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA
| | - Sonali Singh
- Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA
| | - Shaveta Malik
- Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA
| | - Eric S Knochenhauer
- Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.,Island Reproductive Services, 237 Richmond Valley Road, Staten Island, NY, 10309, USA
| | - Michael L Traub
- Obstetrics and Gynecology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA. .,Island Reproductive Services, 237 Richmond Valley Road, Staten Island, NY, 10309, USA.
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Naredi N, Singh SK, Sharma R. Does First Serum Beta-Human Chorionic Gonadotropin Value Prognosticate the Early Pregnancy Outcome in an In-Vitro Fertilisation Cycle? J Hum Reprod Sci 2017; 10:108-113. [PMID: 28904499 PMCID: PMC5586083 DOI: 10.4103/jhrs.jhrs_50_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Pregnancies achieved through in-vitro fertilisation (IVF) are associated with adverse first trimester outcomes in comparison to spontaneously achieved pregnancies. In view of this, it is imperative to predict the success as well as prognosticate the pregnancy outcome of an IVF cycle not only for the clinicians but also the couples undergoing IVF. Serum beta-human chorionic gonadotropin (β-hCG) value has, thus, been used as a biomarker for pregnancy outcome after IVF and also an aid in counselling and management of the patient. Aim: The main objective of this study was to compare the predictive value of the first serum β-hCG value and the pregnancy outcome after an IVF cycle (whether fresh or frozen embryo transfer) in the two subgroups of patients. Settings and Design: The study was conducted at Assisted Reproductive Technology Centre of a tertiary care hospital, and it was a retrospective cohort study. Methods and Materials: A retrospective study was performed for post-IVF pregnancies at a single IVF centre from March 2014 to February 2015 with serum β-hCG values less than or equal to 1000 mIU/ml. The initial serum values of β-hCG on the day 16 of embryo transfer were correlated with first trimester pregnancy outcome and ongoing pregnancy rate (>12 weeks gestation). Results: Of the 208 post-IVF pregnancies included in the study, the group with β-hCG more than 500 mIU/ml had statistically significant higher ongoing pregnancy rates and a lesser poor pregnancy outcome. Conclusion: The study concluded that an early serum β-hCG value can be used as a predictor of a successful or an adverse first trimester pregnancy outcome helping in better counselling and monitoring of the high-risk precious IVF pregnancies.
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Affiliation(s)
- Nikita Naredi
- Assisted Reproductive Technology Centre, Command Hospital, Pune, Maharashtra, India
| | - S K Singh
- Department of Obstetrics & Gynaecology, Command Hospital, Pune, Maharashtra, India
| | - Rajesh Sharma
- Assisted Reproductive Technology Centre, Command Hospital, Pune, Maharashtra, India
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12
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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] [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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Occult abnormal pregnancies after first post-embryo transfer serum beta-human chorionic gonadotropin levels of 1.0-5.0 mIU/mL. Fertil Steril 2015; 105:938-945.e1. [PMID: 26702770 DOI: 10.1016/j.fertnstert.2015.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the occult pregnancy rate after "negative" first post-embryo transfer (ET) serum β-hCG results. DESIGN Two-part retrospective cohort study and nested case series. SETTING University-based fertility center. PATIENT(S) A total of 1,571 negative first post-ET serum β-hCG results were included in the study; 1,326 results (primary cohort, June 2009-December 2013) were initially reported as <5 mIU/mL and 245 results (secondary cohort, January 2014-March 2015) were reported as discrete values from 1.0 to 5.0 mIU/mL. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Rates of occult pregnancy, ectopic pregnancy, and complications after negative first post-ET serum β-hCG results. RESULT(S) A total of 88.8% (1,178/1,326) of the negative first post-ET results reported as <5 were actually <1.0 mIU/mL. Occult pregnancy was incidentally identified in 1.2% (12/1,041) of subjects with follow-up. Six had ectopic pregnancies, and seven experienced serious complications; 11 (91.7%) of the 12 occult pregnancies had a first post-ET serum β-hCG level of 1.0-5.0 mIU/mL and 1 (8.3%) <1.0 mIU/mL. All pregnancies with serious complications had initial β-hCG levels of 1.0-5.0 mIU/mL. Of the 245 results reported as discreet values, occult pregnancies were diagnosed in 5.5% (9/163) of subjects with follow-up. One had an ectopic pregnancy, which was treated with methotrexate. There were no serious complications in the secondary cohort. CONCLUSION(S) The majority of negative first post-ET serum β-hCG levels are <1.0 mIU/mL. Results from 1.0 to 5.0 mIU/mL may fail to exclude abnormal pregnancy and are associated with poor outcomes compared with β-hCG levels <1.0 mIU/mL. Serial serum β-hCG may be warranted in this population.
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Oron G, Esh-Broder E, Son WY, Holzer H, Tulandi T. Predictive value of maternal serum human chorionic gonadotropin levels in pregnancies achieved by in vitro fertilization with single cleavage and single blastocyst embryo transfers. Fertil Steril 2015; 103:1526-31.e1-2. [DOI: 10.1016/j.fertnstert.2015.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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