The predictive value of an initial serum β human chorionic gonadotropin level for pregnancy outcome following in vitro fertilization
Clinical Assisted Reproduction
Purpose: Our purpose was to assess the predictive value for pregnancy outcome of an initial serum quantitative β-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 β-hCG levels and subsequent pregnancy outcomes were compared.
Results: The overall mean initial β-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 β-hCG levels ≥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 β-hCG levels obtained 11 or 12 days after embryo transfer may be predictive of pregnancy outcome in an in vitro fertilization program.
Key wordsinitial β-human chorionic gonadotropin levels in vitro fertilization pregnancy outcome
Mettler L, Tavmergen EN: Significance of oestradiol values in IVF-ET under a combined GnRH analogue-desensitization and simultaneous gonadotrophin stimulation for the outcome of pregnancies. Hum Reprod 1989;4 (Suppl):59–64PubMedGoogle Scholar
Heiner JS, Kerin JF, Schmidt LL, Jackson Wu T-C: Can a single, early quantitative human chorionic gonadotropin measurement in an in vitro fertilization-gamete intrafallopian transfer program predict pregnancy outcome? Fertil Steril 1992;58:373–377PubMedGoogle Scholar
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;63:350–356PubMedGoogle Scholar
Liu H-C, Kreiner D, Muasher SJ, Jones G, Jones Jr HW, Rosenwaks Z: Beta-human chorionic gonadotropin as a monitor of pregnancy outcome in in vitro fertilization-embryo transfer patients. Fertil Steril 1988;50:89–94PubMedGoogle Scholar
Dor J, Rudak E, Rotmench S, Levran D, Blankstein J, Lusky A, Nebel L, Serr DM, Mashiach S: The role of early post-implantation beta-HCG levels in the outcomes of pregnancies following in-vitro fertilization. Hum Reprod 1988;5:663–667Google Scholar
Yamashita T, Okamoto S, Thomas A, MacLachlan V, Healy DL: Predicting pregnancy outcome after in vitro fertilization and embryo transfer using estradiol, progesterone, and human chorionic gonadotropin beta-subunit. Fertil Steril 1989;51:304–309PubMedGoogle Scholar
Bustillo M, Stern JJ, King D, Coulam CB: Serum progesterone and estradiol concentrations in the early diagnosis of ectopic pregnancy after in vitro fertilization-embryo transfer. Fertil Steril 1993;59:668–670PubMedGoogle Scholar
Edelstein M, Seltman H, Cox B, Robinson SM, Shaw RA, Muasher SJ: Progesterone levels on the day of human chorionic gonadotropin administration in cycles with gonadotropin-releasing hormone agonist suppression are not predictive of pregnancy outcome. Fertil Steril 1990;54:853–857PubMedGoogle Scholar
Silverberg KM, Burns WN, Olive DL, Riehl RM, Schenken RS: Serum progesterone levels predict success of in vitro fertilization/embryo transfer in patients stimulated with leuprolide acetate and human menopausal gonadotropins. J Clin Endocrinol Metab 1991;73:797–803PubMedGoogle Scholar
Munabi AK, King D, Bender S, Bustillo M, Dorfmann A, Schulman JD: Small increases in circulating luteinizing hormone (LH) concentrations shortly before human chorionic gonadotropin (hCG) are associated with reduced in vitro fertilization (IVF) pregnancy rate. J Vitro Fert Embryo Transfer 1990;7:310–313Google Scholar
Khalifa E, Brzyski RG, Oehninger S, Acosta AA, Muasher SJ: Sonographic appearance of the endometrium; the predictive value for the outcome of in vitro fertilization in stimulated cycles. Hum Reprod 1992;7:677–680PubMedGoogle Scholar
Check JH, Nowroozi K, Choe J, Dietterich C: Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization. Fertil Steril 1991;56:1173–1175PubMedGoogle Scholar
Levy T, Goldman JA, Dicker D, Ashkenazi J, Feldberg D: Very early pregnancy wastage in in vitro fertilization and embryo transfer (IVF-ET). J Vitro Fert Embryo Transfer 1991;8:250–253Google Scholar
Medical Research International and the Society for Assisted Reproductive Technology: In vitro fertilization-embryo transfer in the United States: 1988 results from the IVF-ET Registry. Fertil Steril 1990;53:13–20Google Scholar
Dobuisson JB, Aubriot FX, Mathieu L, Foulot H, Mandelbrot L, de Joliniere JB: Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: Implications for preventive management. Fertil Steril 1991;56:686–690PubMedGoogle Scholar
Herman A, Ron-El R, Golan A, Weinraub Z, Bukovsky I, Caspi E: The role of tubal pathology and other parameters in ectopic pregnancies occurring in in vitro fertilization and embryo transfer. Fertil Steril 1990;54:864–868PubMedGoogle Scholar
Zouves C, Erenus M, Gomel V: Tubal ectopic pregnancy after in vitro fertilization and embryo transfer: A role for proximal occlusion or salpingectomy after failed distal tubal surgery? Fertil Steril 1991;56:691–695PubMedGoogle Scholar
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