Journal of Assisted Reproduction and Genetics

, Volume 35, Issue 3, pp 483–489 | Cite as

Abnormal human chorionic gonadotropin (hCG) trends after transfer of multiple embryos resulting in viable singleton pregnancies

  • Paula C. Brady
  • Leslie V. Farland
  • Stacey A. Missmer
  • Catherine Racowsky
  • Janis H. Fox
Assisted Reproduction Technologies



The purpose of this study is to investigate whether abnormal hCG trends occur at a higher incidence among women conceiving singleton pregnancies following transfer of multiple (two or more) embryos (MET), as compared to those having a single embryo transfer (SET).


Retrospective cohort study was performed of women who conceived singleton pregnancies following fresh or frozen autologous IVF/ICSI cycles with day 3 or day 5 embryo transfers between 2007 and 2014 at a single academic medical center. Cycles resulting in one gestational sac on ultrasound followed by singleton live birth beyond 24 weeks of gestation were included. Logistic regression models adjusted a priori for patient age at oocyte retrieval and day of embryo transfer were used to estimate the Odds Ratio of having an abnormal hCG rise (defined as a rise or < 66% in 2 days) following SET as compared to MET.


Among patients receiving two or more embryos, 6.1% (n = 84) had abnormal hCG rises between the first and second measurements, compared to 2.7% (n = 17) of patients undergoing SET (OR 2.16, 95% CI 1.26–3.71). Among patients with initially abnormal hCG rises who had a third level checked (89%), three-quarters had normal hCG rises between the second and third measurements.


Patients who deliver singletons following MET were more likely to have suboptimal initial hCG rises, potentially due to transient implantation of other non-viable embryo(s). While useful for counseling, these findings should not change standard management of abnormal hCG rises following IVF. The third hCG measurements may clarify pregnancy prognosis.


Embryo transfer Human chorionic gonadotropin Chemical pregnancy In vitro fertilization 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Paula C. Brady
    • 1
  • Leslie V. Farland
    • 1
  • Stacey A. Missmer
    • 2
    • 3
    • 4
  • Catherine Racowsky
    • 1
  • Janis H. Fox
    • 1
  1. 1.Department of Obstetrics and GynecologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.Channing Division of Network Medicine, Department of MedicineBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human MedicineMichigan State UniversityGrand RapidsUSA

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