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Pregnancy outcome prediction after embryo transfer based on serum human chorionic gonadotrophin concentrations


Authors: Balasičová K. 1,2;  Kraus A. 3;  Peterová L. 1;  Nykolaichuk R. 4;  Toporcerová S. 1,2
Authors place of work: Centrum pre asistovanú reprodukciu Gyncare, s. r. o., Košice, Slovenská republika 1;  Gynekologicko-pôrodnícka klinika LF UPJŠ v Košiciach, Slovenská republika 2;  Ústav matematiky a statistiky, Přirodovědecká fakulta, MU Brno, Česká republika 3;  Gynekologicko-porodnické oddělení, Karlovarská krajská nemocnice a. s., Česká republika 4
Published in the journal: Ceska Gynekol 2022; 87(1): 4-12
Category: Původní práce
doi: https://doi.org/10.48095/cccg20224

Summary

Objective: The aim of the study was to evaluate the predictive value of the human chorionic gonadotropin (hCG) concentration on the 14th and 16th post-ovulation day after embryo transfer/cryoembryo transfer as well as the dynamics of its increase with respect to the outcome of pregnancy. Materials and methods: In total, 130 embryo transfers and cryoembryo transfers in women aged 22 to 38 years who experienced a single embryo transfer or single cryoembryo transfer with confirmed pregnancy (hCG level over 15 IU/l on 14th post-ovulation day – D14) were selected. The input parameters (hCG D14, hCG D16, hCG D16-D14, hCG D16/D14 and positivity of at least 2.5-fold increase in hCG D16 compared to hCG D14) were evaluated by regression analysis in relation to the outcome parameters (bio­chemical pregnancy, clinical pregnancy, clinical pregnancy terminated by abortion up to 12 weeks of gestation, clinical pregnancy terminated by childbirth). Results: Single concentrations of hCG D14 and D16, as well as the difference between these concentrations, were a statistically significant indicator of the prediction of bio­chemical pregnancy (P = 0.000215, P = 0.000227 and P = 0.000421). Contrary to expectations, the proportion of hCG D16 and D14 concentrations did not show statistical significance for either parameter, as well as the fulfilment of the condition of at least a 2.5fold increase in hCG D16 compared to D14. None of the studied input parameters was confirmed as a statistically significant marker for the prediction of miscarriage in the whole group of patients. However, in the group of confirmed clinical pregnancies, the serum concentration of hCG D16 (P = 0.0248) and the difference between concentrations D16 and D14 (P = 0.0185) were confirmed as a positive predictor of the progression of pregnancy until delivery. Conclusions: Single hCG concentrations are a good prognostic factor for predicting the outcome of pregnancy, but the determination of the cut-off limit is limited by inter-laboratory deviation as well as by timing of blood collection for hCG determination on the exact post-ovulatory day. The results of individual studies are therefore difficult to use in clinical practice. The dynamics of hCG concentrations appear to be a more reliable predictor of pregnancy outcome. In our cohort, we confirmed the statistical significance of the difference in hCG concentration between the 16th and 14th post-ovulation day not only for the prediction of bio­chemical pregnancy, but also as a predictor of the progression of clinical pregnancy into childbirth. To determine the optimal values of this difference, it is necessary to evaluate a larger group of patients. Conversely, the statistical significance of the proportion of hCG concentrations between the 16th and 14th post-ovulation day was not  confirmed.

Keywords:

Embryo transfer – in vitro fertilisation – human chorionic gonadotrophin – cryoembryo transfer – bio­chemical pregnancy – hCG dynamics – ongoing pregnancy – childbirth after embryo transfer


Zdroje

1. Lin S, Li R, Wang Y et al. Increased maternal serum hCG concentrations in the presence of a female fetus as early as 2 weeks after IVF-ET. J Gynecol Onstet Hem Reprod 2021; 50 (7): 102053. doi: 10.1016/j.jogoh.2020.102053.

2. Kuspinar G, Kasapoglu I, Cakir C et al. What is the effect of embryo morfology on serum b-hCG levels? Eur Obstet Gynecol Reprod Biol 2019; 233 (2): 107–113. doi: 10.1016/j.ejogrb.2018. 12.001.

3. Sung N, Kwak-Kim J, Koo HS et al. Serum hCG-b levels of postovulatory day 12 and 14 with the sequential application of hCG-b fold change significantly increased predictability of pregnancy outcome after IVF-ET cycle. J Assist Reprod Genet 2016; 33 (9): 1185–1194. doi: 10.1007/s10815-016-0744-y.

4. Ramu S, Acacio B, Adamowicz M et al. Human chorionic gonadotropin from day 2 spent embryo culture media and its relationship to embryo development. Fertil Steril 2011; 96 (3): 615–617. doi: 10.1016/j.fertnstert.2011.06.035.

5. Butler SA, Luttoo J, Freire MO et al. Human chorionic gonadotropin (hCG) in the secretome of cultured embryos: hyperglycosylated hCG and hCG-free beta submit are potential markers for infertility management and treatment. Reprod Sci 2013; 20 (9): 1038–1045. doi: 10.1177/ 1933719112472739.

6. Han X, Yin B, Lin S et al. Increased maternal hCG concentration in early in vitro pregnancy with elevated basal FSH. PLoS One 2018; 13 (9): e0203610. doi: 10.1371/journal.pone.0203 610.

7. Wu Y, Liu H. Possibility of live birth in patients with low serum b-hCG 14 days after blastocyst transfer. J Ovarian Res 2020; 13 (1): 132. doi: 10.1186/s13048-020-00732-6.

8. Kahyoğlu İ, Demir B, Aksakal SE et al. Value of post-transfer day-12 beta human chorionic  gonadotropin levels of pregnancy outcome predicition of intracytoplasmic sperm injection cycles. Balkan Med J 2017; 34 (5): 450–457. doi: 10.4274/balkanmedj.2016.1769.

9. Yuan L, Yu L, Sun Z et al. Association between 7-day serum b-hCG levels after frozen-thawed embryo transfer and pregnancy outcomes: a single centre retrospective study from China. BMJ Open 2020; 10 (10): e035332. doi: 10.1136/bmjopen-2019-035332.

10. Hammarberg K, Astbury J, Baker H. Wo­men‘s experience of IVF: a follow-up study. Hum Reprod 2001; 16 (2): 374–383. doi: 10.1093/ humrep/16.2.374.

11. Ryniec J, Esfandiari N. Early serum hCG in IVF: are we trending in the right direction? Reprod Sci 2021; 28 (7): 1827–1838. doi: 10.1007/s43032-020-00347-8.

12. Kim YJ, Shin JH, Hur JY et al. Predicitive value of serum progesterone level on b-hCG check day in women with previous repeated miscarriages after in vitro fertilization. PloS One 2017; 12 (7): e0181229. doi: 10.1371/journal.pone.0181229.

13. McCoy TW, Nakajima ST, Bohler HC jr. Age and single day-14 beta-HCG can predict onogoing pregnancy following IVF. Reprod Biomed Online 2009; 19 (1): 114–120. doi: 10.1016/ s1472-6483 (10) 60054-5.

14. Tanbo TG, Zucknick M, Eskild A. Maternal concentrations of human chorionic gonadotrophin in very early IVF pregnancies and duration of pregnancy: a follow-up study. Reprod Biomed Online 2018; 37 (2): 208–215. doi: 10.1016/j.rbmo.2018.04.048.

15. Hobeika E, Singh S, Malik S et al. 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; 34 (10): 1333–1340. doi: 10.1007/s10815-017-0987-2.

16. Naredi N, Singh SK, Sharma R. Does first serum beta-human chorionic gonadotropin value prognosticate the early pregnyncy outcome in an in-vitro fertilisation cycle? J Hum Reprod Sci 2017; 10 (2): 108–113. doi: 10.4103/jhrs.JHRS_50_16.

17. Zbořilová B, Březinová J, Tkadlec E et al. HCG level after embryo transfer as a prognostic indicator of pregnancy finished with delivery. Ceska Gynekol 2018; 83 (5): 329–336.

18. Grin L, Indurski A, Leytes S et al. Trends in primeval b-hCG level increment after fresh and frozen- thawed IVF embryo transfer cycles. Gynecol Endocrinol 2019; 35 (3): 261–266. doi: 10.1080/09513590.2018.1519789.

19. Zhao WE, Li YJ, Ou JP et al. Predicitive value of initial serum human chorionic gonadotropin levels for pregnancies after single fresh and frozen blastocyst transfer. J Huazhong Univ Sci Technolog Med Sci 2017; 37 (3): 395–400. doi: 10.1007/s11596-017-1746-4.

20. Xiong F, Sun Q, Li GG et al. Initial serum HCG levels are higher in pregnant women with a male fetus after fresh or frozen single blastocyst transfer: a retrospective cohort study. Taiwan J Obstet Gynecol 2019; 58 (6): 833–839. doi: 10.1016/j.tjog.2019.09.019.

21. Al Mamari N, Al Zawawi N, Khayat S et al. Revisiting serum b HCG cut-off levels and pregnancy outcomes using single embryo transfer. J Assist Reprod Genet 2019; 36 (11): 2307–2313. doi: 10.1007/s10815-019-01 583-x.

22. Wang ZM, Gao Y, Zhang D et al. Predictive value of serum b-human chorionic go­nadotropin for early pregnancy outcomes. Arch Gynecol Obstet 2020; 301 (1): 295–302. doi: 10.1007/s00404-019-05388-2.

Štítky
Dětská gynekologie Gynekologie a porodnictví Reprodukční medicína

Článek vyšel v časopise

Česká gynekologie

Číslo 1

2022 Číslo 1

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