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Wu M, Xiao X, Wang C, Zhao M, Xiong F, Jin X, Zheng X. Combined analysis of estradiol and β-hCG to predict the early pregnancy outcome of FET: a retrospective study. J Ovarian Res 2024; 17:128. [PMID: 38907300 PMCID: PMC11193290 DOI: 10.1186/s13048-024-01433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/07/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND The accurate prediction of pregnancy outcomes in in vitro fertilization (IVF) cycles is crucial. While several studies have been conducted on the predictive power of serum estradiol (E2) and β-hCG concentrations post-embryo transfer (ET) for pregnancy outcomes, there is debate on the predictive value of E2. The objective of this study was to investigate the predictive efficacy of combining serum E2 and β-hCG levels on early reproductive outcomes 12 days after embryo transfer. METHODS A total of 1521 patients with β-hCG positive values on day 12 following frozen-thawed embryo transfer (FET) with natural endometrial preparation cycles (NCs) were gathered in affiliated Women's Hospital of Jiangnan University. Using logistic regression, the relationship between pregnancy outcome and early serum E2 and β-hCG concentrations was examined. The receiver-operating characteristic (ROC) analysis was used to assess the predictive accuracy of the serum E2 and β-hCG concentrations. RESULTS Notable distinctions were observed in the serum E2 and β-hCG levels on the twelfth day following FET with NCs between the groups classified as clinical pregnancy group (CP Group) and biochemical pregnancy group (BP Group). In addition, the cutoff values for E2 and β-hCG on day 12 following FET with NCs in cleavage embryo group (CE Group) were 129.25 pg/mL and 156.60 mIU/mL, respectively. The threshold values for E2 and β-hCG for the blastocyst group (B Group) were 174.45 pg/mL and 217.70 mIU/mL. Serum E2 day12 and β-hCG day12 were found to be substantially linked with clinical pregnancy by logistic regression analysis. CONCLUSIONS Serum E2 and β-hCG concentrations were found to be significantly different between the CP Group and BP Group in infertility women underwent FET with NCs. Our retrospective cohort study's findings suggest that the combination of early E2 and β-hCG levels on day 12 post-FET could be used as a predictive tool to evaluate the likelihood of both positive and negative pregnancy outcomes in FET with NCs.
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Affiliation(s)
- Man Wu
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China
| | - Xiao Xiao
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China
| | - Chen Wang
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China
| | - Min Zhao
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China
| | - Fang Xiong
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China
| | - Xin Jin
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China.
| | - Xiaomin Zheng
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi 214002, China.
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Shibli Abu Raya Y, Bilgory A, Aslih N, Atzmon Y, Shavit M, Estrada D, Sharqawi M, Shalom-Paz E. High initial β-hCG predicts IVF outcomes accurately and precludes the need for repeated measurements. Endocr Connect 2023; 12:e230189. [PMID: 37555512 PMCID: PMC10563592 DOI: 10.1530/ec-23-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/09/2023] [Indexed: 08/10/2023]
Abstract
This study evaluated β-human chorionic gonadotropin (hCG) changes during the early period of pregnancy in an attempt to predict successful pregnancy outcomes in ART. It determined the median values of the β-hCG and the 2-day β-hCG increments of clinical vs biochemical pregnancies. The results of fresh day 3 embryo, frozen day 3 embryo, and frozen day 5 embryo transfers were evaluated. The cutoff values of β-hCG and the 2-day increments predicting clinical pregnancy and delivery were determined. All women who underwent embryo transfer and had a singleton pregnancy from January 2017 to December 2019 were included. As expected, clinical pregnancies had higher initial median β-hCG values compared to biochemical pregnancies (fresh day 3 (400 vs 73 mIU/mL), frozen day 3 (600 vs 268.5 mIU/mL) and frozen day 5 (937 vs 317 mIU/mL)). Nonetheless, the abortion rate was significantly lower in the group with β-hCG above the cutoff values in fresh (141 mIU/mL) and frozen (354.5 mIU/mL) cleavage stage transfers (17.2% vs 44%, P < 0.001 and 18.5% vs 38%, P = 0.003, respectively). Blastocyst transfers resulted in higher median initial β-hCG compared to cleavage embryo transfers (937 vs 600 mIU/mL), and the initial β-hCG values from frozen cleavage embryos were higher compared to fresh cleavage embryos (600 vs 400 mIU/mL). Earlier implantation in frozen cycles may be caused by freezing-thawing procedures. Moreover, in fresh cycles, negative effects of the hormonal milieu of fresh cycles may delay implantation. These results indicate that high initial β-hCG and high 2-day β-hCG increments demonstrated better outcomes, including more clinical pregnancies and fewer abortions.
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Affiliation(s)
- Yasmin Shibli Abu Raya
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Asaf Bilgory
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nardin Aslih
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yuval Atzmon
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Maya Shavit
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Daniela Estrada
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Moamina Sharqawi
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Einat Shalom-Paz
- Department of Obstetrics & Gynecology, Gynecological Research Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport School of Medicine, The Technion Institute of Technology, Haifa, Israel
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Ozer G. Initial β-hCG levels and 2-day-later increase rates effectively predict pregnancy outcomes in single blastocyst transfer in frozen-thawed or fresh cycles: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35605. [PMID: 37861533 PMCID: PMC10589581 DOI: 10.1097/md.0000000000035605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
To investigate whether the initial beta-human chorionic gonadotropin (β-hCG) levels and their rate of increase differ after single fresh and frozen blastocyst transfers, and whether these values effectively predict pregnancy outcomes. This retrospective cohort study was conducted at the Sisli Memorial Hospital, assisted reproductive technology, and Reproductive Genetics Center in Istanbul, Turkey, between January 2016 and January 2022. Three thousand two hundred thirty-eight single blastocyst transfers with positive pregnancy test results were evaluated. Of these, 738 were fresh transfer cycles and 2500 were frozen-thawed embryo transfer (FET) cycles. β-hCG test results from 9 days after fresh and FET cycles were compared between the groups with biochemical pregnancy, early pregnancy loss, and live birth outcomes. The threshold values were determined for each pregnancy outcome. The rate of increase between the first and second β-hCG tests performed 2 days apart was determined for each pregnancy outcome. Finally, the listed values were compared between the FET and fresh cycle. Mean baseline β-hCG levels were significantly higher in FET cycles than in fresh cycles, regardless of pregnancy outcomes (P < .005). Baseline β-hCG levels were higher in fresh cycles with live births (171.76 ± 109.64 IU/L) compared to biochemical and clinical pregnancy losses (50.37 ± 24.31 and 114.86 ± 72.42, respectively) (P < .001). Live births in FET cycles resulted in higher baseline β-hCG levels (193.57 ± 100.38 IU/L) compared to biochemical and clinical pregnancy loss groups (68.41 ± 51.85 and 149.29 ± 96.99 IU/L, respectively) (P < .001). The β-hCG threshold for live birth for fresh cycles was 116.5 IU/L (sensitivity 80%, specificity 70%, positive predictive value 90%, negative predictive value 54%) and 131.5 IU/L for FET cycles (sensitivity 71%, specificity 68%, positive predictive value 87%, negative predictive value 50%). The percentage of the area under the curve for single fresh blastocyst transfers was 0.81 and 0.76 for frozen transfers. The rate of increase in β-hCG was similar in fresh and FET cycles. Initial β-hCG levels and 2-day increases are effective parameters for diagnosing pregnancy in fresh and FET cycles. The initial β-hCG level was significantly higher in the FET cycles than in the fresh cycles. Predicting outcomes earlier helps clinicians to manage and follow high-risk pregnancies.
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Affiliation(s)
- Gonul Ozer
- Memorial Sisli Hospital, IVF and Reproductive Genetics Centre, Istanbul, Turkey
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Zhang Y, Li Z, Ren B, Liu Y, Guan Y. The application of single beta-human chorionic gonadotropin (β-hCG) level measurement in women undergoing single blastocyst transfer. Reprod Biol 2022; 22:100703. [DOI: 10.1016/j.repbio.2022.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
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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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Hernandez-Nieto C, Lee J, Alkon-Meadows T, Briton-Jones C, Sandler B, Copperman A, Mukherjee T. Biological relevance of trophectoderm morphology: initial β-hCG measurements correlate with trophectoderm grading on euploid frozen embryo transfers. J Assist Reprod Genet 2022; 39:2051-2059. [PMID: 35751829 PMCID: PMC9475011 DOI: 10.1007/s10815-022-02553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To analyze the correlation between TE grading and initial β-hCG serum level after single euploid embryo transfer. Secondarily, to explore the association between TE grading with subsequent IVF outcomes. DESIGN Retrospective cohort analysis. SETTING Single, academic, private infertility and assisted reproductive care institute. PATIENTS OR OTHER PARTICIPANTS Infertility patients who underwent a single euploid embryo transfer that resulted in a positive pregnancy test. INTERVENTION(S) β-hCG measurements. MAIN OUTCOME MEASURE(S) Correlation between TE grade with first β-hCG measurement. Second outcome measurements included ongoing pregnancy, biochemical pregnancy loss, and clinical pregnancy loss rates. RESULTS 2,798 cases were analyzed. A significant difference in initial β-hCG measurement among groups (TE A: median 143.4 mIU/mL IQR 79.2-211.2; TE B: 119 mIU/mL IQR 57.1-177.8; TE C: 82.4 mIU/mL IQR 36.3-136.4, p ≤ 0.0001) was observed. There was a significant correlation found between the TE grade and β-hCG measurements (p ≤ 0.0001, r2 = 0.10). TE grade was not associated with higher odds of biochemical pregnancy loss (TE A vs. TE B: aOR 1.01 CI95% 0.97-1.05; TE A vs. TE C: aOR 1.03 CI95% 0.98-1.08), or higher odds of clinical pregnancy loss (TE A vs. TE B: aOR 1.02 CI95% 0.98-1.05; TE A vs. TE C: aOR 1.03 CI95% 0.98-1.07). CONCLUSIONS In patients with euploid embryos, TE grade correlates with the first pregnancy test measurement of β-hCG. We propose this finding helps to appoint a relevant link between morphology assessment and early embryo development in vivo.
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Affiliation(s)
- Carlos Hernandez-Nieto
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA.
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Joseph Lee
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tamar Alkon-Meadows
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine Briton-Jones
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Sandler
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Copperman
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tanmoy Mukherjee
- Reproductive Medicine Associates of New York, 635 Madison Ave, Floor 10th, New York City, NY, 10022, USA
- Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zhang Y, Li Z, Ren B, Wu W, Liu Y, Wang X, Guan Y, Jia L. Diagnostic value of a single β-hCG test in predicting reproductive outcomes in women undergoing cleavage embryo transfer: a retrospective analysis from a single center. Reprod Health 2022; 19:145. [PMID: 35733148 PMCID: PMC9215108 DOI: 10.1186/s12978-022-01455-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose The present study investigated the role of β-hCG in predicting reproductive outcomes and established optimal β-hCG cutoff values in women undergoing cleavage embryo transfer. Methods The patients were transferred with fresh or frozen-thawed embryos and had serum β-hCG levels tested on the 14th day post-embryo transfer. Serum β-hCG levels were compared between different groups. Different cutoff values of β-hCG were established and used to divide the patients into different groups. Reproductive outcomes between groups based on β-hCG levels were compared. Results Significant discrepancies in general characteristics were observed in the subgroups. The cutoff values of β-hCG for predicting the presence/absence of pregnancy, biochemical pregnancy/clinical pregnancy, presence/absence of adverse pregnancy outcomes, and singleton/twin live birth in the cleavage groups were 89.6, 241.1, 585.9, and 981.1 mIU/L, respectively. Biochemical pregnancy rates and adverse pregnancy outcome rates significantly decreased from the low β-hCG group to the higher β-hCG group in sequence. Significantly higher full-term live birth rates were observed in the highest β-hCG group (P < 0.001). Conclusion Serum β-hCG levels were strongly associated with reproductive outcomes. However, the interpretation of β-hCG levels must consider the number and quality of embryos and transfer protocols. When β-hCG was tested on a fixed day post-ET, different cutoff values were required for the prediction of early clinical outcomes. The association between β-hCG and obstetric outcomes must be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01455-1. To investigate the association between β-hCG and reproductive and obstetrical outcomes in women with cleavage ET and to establish different β-hCG cutoff values for the prediction of reproductive outcomes, this study retrospectively included 6909 infertile women who were divided into different groups based on the number and quality of transferred embryos, age, and transfer protocols. The cutoff values of β-hCG for predicting the presence/absence of pregnancy, biochemical pregnancy/clinical pregnancy, presence/absence of adverse pregnancy outcomes, singleton/twin live birth in the cleavage groups were 89.6, 241.1, 585.9, and 981.1 mIU/L, respectively. Biochemical pregnancy rates and adverse pregnancy outcome rates decreased significantly in the higher β-hCG groups. In conclusion, the interpretation of β-hCG levels must consider the number and quality of embryos and transfer protocols. When β-hCG was tested on a fixed day post-ET, different cutoff values were required for the prediction of early clinical outcomes.
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Affiliation(s)
- Yuchao Zhang
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Zhen Li
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Bingnan Ren
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Wenbin Wu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Yanli Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Xingling Wang
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China
| | - Yichun Guan
- Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China.
| | - Liting Jia
- Neonatal Screening Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Wu W, Xu GF, Hu YJ. The therapeutic effect of granulocyte colony stimulating factor (G-CSF) on potential biochemical pregnancy in patients with unexplained repeated transplantation failure (RIF): a case series and literature review. Gynecol Endocrinol 2022; 38:443-447. [PMID: 35244509 DOI: 10.1080/09513590.2022.2036716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Biochemical pregnancy is a type of embryo transfer failure, patients with unexplained repeated implantation failure (RIF) also have higher biochemical pregnancy rate. Our study intends to evaluate the effect of granulocyte colony-stimulating factor (G-CSF) in patients with unexplained RIF with low hCG levels in early pregnancy. METHODS Unexplained RIF patients with low hCG levels after embryo transfer were allocated. G-CSF were administrated from the ninth days after embryo transfer. Clinical pregnancy, miscarriage and live birth rates were evaluated. RESULTS The clinical pregnancy and live birth rates were 52.5% and 30%. CONCLUSION G-CSF is an effective treatment for potential biochemical pregnancy in unexplained RIF patients.
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Affiliation(s)
- Wei Wu
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gu-Feng Xu
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan-Jun Hu
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Ren Y, Li H, Jie Q, Xiaoying Z, Li R, Wang HY. Combined analysis of human chorionic gonadotrophin concentrations at different time points after frozen-thawed blastocyst transfer can improve our ability to predict the pregnancy outcomes of single gestations. J OBSTET GYNAECOL 2022; 42:1424-1430. [PMID: 35014918 DOI: 10.1080/01443615.2021.1985442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this study, we conducted a retrospective single-centre study of 1664 singleton pregnancies derived from frozen-thawed blastocyst transfer between January 2017 and December 2018. Analysis showed that there were 596 early pregnancy losses and 1068 ongoing pregnancies. We compared serum HCG (human chorionic gonadotophin) concentrations on days 12, 14, 19, and 21, between the pregnancy loss group and the ongoing pregnancy group. The cut-off level of HCG at each time point was calculated to predict pregnancy outcome. Joint analysis of two single HCG levels taken one week apart was carried out to improve predictive accuracy. The levels of HCG at four time points were significantly lower in the early pregnancy loss group than in the ongoing pregnancy group. According to the area under ROC (receiver operating characteristic curve) curves, all levels of HCG taken at four time points showed good ability to predict the outcome of pregnancy. The joint analysis of two single HCG levels taken one week apart further improved the accuracy of prediction.Impact statementWhat is already known on this subject? Multiple studies have shown that the maternal level of serum HCG is the best parameter for predicting the course of pregnancy.What do the results of this study add? The levels of HCG on days 12, 14, 19 and 21 were significantly lower in the early pregnancy loss group than in the group of ongoing pregnancies. According to the area under ROC curves, all levels of HCG taken at four time points showed a good ability to predict the outcome of pregnancy.What are the implications of these findings for clinical practice and/or further research? The joint analysis of two single HCG levels, taken one week apart, further improved the accuracy of prediction.
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Affiliation(s)
- Yun Ren
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Hongzhen Li
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Qiao Jie
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Zhen Xiaoying
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Rong Li
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
| | - Hai-Yan Wang
- Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University, Third Hospital, Beijing, China.,Ministry of Education, Key Laboratory of Assisted Reproduction, Beijing, China
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Abstract
OBJECTIVE To investigate the pregnancy outcomes of patients with low serum β-hCG level 14 days after day 3 embryo transfer. METHODS A retrospective study was performed with 723 patients with a serum β-hCG level between 5 and 100 mIU/ml 14 days after embryo transfer. Pregnancy outcomes (live birth, clinical pregnancy) were analyzed according to the female patients' age. ROC curves were plotted to indicate the threshold for prediction of clinical pregnancy and live birth. RESULTS Of the 723 patients with serum β-hCG level <100 mIU/mL, 85.6% (619) had biochemical pregnancy, and only 14.4% (104) had clinical pregnancy (including 4.3% with live birth, 3.7% with ectopic pregnancy, and 6.1% with early miscarriage). The rate of live birth was significantly lower in ≥38-year group ,compared with <38-year group (1.3% vs. 5.1%, p = 0.045). The rates of biochemical pregnancy in patients with serum β-hCG of 5-25 mIU/mL and 26-50 mIU/mL were 99.5% and 92.4%, respectively. The serum β-hCG level to predict clinical pregnancy was 44.8 mIU/ml (sensitivity, 90.4%; specificity, 82.1%). For live birth, the serum β-hCG level was 53.7 mIU/ml (sensitivity, 90.3%; specificity, 81.1%). CONCLUSIONS The likelihood of live birth was minimal with low serum β-hCG level 14 days after embryo transfer.
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Affiliation(s)
- Yixuan Wu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Reproductive Medicine of Guangdong Province, Guangdong, China
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, China, Guangdong
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangdong, China
| | - Haiying Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Reproductive Medicine of Guangdong Province, Guangdong, China
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, China, Guangdong
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangdong, China
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Wu Y, Liu H. Possibility of live birth in patients with low serum β-hCG 14 days after blastocyst transfer. J Ovarian Res 2020; 13:132. [PMID: 33183346 PMCID: PMC7664039 DOI: 10.1186/s13048-020-00732-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer. Methods A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5–299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results 312 patients had serum β-hCG levels < 300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 h, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%. Conclusions Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG > 58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.
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Affiliation(s)
- Yixuan Wu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine/Department of Fetal Medicine and Prenatal Diagnosis/BioResource Research Center, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproductive Medicine of Guangdong Province, No. 63, Duobao Road, Guangzhou, Guangdong, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, No. 63, Duobao Road, Guangzhou, Guangdong, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, No. 63, Duobao Road, Guangzhou, Guangdong, China
| | - Haiying Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine/Department of Fetal Medicine and Prenatal Diagnosis/BioResource Research Center, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Key Laboratory of Reproductive Medicine of Guangdong Province, No. 63, Duobao Road, Guangzhou, Guangdong, China. .,Key Laboratory for Major Obstetric Diseases of Guangdong Province, No. 63, Duobao Road, Guangzhou, Guangdong, China. .,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, No. 63, Duobao Road, Guangzhou, Guangdong, China.
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Yuan L, Yu L, Sun Z, Song J, Xiao J, Jiang H, Sa Y. Association between 7-day serum β-hCG levels after frozen-thawed embryo transfer and pregnancy outcomes: a single-centre retrospective study from China. BMJ Open 2020; 10:e035332. [PMID: 33039985 PMCID: PMC7549452 DOI: 10.1136/bmjopen-2019-035332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Early monitoring of plasma human chorionic gonadotropin (β-hCG) level is vital in predicting pregnancy outcome. This study investigated the predictive value of serum β-hCG level on the seventh day after frozen-thawed embryo transfer (FET) for ongoing pregnancy (OP) and adverse pregnancy (AP). DESIGN Retrospective study. SETTING The Reproductive and Genetic Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China. PARTICIPANTS 1061 pregnant women who underwent FET between January 2014 and January 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Pregnancy outcome. RESULTS Serum β-hCG levels on the seventh day after FET were higher in the single OP group compared with the biochemical pregnancy group (p<0.001). Besides, the serum β-hCG cut-off level at 4.34 mIU/mL on the seventh day showed high predictive value (area under the curve (AUC)=0.852). Serum β-hCG levels on the seventh day after FET were higher in the twin OP group compared with the single OP group (p<0.001). Also, the serum β-hCG cut-off level at 17.95 mIU/mL on the seventh day showed high predictive value (AUC=0.903). Serum β-hCG levels on the seventh day after FET were lower in the ectopic pregnancy group compared with the single OP group (p<0.001) whereas, serum β-hCG cut-off level at 4.53 mIU/mL on the seventh day exhibited a high predictive value (AUC=0.860). Further, the serum β-hCG levels on the seventh day after FET were lower in the single early spontaneous abortion group compared with the single OP group (p<0.001) while the serum β-hCG cut-off level at 5.34 mIU/mL on the seventh day exhibited high predictive value (AUC=0.738). CONCLUSION Serum β-hCG on the seventh day after FET has good clinical significance for the prediction of OP and AP.
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Affiliation(s)
- Lihua Yuan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Lingyu Yu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhengao Sun
- Integrative Medicine Research Centre of Reproduction and Heredity, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Jingyan Song
- The First Clinical College, Shandong University of traditional Chinese Medicine, Jinan, China
| | - Jimei Xiao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Huaying Jiang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuanhong Sa
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Early Serum hCG in IVF: Are We Trending in the Right Direction? Reprod Sci 2020; 28:1827-1838. [PMID: 33034863 DOI: 10.1007/s43032-020-00347-8] [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: 05/26/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Human chorionic gonadotropin (hCG) measurements may be the earliest indicator of fertility cycle success, available several weeks before an ultrasound would be diagnostic for pregnancy. Outcomes of these cycles are high stakes for a couple, and the earliest reassurance of a normal pregnancy would be beneficial for their well-being. Additionally, earlier diagnosis can allow for more rapid management by providers in the case of abnormal pregnancies. Therefore, establishing normal values for initial hCG level and early hCG kinetics is of great interest. There are many factors involved in assisted reproductive techniques that may lead to alterations in hCG kinetics when compared with spontaneous pregnancies. We aim to characterize normal hCG values for in vitro fertilization (IVF) pregnancies and review how different aspects of the IVF process may alter these trends in order to establish how best to counsel patients during the waiting period.
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Brady PC, Farland LV, Racowsky C, Ginsburg ES. Hyperglycosylated human chorionic gonadotropin as a predictor of ongoing pregnancy. Am J Obstet Gynecol 2020; 222:68.e1-68.e12. [PMID: 31401260 DOI: 10.1016/j.ajog.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hyperglycosylated human chorionic gonadotropin, the predominant human chorionic gonadotropin variant secreted following implantation, is associated with trophoblast invasion. OBJECTIVE To determine whether the initial serum hyperglycosylated human chorionic gonadotropin differs between ongoing and failed pregnancies, and to compare it to total serum human chorionic gonadotropin as a predictor of ongoing pregnancy. MATERIALS AND METHODS Women undergoing fresh/frozen in vitro fertilization cycles at a university-based infertility clinic with an autologous day 5 single embryo transfer resulting in serum human chorionic gonadotropin >3 mIU/mL (n = 115) were included. Human chorionic gonadotropin was measured 11 days after embryo transfer in a single laboratory (coefficient of variation <6%). Surplus frozen serum (-80oC) was shipped to Quest Laboratories for measurement of hyperglycosylated human chorionic gonadotropin (coefficient of variation <9.1%). Linear regression analyses adjusted for oocyte age a priori were used to compare human chorionic gonadotropin and hyperglycosylated human chorionic gonadotropin in ongoing pregnancies (>8 weeks of gestation) and failed pregnancies (clinical pregnancy loss, biochemical and ectopic pregnancies). RESULTS A total of 85 pregnancies (73.9%) were ongoing. Hyperglycosylated human chorionic gonadotropin and human chorionic gonadotropin values were highly correlated (Pearson correlation coefficient 92.14, P < .0001), and mean values of both were positively correlated with blastocyst expansion score (P value test for trend < .0004). Mean human chorionic gonadotropin and hyperglycosylated human chorionic gonadotropin were significantly higher in ongoing vs failed pregnancies. Among ongoing pregnancies vs clinical losses, mean hyperglycosylated human chorionic gonadotropin, but not human chorionic gonadotropin, was significantly higher (19.0 vs 12.2 ng/mL, β -8.1, 95% confidence interval -13.0 to -3.2), and hyperglycosylated human chorionic gonadotropin comprised a higher proportion of total human chorionic gonadotropin (4.6% vs 4.1%; risk ratio, 0.79; 95% confidence interval, 0.66-0.94). CONCLUSION Measured 11 days after single blastocyst transfer, hyperglycosylated human chorionic gonadotropin and human chorionic gonadotropin values were highly correlated, but only mean hyperglycosylated human chorionic gonadotropin and its ratio to total human chorionic gonadotropin were significantly higher in ongoing pregnancies vs clinical pregnancy losses. Further evaluation of hyperglycosylated human chorionic gonadotropin, including in multiple embryo transfers and multiple pregnancy, and using serial measurements, is required.
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Affiliation(s)
- Paula C Brady
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Leslie V Farland
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Racowsky
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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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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Zhu W, Yeung Q, Chan D, Chi L, Huang J, Wang Q, Chung J, Li TC. Maternal β-HCG concentrations in early IVF pregnancy: association with the embryo development stage of blastocysts. Reprod Biomed Online 2019; 38:683-690. [DOI: 10.1016/j.rbmo.2018.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
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Grin L, Indurski A, Leytes S, Rabinovich M, Friedler S. Trends in primeval β-hCG level increment after fresh and frozen-thawed IVF embryo transfer cycles. Gynecol Endocrinol 2019; 35:261-266. [PMID: 30296871 DOI: 10.1080/09513590.2018.1519789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Mid-trimester beta-human chorionic gonadotropin (BHCG) levels are considerably higher in pregnancies resulting from frozen embryo transfer (FET) compared with fresh (FRET), leading to a higher false positive rate in aneuploidy screening tests. We aimed to investigate the dynamics of BHCG increment and its predictive value for cycle outcome. A retrospective analysis of FRET and FET cycles. BHCG values on days 14 and 16 post embryo transfer were compared and stratified according to the number of sacs demonstrated on US scan at six weeks gestation, and pregnancy outcome (biochemical pregnancy, ectopic pregnancy, spontaneous abortion, and a singleton or twin birth). A prediction model for live birth was built. A total of 430 treatment cycles were analyzed. The average BHCG levels were significantly higher in FET compared with FRET group in nonviable pregnancies on day 14, 450 vs. 183 IU/L, p < .05 and day 16, 348 vs. 735 IU/L, p < .05, respectively. The increment of BHCG was significantly steeper in the FET compared with FRET group in biochemical pregnancies (F = 6.485, p = .012*). Optimal cutoff level for live birth prediction in the FRET group was 211 IU/L (sensitivity 84%, specificity 76.2%) for day 14 and 440 IU/L (sensitivity 86.0% and specificity 72.5%) for day 16. The increment in BHCG differed significantly between the FRET and FET cycles in nonviable pregnancies. Nevertheless, the difference in BHCG levels observed in the second trimester in pregnancies conceived after FRET and FET cycle may begin as early as the fourth week of pregnancy.
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Affiliation(s)
- Leonti Grin
- a Faculty of Health Sciences, Department of OBGYN and Infertility , Barzilai University Medical Center, Ben-Gurion University of the Negev , Ashkelon , Israel
| | - Atara Indurski
- a Faculty of Health Sciences, Department of OBGYN and Infertility , Barzilai University Medical Center, Ben-Gurion University of the Negev , Ashkelon , Israel
| | - Sophia Leytes
- b Sackler Faculty of Medicine, Department of Obstetrics and Gynecology , the Edith Wolfson Medical Center, Tel Aviv University , Holon , Israel
| | - Mark Rabinovich
- a Faculty of Health Sciences, Department of OBGYN and Infertility , Barzilai University Medical Center, Ben-Gurion University of the Negev , Ashkelon , Israel
| | - Shevach Friedler
- a Faculty of Health Sciences, Department of OBGYN and Infertility , Barzilai University Medical Center, Ben-Gurion University of the Negev , Ashkelon , Israel
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Xiong F, Li G, Sun Q, Chen P, Wang Z, Wan C, Yao Z, Zhong H, Zeng Y. Obstetric and perinatal outcomes of pregnancies according to initial maternal serum HCG concentrations after vitrified-warmed single blastocyst transfer. Reprod Biomed Online 2019; 38:455-464. [PMID: 30660603 DOI: 10.1016/j.rbmo.2018.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION Do pregnancy, obstetric and perinatal outcomes differ according to initial maternal serum human chorionic gonadotrophin (HCG) level measured on day 11 after single blastocyst transfer? DESIGN Vitrified-warmed single blastocyst transfer cycles (n = 640) were collected between 1 January 2013 and 30 April 2017 with positive HCG values and retrospectively analysed by receiver operating characteristic curves to predict clinical pregnancy, ongoing pregnancy and delivery. Cycles were divided into a low HCG group (n = 155) and high HCG group (n = 485) based on cut-off value of live birth prediction. Cycles in the HCG group were subdivided into a low-high subgroup (n = 162), medium-high subgroup (n = 162) and high-high subgroup (n = 161) based on tertile points. Pregnancy rates and obstetric and perinatal outcomes were compared. RESULTS The area under curves for clinical pregnancy, ongoing pregnancy and live birth prediction were 0.95, 0.81 and 0.79, respectively; corresponding cut-off values were 152.2 IU/l, 211.9 IU/l and 211.9 IU/l; HCG less than 211.9 IU/l indicated an extremely low clinical pregnancy rate (34.84%), a high early miscarriage rate (61.11%) and a low live birth rate (12.26%). Rates of gestational diabetes mellitus (GDM) (P = 0.007) and female neonates (P = 0.001) were significantly higher in the LHG group compared with the HHG group; no significant differences were observed in the low versus high HCG group overall. CONCLUSIONS Lower initial maternal serum HCG levels indicated poorer clinical outcomes. Within the high HCG group, a lower initial maternal HCG level was found to be associated with GDM occurrence and proportion of female neonates.
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Affiliation(s)
- Feng Xiong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Guangui Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Peilin Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Zhuran Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Caiyun Wan
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Zhihong Yao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Huixian Zhong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen 518045, Guangdong, People's Republic of China.
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Increased maternal hCG concentrations in early in vitro pregnancy with elevated basal FSH. PLoS One 2018; 13:e0203610. [PMID: 30199550 PMCID: PMC6130877 DOI: 10.1371/journal.pone.0203610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate factors that influence maternal hCG concentration in early pregnancy and the relationship between hCG concentration in early pregnancy and basal FSH (bFSH) level. Design Retrospective cohort study. Setting Reproductive medical center. Patient(s) In total, 482 women aged 22 to 38 years with elevated basal FSH (> 10 IU/L) and who experienced a single live birth after in vitro fertilization-embryo transfer were selected. These 482 women were age-matched with an equal number of women with normal basal FSH (≤10 IU/L) who also experienced a single live birth. Intervention(s) None. Main Outcome Measure(s) HCG concentration. Result(s) The hCG concentrations on Day 14 and Day 21 were 560.46 (363.63–842.52) IU/L and 9862.00 (6512.25–14029.50) IU/L, respectively, in the elevated bFSH group, and these values were significantly increased compared with the normal bFSH group. After adjusting for confounding factors, the concentrations of maternal hCG on Day 14 and Day 21 were significantly associated with basal FSH. In addition, crude linear regression analysis demonstrated that hCG concentrations increased as the basal serum levels of FSH increased. Conclusion(s) Elevated basal FSH has implications for the interpretation of hCG concentrations in early pregnancy after in vitro fertilization-embryo transfer (IVF-ET) that led to a single live birth.
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Girard JM, Simorre M, Leperlier F, Reignier A, Lefebvre T, Barrière P, Fréour T. Association between early βhCG kinetics, blastocyst morphology and pregnancy outcome in a single-blastocyst transfer program. Eur J Obstet Gynecol Reprod Biol 2018; 225:189-193. [DOI: 10.1016/j.ejogrb.2018.04.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 04/29/2018] [Indexed: 11/27/2022]
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Predictive value of serum progesterone level on β-hCG check day in women with previous repeated miscarriages after in vitro fertilization. PLoS One 2017; 12:e0181229. [PMID: 28708875 PMCID: PMC5510853 DOI: 10.1371/journal.pone.0181229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the predictive value of the progesterone level at the beta-human chorionic gonadotropin (β-hCG) check day for ongoing pregnancy maintenance in in vitro fertilization (IVF) cycles in women with previous unexplained repeated miscarriages. Materials and methods One hundred and forty-eight women, with visible gestational sac after IVF, were recruited in this observational study. All subjects had unexplained recurrent miscarriages in more than two previous IVF cycles. The progesterone level at the β-hCG check day (i.e. 14 days after oocyte retrieval) was assessed. The area under the curve (AUC) of the progesterone level was evaluated to predict the ongoing pregnancy or miscarriage outcomes. Results The overall ongoing pregnancy rate was 60.8% (90/148). The cut-off value with β-hCG levels higher than 126.5 mIU/mL and with progesterone levels higher than 25.2 ng/mL could be the predictive factors for ongoing pregnancy maintenance (AUC = 0.788 and 0.826; sensitivity = 0.788 and 0.723; specificity = 0.689 and 0.833; P < 0.0001 and P < 0.0001, respectively). The miscarriage rates were 19.5% (15/77) in the women with β-hCG > 126.5 mIU/mL and 13.0% (10/77) in those with > 25.2 ng/mL. In the comparison of the ROC curves between both values, a similar significance was found. The subjects with β-hCG > 126.5 mIU/mL and progesterone > 25.2 ng/mL showed higher ongoing pregnancy rates [98.0% (49/50) vs. 41.8% (41/98)] than those with β-hCG ≤ 126.5 mIU/mL or progesterone ≤ 25.2 ng/mL. Conclusions The progesterone level at 14 days after oocyte retrieval can be a good predictive marker for ongoing pregnancy maintenance in women with repeated IVF failure with miscarriage, together with the β-hCG level. The combined cut-off value of progesterone > 25.2 ng/mL and β-hCG > 126.5 mIU/mL may suggest a good prognosis.
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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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Liu S, Kuang Y, Wu Y, Feng Y, Lyu Q, Wang L, Sun Y, Sun X. High oestradiol concentration after ovarian stimulation is associated with lower maternal serum beta-HCG concentration and neonatal birth weight. Reprod Biomed Online 2017; 35:189-196. [PMID: 28606454 DOI: 10.1016/j.rbmo.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Abstract
In this retrospective study, the relationship between maternal serum oestradiol and progesterone levels after fresh embryo transfer or frozen embryo transfer (FET), and serum beta-HCG levels in early pregnancy and neonatal birth weight was examined. Included for analysis were 5643 conceived singletons: 2610 after FET and 3033 after fresh embryo transfer. Outcome measures included maternal serum oestradiol, progesterone, beta-HCG levels during the peri-implantation period, birth weight and small-for-gestational-age (SGA). Results at 4, 5 and 6 weeks' gestation were as follows: serum oestradiol and progesterone levels were significantly higher in women who underwent fresh embryo transfer compared with FET (all P < 0.0001 except progesterone at 6 weeks; P = 0.009); for fresh embryo transfers, serum beta-HCG levels were significantly lower than in women who underwent FET (P < 0.0001); beta-HCG levels were negatively correlated with serum oestradiol; and birth weight was negatively correlated with serum oestradiol. Incidence of SGA in fresh embryo transfer was increased significantly compared with FET (P < 0.001). Higher maternal oestradiol levels after fresh embryo transfer was correlated with lower beta-HCG in early pregnancy, lower birth weight and higher incidence of SGA.
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Affiliation(s)
- Suying Liu
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | | | - Yu Wu
- Shanghai International Peace Obstetrics and Gynecology Hospital, Shanghai, China
| | - Yun Feng
- Shanghai Ruijin Hospital, Medical School of Shanghai Jiaotong University, Shanghai 200011, China
| | - Qifeng Lyu
- Shanghai Ninth Hospital, Shanghai, China
| | - Li Wang
- Shanghai International Peace Obstetrics and Gynecology Hospital, Shanghai, China
| | - Yijuan Sun
- Shanghai Ruijin Hospital, Medical School of Shanghai Jiaotong University, Shanghai 200011, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China.
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24
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Løssl K, Oldenburg A, Toftager M, Bogstad J, Praetorius L, Zedeler A, Yding Andersen C, Grøndahl ML, Pinborg A. Predictive value of plasma human chorionic gonadotropin measured 14 days after Day-2 single embryo transfer. Acta Obstet Gynecol Scand 2017; 96:960-967. [PMID: 28374908 DOI: 10.1111/aogs.13144] [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] [Received: 12/12/2016] [Accepted: 03/28/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Prediction of pregnancy outcome after in vitro fertilization is important for patients and clinicians. Early plasma human chorionic gonadotropin (p-hCG) levels are the best known predictor of pregnancy outcome, but no studies have been restricted to single embryo transfer (SET) of Day-2 embryos. The aim of the present study was to investigate the predictive value of p-hCG measured exactly 14 days after the most commonly used Day-2 SET on pregnancy, delivery, and perinatal outcome. MATERIAL AND METHODS A retrospective analysis of prospectively collected data on 466 women who had p-hCG measured exactly 14 days after Day-2 SET during a randomized trial including 1050 unselected women (aged 18-40 years) undergoing their first in vitro fertilization/ intracytoplasmic sperm injection treatment. RESULTS The p-hCG predicted clinical pregnancy [area under the curve (AUC) 0.953; 95% CI 0.915-0.992] significantly better than ongoing pregnancy (AUC 0.803, 95% CI 0.717-0.890) and delivery (AUC 0.772, 95% CI 0.691-0.854). Women with p-hCG levels in the lowest quartile had significantly lower clinical pregnancy, ongoing pregnancy, and delivery rates (p < 0.001), whereas the pregnancy outcome and post-clinical pregnancy loss remained similar throughout the three highest p-hCG quartiles. The p-hCG level was related to neither birthweight nor gestational age at delivery. CONCLUSIONS Clinical pregnancy is significantly better predicted by p-hCG compared with ongoing pregnancy and delivery. Clinical pregnancy rates, ongoing pregnancy rates, and delivery rates remained similar throughout the three highest p-hCG quartiles with no trend towards "the higher the better".
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Affiliation(s)
- Kristine Løssl
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Anna Oldenburg
- Department of Obstetrics & Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Mette Toftager
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jeanette Bogstad
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lisbeth Praetorius
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Anne Zedeler
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marie L Grøndahl
- The Fertility Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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