1
|
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.
Collapse
Affiliation(s)
- Gonul Ozer
- Memorial Sisli Hospital, IVF and Reproductive Genetics Centre, Istanbul, Turkey
| |
Collapse
|
2
|
Ganer Herman H, Volodarsky-Perel A, Ton Nu TN, Machado-Gedeon A, Cui Y, Shaul J, Dahan MH. Pregnancy complications and placental histology in in vitro fertilization pregnancies with initial low serum β-hCG levels. Fertil Steril 2022; 118:1058-1065. [PMID: 36229298 DOI: 10.1016/j.fertnstert.2022.08.852] [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: 04/11/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess perinatal outcomes and placental findings after in vitro fertilization (IVF) with an initial low serum β-human chorionic gonadotropin (hCG). DESIGN A retrospective cohort study. SETTING University-affiliated tertiary hospital. INTERVENTION(S) Low serum β-hCG after transfer, defined as the low 10th percentile for the cohort on day 16 embryo age (low β-hCG group), compared with an initial serum β-hCG at or above the low 10th percentile (control group). PATIENT(S) Live singleton births after IVF between 2009 and 2017. MAIN OUTCOME MEASURE(S) Primary outcomes were placental findings, including anatomic, inflammatory, vascular malperfusion, and villous maturation lesions, as categorized according to the Amsterdam Placental Workshop Group Consensus. Secondary outcomes included obstetric and perinatal outcomes. RESULT(S) The low 10th percentile of β-hCG results corresponded to 149 mUI/mL. There were 103 cases in the low β-hCG group, and 928 in the control group. Maternal demographics were similar between the groups, whereas blastocyte transfer was more common in the control group. Deliveries in the low β-hCG group were associated with an increased rate of preterm births, 15.5% vs. 8.1%, which maintained significance after adjustment for confounders. Placentas in the low β-hCG group were notable for a high rate of velamentous cord insertion, 19.4% vs. 7.7%, single umbilical artery 3.8% vs. 0.6%, and histological maternal vasculopathy, 10.6% vs. 4.8%. CONCLUSION Live births after IVF with an initial low β-hCG level are associated with a twofold increase in preterm births and placental gross and histological changes. It may thus be considered to observe such cases in a high-risk pregnancy setting.
Collapse
Affiliation(s)
- Hadas Ganer Herman
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Yiming Cui
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Jonathan Shaul
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Wong E, Ko JK, Li RH, Ng EH. Comparison of the prevalence and severity of nausea and vomiting in the first trimester between singleton pregnancies conceived from stimulated in vitro fertilization and frozen embryo transfer cycles. BMC Pregnancy Childbirth 2022; 22:746. [PMID: 36195858 PMCID: PMC9531374 DOI: 10.1186/s12884-022-05072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this prospective study is to compare the prevalence and severity of nausea and vomiting in the first trimester between singleton pregnancies conceived from stimulated in vitro fertilization (IVF) and frozen embryo transfer cycles (FET). Methods All women were recruited at 6 weeks gestation and filled in the modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) to document whether they had any experience of nausea and vomiting weekly till 12 weeks gestation. The primary outcome was the prevalence of nausea and vomiting and the secondary outcomes included severity of nausea and vomiting and pregnancy outcomes. Results A total of 360 pregnant women were recruited and 171 were in the stimulated IVF group and 189 in the FET group. The overall return rate was 82.2% (81.8% in the stimulated IVF group and 82.5% in the FET group). Nausea and vomiting were worse in the FET group compared with the IVF group. There were significantly more women who felt nauseated or sick in the FET group (p value = 0.032 for week 11 and p value = 0.046 for week 12); significantly more women with a longer duration of nausea in the FET group (p value = 0.044 for week 7 and p value = 0.030 for week 8); significantly more women with more vomiting in a day in the FET group (p value = 0.042) and significantly more women with retching or dry heaves in the FET group (p value = 0.030 for week 8 and p value = 0.028 for week 11). Conclusion Nausea and vomiting were significantly more prevalent and severe in the FET group when compared with the stimulated IVF group. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05072-5.
Collapse
Affiliation(s)
- Evelyn Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pok Fu Lam, Hong Kong.
| | - Jennifer Ky Ko
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Raymond Hw Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Ernest Hy Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Shah JS, Modest AM, Hacker MR, Resetkova N, Dodge LE. Association of Early Beta Human Chorionic Gonadotropin With Ischemic Placental Disease in Singleton Pregnancies After In Vitro Fertilization. Cureus 2022; 14:e28117. [PMID: 36134080 PMCID: PMC9481264 DOI: 10.7759/cureus.28117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate whether an initial or two-day percent increase in serum beta-human chorionic gonadotropin (βhCG) is associated with ischemic placental disease (IPD) in singleton pregnancies after autologous or donor IVF. Study design: This was a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles at a single academic tertiary hospital and infertility treatment center. We included all patients (≥18 years old) who had a singleton live birth or intrauterine fetal demise (IUFD) resulting from either autologous fresh (n=1,347), autologous frozen (n=454), or donor (n=253) IVF cycles. Main outcome reassures: The primary outcome was a composite outcome of IPD or IUFD due to placental insufficiency. IPDs included preeclampsia, placental abruption, and small for gestational age (SGA). Results: Neither initial βhCG nor two-day percent increases in βhCG were associated with an increased risk of IPD for any type of IVF cycle. Initial and two-day percent increases in βhCG were significantly higher when comparing frozen with fresh IVF and donor with autologous IVF (all P≤0.01). Conclusions: Among singleton autologous and donor IVF cycles, the initial and two-day percent increase in serum βhCG were not associated with IPD or its components. However, significant βhCG differences existed by cycle type and oocyte source.
Collapse
|
6
|
Gungor K, Dokuzeylul Gungor N. Antithyroid antibodies may predict serum beta HCG levels and biochemical pregnancy losses in euthyroid women with IVF single embryo transfer. Gynecol Endocrinol 2021; 37:702-705. [PMID: 33047637 DOI: 10.1080/09513590.2020.1830968] [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] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate the relationship between thyroid autoimmunity and early pregnancy serum β-HCG levels in intracytoplasmic sperm injection patients. METHODS The study subjects were 85 female euthyroid patients undergoing intracytoplasmic sperm injection embryo transfer cycles with GnRH antagonist treatment. Patients who received transfer of more than one embryo, those with serum TSH levels of greater than 2.5 IU/ml and subjects using levothyroxine were excluded. Normal responder patients under the age of 40 years were randomly selected from the patient files retrospectively. Subjects were divided into two groups: those with autoimmune thyroid disease (thyroid autoimmunity group; n = 39) and those without the disease (control group; n = 46). RESULTS The age, body mass index, trial number, total rFSH treatment dose, the number of cumulus oophorus complexes, number of metaphase II oocytes, and number of 2-pronuclei embryos were similar in the thyroid autoimmunity and control groups. Serum β-HCG levels measured on the 14th day after oocyte pickup were significantly lower in the thyroid autoimmunity group than in the control group (93.8 ± 35.8 versus 128.5 ± 55.8 mlU/ml, respectively; p < .001). The miscarriage rate was higher in the thyroid autoimmunity group than in the control group (34.4% versus 21.7%, respectively; p = .034). CONCLUSION We found that early-stage pregnancy serum β-HCG hormone levels among euthyroid patients undergoing intracytoplasmic sperm injection were lower in subjects with thyroid autoimmunity than in those without thyroid autoimmunity. This result, reported for the first time in the literature on euthyroid pregnant women with thyroid autoimmunity, may be predictor of early pregnancy losses in pregnant women with thyroid autoimmunity.Key messageIn intracytoplasmic sperm injection (ICSI)/IVF patients, due to lack of evidence-based data about the relationship between thyroid autoimmunity and pregnancy loss the current research was conducted. Early-stage pregnancy serum β-HCG hormone levels in euthyroid ICSI patients with thyroid autoimmunity are lower than those without autoimmunity which may be associated with early pregnancy losses.
Collapse
Affiliation(s)
- Kagan Gungor
- Department of Endocrinology and Metabolism, Istanbul Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Nur Dokuzeylul Gungor
- Department of Reproductive Endocrinology and IVF Unit, Bahcesehir University Medical Park Goztepe Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Reljič M, Porović A. Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer. J Assist Reprod Genet 2019; 36:1489-1495. [PMID: 31104293 DOI: 10.1007/s10815-019-01484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). METHODS Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7 weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. RESULTS Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62 IU/L vs. 28.74 ± 23.52, p = 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05 IU/L, p = 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23 pg/L, p < 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. CONCLUSION Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.
Collapse
Affiliation(s)
- Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Division of Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Admir Porović
- Department of Gynaecology and Perinatology, Academic HELIOS Hospital Köthen, University Martin-Luther Halle-Wittenberg, Hallesche Str. 29, 06366, Köthen (Anhalt), Germany
| |
Collapse
|