İnci KAHYAOĞLU, İskender KAPLANOĞLU, Berfu DEMİR, Leyla MOLLAMAHMUTOĞLU, Sezin Ertürk AKSAKAL

Value of Post-transfer Day-12 Beta Human Chorionic Gonadotropin Levels for Pregnancy Outcome Prediction of Intracytoplasmic Sperm Injection Cycles

Background: Several markers were studied previously in order to predict the pregnancy outcome of assisted reproductive techniques; however, serum beta human chorionic gonadotropin was found to be the most predictive marker. Aims: To evaluate the value of serum beta human chorionic gonadotropin levels in discriminating biochemical and clinical pregnancies 12 days after embryo transfer, while determining the factors predicting ongoing pregnancy was established as the secondary aim. Study Design: Retrospective cross-sectional study. Methods: A total of 445 pregnant cycles were retrospectively analysed in 2359 embryo transfer cycles. Patients were divided into two groups according to the outcome of pregnancy: biochemical and clinical. Results: The cut-off value of beta human chorionic gonadotropin levels on day 12 in predicting clinical pregnancies was 86.8 IU/mL with 65.1% sensitivity and 74.7% specificity [CI: 0.76 (0.71-0.81). Receiver operating characteristic curve analysis revealed different cut-off values for embryo transfer days (57 mIU/mL for day 3 embryo transfer CI: 0.59-0.79 and 87 mIU/ mL for day 5 embryo transfer, CI: 0.74-0.86). Subgroup analysis of clinical pregnancies revealed a significant difference between ongoing pregnancies and early fetal losses regarding duration of infertility (81.3±54.4 vs. 100.2±62.2 months), serum oestradiol on hCG day (2667.4±1276.4 vs. 2094.6±1260.5 pg/mL), number of transferred embryos (1.9±0.8 vs. 1.5±0.7) and the prevalence of diminished ovarian reserve as an indication (2.3% vs 12.2%). Conclusion: Beta human chorionic gonadotropin levels on day 12 following embryo transfer provide an important parameter for the prediction of clinical pregnancy; however, other stimulation parameters are indicated in the prediction of ongoing pregnancies.

PDF

___

1. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol 1993;14(Suppl):45-52.
2. Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni L Jr. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril 1985;43:48-53.
3. Yong P, Martin C, Thong J. A comparison of psychological functioning in women at different stages of in vitro fertilization treatment using the mean affect adjective check list. J Assist Reprod Genet 2000;17:553-6.
4. Hammarberg K, Astbury J, Baker H. Women's experience of IVF: a followup study. Hum Reprod 2001;16:374-83.
5. Ben-Rafael Z, Fateh M, Flickinger GL, Tureck R, Blasco L, Mastroianni L Jr. Incidence of abortion in pregnancies after in vitro fertilization and embryo transfer. Obstet Gynecol 1988;71:297-300.
6. Yamashita T, Okamoto S, Thomas A, MacLachlan V, Healy DL. Predicting pregnancy outcome after in vitro fertilization and embryo transfer using estradiol, progesterone, and human chorionic gonadotropin beta-subunit. Fertil Steril 1989;51:304-9.
7. Hauzman EE, Lagarde AR, Nagy K, Fancsovits P, Murber A, Jánoki G, et al. Prognostic value of serum CA-125 measurements on stimulation day 1 and on the day of oocyte pickup in the prediction of IVF treatment outcome. J Assist Reprod Genet 2005;22:265-8.
8. Hauzman E, Fedorcsák P, Klinga K, Papp Z, Rabe T, Strowitzki T, et al. Use of serum inhibin A and human chorionic gonadotropin measurements to predict the outcome of in vitro fertilization pregnancies. Fertil Steril 2004;81:66-72.
9. Qasim SM, Callan C, Choe JK. The predictive value of an initial serum beta human chorionic gonadotropin level for pregnancy outcome following in vitro fertilization. J Assist Reprod Genet 1996;13:705-8.
10. Kumbak B, Oral E, Karlikaya G, Lacin S, Kahraman S. Serum oestradiol and beta-HCG measurements after day 3 or 5 embryo transfers in interpreting pregnancy outcome. Reprod Biomed Online 2006;13:459- 64.
11. Porat S, Savchev S, Bdolah Y, Hurwitz A, Haimov-Kochman R. Early serum beta-human chorionic gonadotropin in pregnancies after in vitro fertilization: contribution of treatment variables and prediction of longterm pregnancy outcome. Fertil Steril 2007;88:82-9.
12. McCoy TW, Nakajima ST, Bohler HC Jr. Age and a single day-14 betaHCG can predict ongoing pregnancy following IVF. Reprod Biomed Online 2009;19:114-20.
13. Poikkeus P, Hiilesmaa V, Tiitinen A. Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Hum Reprod 2002;17:1901-5.
14. Urbancsek J, Hauzman E, Fedorcsák P, Halmos A, Dévényi N, Papp Z. Serum human chorionic gonadotropin measurements may predict pregnancy outcome and multiple gestation after in vitro fertilization. Fertil Steril 2002;78:540-2.
15. Confino E, Demir RH, Friberg J, Gleicher N. The predictive value of hCG beta subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: an international collaborative study. Fertil Steril 1986;45:526-31.
16. Daily CA, Laurent SL, Nunley WC Jr. The prognostic value of serum progesterone and quantitative beta-human chorionic gonadotropin in early human pregnancy. Am J Obstet Gynecol 1994;171:380-3.
17. Zegers-Hochschild F, Altieri E, Fabres C, Fernández E, Mackenna A, Orihuela P. Predictive value of human chorionic gonadotrophin in the outcome of early pregnancy after in-vitro fertilization and spontaneous conception. Hum Reprod 1994;9:1550-5.
18. Homan G, Brown S, Moran J, Homan S, Kerin J. Human chorionic gonadotropin as a predictor of outcome in assisted reproductive technology pregnancies. Fertil Steril 2000;73:270-4.
19. Sugantha SE, Webster S, Sundar E, Lenton EA. Predictive value of plasma human chorionic gonadotrophin following assisted conception treatment. Hum Reprod 2000;15:469-73.
20. Poikkeus P, Hiilesmaa V, Tiitinen A. Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Hum Reprod 2002;17:1901-5.
21. Urbancsek J, Hauzman E, Fedorcsák P, Halmos A, Dévényi N, Papp Z. Serum human chorionic gonadotropin measurements may predict pregnancy outcome and multiple gestation after in vitro fertilization. Fertil Steril 2002;78:540-2.
22. Ticconi C, Zicari A, Belmonte A, Realacci M, Rao ChV, Piccione E. Pregnancy-promoting actions of HCG in human myometrium and fetal membranes. Placenta 2007;28(Suppl A):137-43.
23. Carmona F, Balasch J, Creus M, Fábregues F, Casamitjana R, Cívico S, et al. Early hormonal markers of pregnancy outcome after in vitro fertilization and embryo transfer. J Assist Reprod Genet 2003;20:521-6.
24. Glatstein IZ, Hornstein MD, Kahana MJ, Jackson KV, Friedman AJ. The predictive value of discriminatory human chorionic gonadotropin levels in the diagnosis of implantation outcome in in vitro fertilization cycles. Fertil Steril 1995;63:350-6.
25. Yamashita T, Okamoto S, Thomas A, MacLachlan V, Healy DL. Predicting pregnancy outcome after in vitro fertilization and embryo transfer using estradiol, progesterone, and human chorionic gonadotropin beta-subunit. Fertil Steril 1989;51:304-9.
26. Kathiresan AS, Cruz-Almeida Y, Barrionuevo MJ, Maxson WS, Hoffman DI, Weitzman VN, et al. Prognostic value of beta-human chorionic gonadotropin is dependent on day of embryo transfer during in vitro fertilization. Fertil Steril 2011;96:1362-6.
27. Bjercke S, Tanbo T, Dale PO, Mørkrid L, Abyholm T. Human chorionic gonadotrophin concentrations in early pregnancy after in-vitro fertilization. Hum Reprod 1999;14:1642-6.
28. Papageorgiou TC, Leondires MP, Miller BT, Chang AS, Armstrong AB, Scott LA, et al. Human chorionic gonadotropin levels after blastocyst transfer are highly predictive of pregnancy outcome. Fertil Steril 2001;76:981-7.
29. Zhang X, Barnes R, Confino E, Milad M, Puscheck E, Kazer RR. Delay of embryo transfer to day 5 results in decreased initial serum beta-human chorionic gonadotropin levels. Fertil Steril 2003;80:1359-63.
30. Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2010 Assisted Reproductive Technology National Summary Report. U.S. Department of Health and Human Services; 2012 [cited 2014 Aug 10].