Skip to main content
Top
Published in: Journal of Assisted Reproduction and Genetics 11/2019

01-11-2019 | Assisted Reproduction Technologies

Revisiting serum β-hCG cut-off levels and pregnancy outcomes using single embryo transfer

Authors: Naama Al Mamari, Nabighah Al Zawawi, Suhaib Khayat, Ahmed Badeghiesh, Weon-Young Son, Michael H. Dahan

Published in: Journal of Assisted Reproduction and Genetics | Issue 11/2019

Login to get access

Abstract

Purpose

The objective of this study is to identify the pregnancy outcomes based on day-16 β-hCG level assessed with modern assays, in fresh single embryo transfers.

Methods

A retrospective cohort study at a single academic center between 2013 and 2017. A total of 1076 pregnancies were included.

Results

Pregnancies were divided into 10% groupings of 107–108 patients each. The 10 groups did not differ for baseline characteristics. There was no difference on outcomes based on cleavage or blastocyst transfer. At a serum β-hCG level of 103 ± 13 (range 74–135), 50% had a biochemical loss. Biochemical pregnancy losses remained 21% at serum β-hCG range (136–197). It was only once serum β-hCG level reached 199–252 that the probability of a biochemical pregnancy loss was 12%. Interestingly, if a clinical pregnancy is present even at low day-16 serum β-hCG levels, the likelihood of live birth is approximately 50%. This maximizes to 75% when the serum β-hCG level was at least 253 IU/L. The relationship between serum day-16 β-hCG levels and clinical pregnancy or live birth is quite strong with correlation coefficients above 0.8 which accounted for more than 75% of the variability in outcomes in both cases. Receiver operator curves determined that the cut-off for a clinical pregnancy was 190 and for live birth, it was 213 IU/L.

Conclusion

An increase in the serum β-hCG levels at which to expect a reassuring outcome is required based on modern assays, as compared with the old cut-off levels.
Literature
1.
go back to reference Elliott MM, Kardana A, Lustbader JW, Cole LA. Carbohydrate and peptide structure of the alpha- and beta-subunits of human chorionic gonadotropin from normal and aberrant pregnancy and choriocarcinoma. Endocrine. 1997;7(1):15–32.CrossRef Elliott MM, Kardana A, Lustbader JW, Cole LA. Carbohydrate and peptide structure of the alpha- and beta-subunits of human chorionic gonadotropin from normal and aberrant pregnancy and choriocarcinoma. Endocrine. 1997;7(1):15–32.CrossRef
2.
go back to reference Fournier T, Guibourdenche J, Evain-Brion D. Review: hCGs: different sources of production, different glycoforms and functions. Placenta. 2015;36(Suppl 1):S60–5.CrossRef Fournier T, Guibourdenche J, Evain-Brion D. Review: hCGs: different sources of production, different glycoforms and functions. Placenta. 2015;36(Suppl 1):S60–5.CrossRef
3.
go back to reference Fournier T. Human chorionic gonadotropin: different glycoforms and biological activity depending on its source of production. Ann Endocrinol (Paris). 2016;77(2):75–81.CrossRef Fournier T. Human chorionic gonadotropin: different glycoforms and biological activity depending on its source of production. Ann Endocrinol (Paris). 2016;77(2):75–81.CrossRef
4.
go back to reference Christodoulou CN, Zonas C, Loukaides T, Maniatis A, Giannikos L, Giannakopoulos C, et al. Low beta-hCG is associated with poor prognosis in association with an embryo with positive cardiac activity. Ultrasound Obstet Gynecol. 1995;5(4):267–70.CrossRef Christodoulou CN, Zonas C, Loukaides T, Maniatis A, Giannikos L, Giannakopoulos C, et al. Low beta-hCG is associated with poor prognosis in association with an embryo with positive cardiac activity. Ultrasound Obstet Gynecol. 1995;5(4):267–70.CrossRef
5.
go back to reference Morse CB, Barnhart KT, Senapati S, Sammel MD, Prochaska EC, Dokras A, et al. Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization. Fertil Steril. 2016;105(5):1208–1214.e3.CrossRef Morse CB, Barnhart KT, Senapati S, Sammel MD, Prochaska EC, Dokras A, et al. Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization. Fertil Steril. 2016;105(5):1208–1214.e3.CrossRef
6.
go back to reference Liu Y, Liu Y, Li X, Jiao X, Zhang R, Zhang J. Predictive value of serum beta-hCG for early pregnancy outcomes among women with recurrent spontaneous abortion. Int J Gynaecol Obstet. 2016;135(1):16–21.CrossRef Liu Y, Liu Y, Li X, Jiao X, Zhang R, Zhang J. Predictive value of serum beta-hCG for early pregnancy outcomes among women with recurrent spontaneous abortion. Int J Gynaecol Obstet. 2016;135(1):16–21.CrossRef
7.
go back to reference Zeadna A, Son WY, Moon JH, Dahan MH. A comparison of biochemical pregnancy rates between women who underwent IVF and fertile controls who conceived spontaneously. Hum Reprod. 2015;30(4):783–8.CrossRef Zeadna A, Son WY, Moon JH, Dahan MH. A comparison of biochemical pregnancy rates between women who underwent IVF and fertile controls who conceived spontaneously. Hum Reprod. 2015;30(4):783–8.CrossRef
8.
go back to reference Lawler CC, Budrys NM, Rodgers AK, Holden A, Brzyski RG, Schenken RS. Serum beta human chorionic gonadotropin levels can inform outcome counseling after in vitro fertilization. Fertil Steril. 2011;96(2):505–7.CrossRef Lawler CC, Budrys NM, Rodgers AK, Holden A, Brzyski RG, Schenken RS. Serum beta human chorionic gonadotropin levels can inform outcome counseling after in vitro fertilization. Fertil Steril. 2011;96(2):505–7.CrossRef
9.
go back to reference Naredi N, Singh SK, Sharma R. Does first serum beta-human chorionic gonadotropin value prognosticate the early pregnancy outcome in an in-vitro fertilisation cycle? J Hum Reprod Sci. 2017;10(2):108–13.CrossRef Naredi N, Singh SK, Sharma R. Does first serum beta-human chorionic gonadotropin value prognosticate the early pregnancy outcome in an in-vitro fertilisation cycle? J Hum Reprod Sci. 2017;10(2):108–13.CrossRef
10.
go back to reference Kowalik A, Palermo GD, Barmat L, Veeck L, Rimarachin J, Rosenwaks Z. Comparison of clinical outcome after cryopreservation of embryos obtained from intracytoplasmic sperm injection and in-vitro fertilization. Hum Reprod. 1998;13(1o):2848–51.CrossRef Kowalik A, Palermo GD, Barmat L, Veeck L, Rimarachin J, Rosenwaks Z. Comparison of clinical outcome after cryopreservation of embryos obtained from intracytoplasmic sperm injection and in-vitro fertilization. Hum Reprod. 1998;13(1o):2848–51.CrossRef
11.
go back to reference Facchinetti F, Volpe A, Matteo ML, Genazzani AR, Artini GP. An increased vulnerability to stress is associated with a poor outcome of in vitro fertilization-embryo transfer treatment. Fertil Steril. 1997;67(2):309–14.CrossRef Facchinetti F, Volpe A, Matteo ML, Genazzani AR, Artini GP. An increased vulnerability to stress is associated with a poor outcome of in vitro fertilization-embryo transfer treatment. Fertil Steril. 1997;67(2):309–14.CrossRef
12.
go back to reference Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319(4):189–94.CrossRef Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319(4):189–94.CrossRef
13.
go back to reference Sher G. IVF Authority 2010(March 24):Online. Sher G. IVF Authority 2010(March 24):Online.
14.
go back to reference Schreiber CA, Sammel M, Hillier SL, Barnhart KT. A little bit pregnant: modeling how the accurate detection of pregnancy can improve HIV prevention trials. Am J Epidemiol. 2009;169(4):515–21.CrossRef Schreiber CA, Sammel M, Hillier SL, Barnhart KT. A little bit pregnant: modeling how the accurate detection of pregnancy can improve HIV prevention trials. Am J Epidemiol. 2009;169(4):515–21.CrossRef
15.
go back to reference De Neubourg D, et al. Single top quality embryo transfer as a model for prediction of early pregnancy outcome. Hum Reprod. 2004;19(6):1476–9.CrossRef De Neubourg D, et al. Single top quality embryo transfer as a model for prediction of early pregnancy outcome. Hum Reprod. 2004;19(6):1476–9.CrossRef
16.
go back to reference Liu L, Tong X, Jiang L, Li T, Zhou F, Zhang S. A comparison of implantation, miscarriage and pregnancy rates of single and double day 3 embryo transfer between fresh and frozen thawed transfer cycles: a retrospective study. Chin Med J. 2014;127(5):911–5.PubMed Liu L, Tong X, Jiang L, Li T, Zhou F, Zhang S. A comparison of implantation, miscarriage and pregnancy rates of single and double day 3 embryo transfer between fresh and frozen thawed transfer cycles: a retrospective study. Chin Med J. 2014;127(5):911–5.PubMed
17.
go back to reference Kathiresan ASQ, 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(6):1362–6.CrossRef Kathiresan ASQ, 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(6):1362–6.CrossRef
18.
go back to reference Shamonki MI, Frattarelli JL, Bergh PA, Scott RT. Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: an analysis of 6021 pregnancies. Fertil Steril. 2009;91(5):1760–4.CrossRef Shamonki MI, Frattarelli JL, Bergh PA, Scott RT. Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: an analysis of 6021 pregnancies. Fertil Steril. 2009;91(5):1760–4.CrossRef
19.
go back to reference Cole LA, DuToit S, Higgins TN. Total hCG tests. Clin Chim Acta. 2011;412(23–24):2216–22.CrossRef Cole LA, DuToit S, Higgins TN. Total hCG tests. Clin Chim Acta. 2011;412(23–24):2216–22.CrossRef
Metadata
Title
Revisiting serum β-hCG cut-off levels and pregnancy outcomes using single embryo transfer
Authors
Naama Al Mamari
Nabighah Al Zawawi
Suhaib Khayat
Ahmed Badeghiesh
Weon-Young Son
Michael H. Dahan
Publication date
01-11-2019
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 11/2019
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-019-01583-x

Other articles of this Issue 11/2019

Journal of Assisted Reproduction and Genetics 11/2019 Go to the issue