Girard Jean-Maxime, Simorre Mathilde, Leperlier Florence, Reignier Arnaud, Lefebvre Tiphaine, Barrière Paul, Fréour Thomas
Service de Biologie et Médecine de la Reproduction, CHU Nantes, Nantes, France.
Service de Biologie et Médecine de la Reproduction, CHU Nantes, Nantes, France; Gynécologie Obstétrique, Centre AMP, Cité Sanitaire, Saint Nazaire, France.
Eur J Obstet Gynecol Reprod Biol. 2018 Jun;225:189-193. doi: 10.1016/j.ejogrb.2018.04.037. Epub 2018 Apr 30.
OBJECTIVE(S): Beta human chorionic gonadotrophin (β-hCG) is secreted by placenta and detectable in maternal serum a few days after embryo implantation. The evolution of β-hCG serum levels is commonly used to confirm early pregnancy and differentiate normal pregnancies from others, either in spontaneous pregnancies or after IVF. However, little is known on the eventual link between blastocyst quality in IVF, pregnancy outcome, and βhCG kinetics. The objective was to evaluate the association between early βhCG rise, blastocyst morphology and pregnancy evolution in a single-blastocyst transfer program STUDY DESIGN: This retrospective cohort study was conducted in a University-affiliated IVF center in 441 couples undergoing 455 single blastocyst transfer cycles leading to a positive pregnancy test 12 days afterwards. The rate of rise of ß-hCG (ß-hCG kinetics) was calculated in each cycle and its association with blastocyst quality and pregnancy clinical outcome was evaluated.
β-hCG kinetics was significantly different according to blastocyst expansion, but with considerable overlap between groups. β-hCG kinetics was also significantly different according to clinical outcome, with higher values in clinical pregnancies than in other groups. This remained true in subgroups' analysis according to blastocyst expansion and in top quality blastocysts.
CONCLUSION(S): Early β-hCG kinetics after single-blastocyst transfer is different according to pregnancy outcome and is only slightly influenced by blastocyst quality. These results confirm the interest of β-hCG follow up in IVF pregnancies, and do not support the interest of building blastocyst-specific β-hCG ranges in IVF cycles.
β-人绒毛膜促性腺激素（β-hCG）由胎盘分泌，在胚胎着床后数天可在母体血清中检测到。β-hCG血清水平的变化通常用于确认早期妊娠，并区分自然妊娠或体外受精（IVF）后的正常妊娠与其他妊娠情况。然而，关于IVF中囊胚质量、妊娠结局和β-hCG动力学之间的最终联系，我们知之甚少。本研究的目的是在单囊胚移植方案中评估早期β-hCG升高、囊胚形态与妊娠进展之间的关联。
这项回顾性队列研究在一所大学附属的IVF中心进行，纳入了441对夫妇，他们接受了455个单囊胚移植周期，术后12天妊娠试验呈阳性。计算每个周期中β-hCG的上升速率（β-hCG动力学），并评估其与囊胚质量和妊娠临床结局的关联。
根据囊胚扩张情况，β-hCG动力学存在显著差异，但各分组之间有相当大的重叠。根据临床结局，β-hCG动力学也有显著差异，临床妊娠组的值高于其他组。在根据囊胚扩张情况进行的亚组分析以及优质囊胚分析中，情况依然如此。
单囊胚移植后早期β-hCG动力学因妊娠结局而异，仅受囊胚质量的轻微影响。这些结果证实了在IVF妊娠中进行β-hCG随访的意义，并不支持在IVF周期中建立特定于囊胚的β-hCG范围的意义。
